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Sample records for bariatric surgery risks

  1. Kidney Stone Risk Following Modern Bariatric Surgery

    PubMed Central

    Gonzalez, Ricardo D.

    2014-01-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers. PMID:24658828

  2. Bariatric Surgery

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ≥ 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their

  3. Bariatric surgery: three surgical techniques, patient care, risks, and outcomes.

    PubMed

    McGraw, Carrie A; Wool, Daniel B

    2015-08-01

    The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a recognized and accepted approach for addressing weight loss and health conditions that occur as a result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires the use of interventions that differ from those used for nonobese patients, including bariatric-specific equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory compromise. This articles outlines the risks and typical outcomes associated with three common bariatric procedures-laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass-to help perioperative nurses and other health care providers successfully advise patients and monitor their care for optimal outcomes. PMID:26227518

  4. Possible Risk Factors for Increased Suicide Following Bariatric Surgery

    PubMed Central

    Mitchell, James E.; Crosby, Ross; de Zwaan, Martina; Engel, Scott; Roerig, James; Steffen, Kristine; Gordon, Kathryn H.; Karr, Trisha; Lavender, Jason; Wonderlich, Steve

    2015-01-01

    There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved. The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, in order to delineate future research directions. First a variety of medical, biological, and genetic factors, including the persistence of recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed. Possible theoretical models involved and directions for research are suggested. PMID:23404774

  5. Endoscopy after bariatric surgery

    PubMed Central

    Malli, Chrysoula P.; Sioulas, Athanasios D.; Emmanouil, Theodoros; Dimitriadis, George D.; Triantafyllou, Konstantinos

    2016-01-01

    Obesity is a global epidemic with significant morbidity and mortality. Weight loss results in reduction of health risks and improvement in quality of life, thus representing a goal of paramount importance. Bariatric surgery is the most efficacious choice compared to conservative alternatives including diet, exercise, drugs and behavioral modification to treat obese patients. Following bariatric operations, patients may present with upper gastrointestinal tract complaints that warrant endoscopic evaluation and the various bariatric surgery types are often linked to complications. A subset of these complications necessitates endoscopic interventions for accurate diagnosis and effective, minimal invasive treatment. This review aims to highlight the role of upper gastrointestinal endoscopy in patients who have undergone bariatric surgery to evaluate and potentially treat surgery-related complications and upper gastrointestinal symptoms. PMID:27366025

  6. Pregnancy management following bariatric surgery.

    PubMed

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population. PMID:23445128

  7. Psychiatric aspects of bariatric surgery

    PubMed Central

    Yen, Yung-Chieh; Huang, Chih-Kuan; Tai, Chi-Ming

    2014-01-01

    Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients. PMID:25036421

  8. Hyperoxaluria and Bariatric Surgery

    NASA Astrophysics Data System (ADS)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  9. The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis.

    PubMed

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Vijayvargiya, Priya; Anthanont, Pimjai; Erickson, Stephen B

    2016-04-01

    Background With rising prevalence of morbid obesity, the number of bariatric surgeries performed each year has been increasing worldwide. The objective of this meta-analysis was to assess the risk of kidney stones following bariatric surgery. Methods A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through July 2015. Only studies reporting relative risks, odd ratios or hazard ratios (HRs) to compare risk of kidney stones in patients who underwent bariatric surgery versus no surgery were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results Four studies (One randomized controlled trial and three cohort studies) with 11,348 patients were included in analysis to assess the risk of kidney stones following bariatric surgery. The pooled RR of kidney stones in patients undergoing bariatric surgery was 1.22 (95% CI, 0.63-2.35). The type of bariatric surgery subgroup analysis demonstrated an increased risk of kidney stones in patients following Roux-en-Y gastric bypass (RYGB) with the pooled RR of 1.73 (95% CI, 1.30-2.30) and a decreased risk of kidney stones in patients following restrictive procedures including laparoscopic banding or sleeve gastrectomy with the pooled RR of 0.37 (95% CI, 0.16-0.85). Conclusions Our meta-analysis demonstrates an association between RYGB and increased risk of kidney stones. Restrictive bariatric surgery, on the other hand, may decrease kidney stone risk. Future study with long-term follow-up data is needed to confirm this potential benefit of restrictive bariatric surgery. PMID:26803902

  10. Bariatric Surgery and Stone Disease

    NASA Astrophysics Data System (ADS)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  11. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    PubMed Central

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  12. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study

    PubMed Central

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-01-01

    Abstract Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02–1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01–2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99–2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse

  13. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

    PubMed

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-12-01

    Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric

  14. Bariatric Surgery in Youth.

    PubMed

    Mirensky, Tamar L

    2016-06-01

    Bariatric surgery provides a clinically effective and cost-effective means of achieving sustained weight reduction and management of associated comorbidities and has been met with increasing enthusiasm for application in obese youth. Following trends seen among obese adults, carefully selected obese youth are now undergoing bariatric surgical procedures with excellent short-term and intermediate-term outcomes. Although long-term data are not yet available, the results thus far hold great promise in the management of this population. PMID:27241972

  15. Laparoscopic revolution in bariatric surgery

    PubMed Central

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

  16. Genetics of Bariatric Surgery Outcomes.

    PubMed

    Noel, Olivier F; Still, Christopher D; Gerhard, Glenn S

    2016-09-01

    Outcomes after bariatric surgery can vary widely and seem to have a significant genetic component. Only a small number of candidate gene and genome-wide association studies have analyzed bariatric surgery outcomes. The role of bile acids in mediating the beneficial effects of bariatric surgery implicate genes regulated by the farnesoid X receptor transcription factor. PMID:27519134

  17. Psychopharmacology and Bariatric Surgery.

    PubMed

    Roerig, James L; Steffen, Kristine

    2015-11-01

    Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports. PMID:26338011

  18. BARIATRIC SURGERY REVERSES METABOLIC RISK IN PATIENTS TREATED IN OUTPATIENT LEVEL

    PubMed Central

    da SILVA-NETO, Epifânio Feitosa; VÁZQUEZ, Cecília Mª Passos; SOARES, Fabiana Melo; da SILVA, Danielle Góes; de SOUZA, Márcia Ferreira Cândido; BARBOSA, Kiriaque Barra Ferreira

    2014-01-01

    Background The conventional treatment of obesity presents unsatisfactory results on weight loss and its long-term sustainability, therefore bariatric surgery has been suggested as an effective therapy, determining sustainable long-term weight loss, reversal of components of cardiometabolic risk and improved quality and life expectancy. Aim To investigate the clinical component of the cardiometabolic risk in patients undergoing bariatric surgery assisted on outpatient basis. Methods The sample consisted of 47 patients with ages between 18 and 60 years, 72% females. Diabetes mellitus, hypertension, and dyslipidemia were prospectively evaluated by using the Assessment of Obesity-Related Co-morbidities scale. Results Occurred improvement in these co-morbidities within 12 months after surgery. Co-morbidities resolved were greater than those improved. Conclusion The study revealed that the Assessment of Obesity-Related Co-morbidities is a system that can be effectively used to quantify the degree of reduction of the severity of the cardiometabolic risk in response to bariatric surgery. PMID:24676297

  19. Endocrine and Metabolic Complications After Bariatric Surgery

    PubMed Central

    Jammah, Anwar A.

    2015-01-01

    Bariatric surgery is the most effective therapeutic option for obese patients; however, it carries substantial risks, including procedure-related complications, malabsorption, and hormonal disturbance. Recent years have seen an increase in the bariatric surgeries performed utilizing either an independent or a combination of restrictive and malabsorptive procedures. We review some complications of bariatric procedures more specifically, hypoglycemia and osteoporosis, the recommended preoperative assessment and then regular follow up, and the therapeutic options. Surgeon, internist, and the patient must be aware of the multiple risks of this kind of surgery and the needed assessment and follow up. PMID:26458852

  20. Bariatric surgery: to whom and when?

    PubMed

    Benaiges, D; Goday, A; Pedro-Botet, J; Más, A; Chillarón, J J; Flores-Le Roux, J A

    2015-06-01

    Bariatric surgery is the most effective treatment for obesity. Its effects go beyond weight loss, in a high percentage of cases achieving remission of comorbidities associated with obesity and reducing mortality. However, not all patients achieve satisfactory weight loss or resolution of comorbidities and perioperative complications are a constant risk. Correct preoperative evaluation is essential to predict the likelihood of success and choose the most appropriate surgical technique for this purpose. The aim of this review was to ascertain which obese subjects will benefit from bariatric surgery taking into account body mass index, age, comorbidities, risk of complications and the impact of different bariatric surgery techniques. PMID:25665592

  1. Body Contouring After Bariatric Surgery.

    PubMed

    Ellison, Jo M; Steffen, Kristine J; Sarwer, David B

    2015-11-01

    Individuals who undergo bariatric surgery generally experience rapid and dramatic weight loss. While the weight loss typically confers significant health benefits, an undesirable consequence is often excessive quantities of hanging, surplus skin. Some patients undergo body-contouring surgery (BCS) in order to improve health, mobility, appearance and psychological adjustment. While the majority of post-bariatric patients desire BCS in one or more body regions, a small percentage of patients receive such surgeries. Lack of knowledge about procedures, cost and (in the USA and several other countries) difficulty obtaining insurance reimbursement likely prevents many patients from undergoing BCS. Those who do undergo BCS appear to be at heightened risk for wound-healing complications. Despite these complications, the majority of patients report satisfactory BCS outcomes. The extant literature in this area provides a great deal of information about these issues; nevertheless, additional research is needed to further inform clinical management and improve patient outcomes. PMID:26395601

  2. Bariatric Surgery for Severe Obesity

    MedlinePlus

    ... switch, less often. Each type of surgery has advantages and disadvantages. ​ ​​​​ Bariatric Surgery Benefits Bariatric surgery can ... basic and clinical research into many disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting ...

  3. Bariatric Surgery and the Endocrine System

    MedlinePlus

    ... Endocrine System Fact Sheet Bariatric Surgery and the Endocrine System February, 2012 Download PDFs English Espanol Editors John ... could have both benefits and risks for your endocrine system—the network of glands that produce, store, and ...

  4. [Pregnancy following bariatric surgery requires special attention].

    PubMed

    Renault, Kristina; Andersen, Lise Lotte; Kjær, Mette Mandrup; Lauenborg, Jeanette; Gjerris, Anne Cathrine; Berlac, Janne Foss; Jensen, Dorte Møller; Damm, Peter

    2012-04-16

    In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women. PMID:22510546

  5. Type 2 diabetes, bariatric surgery and the risk of subsequent gestational diabetes

    PubMed Central

    Steven, S; Woodcock, S; Small, P K; Taylor, R

    2011-01-01

    Women with pre-existing abnormal glucose regulation are certain to develop gestational diabetes in pregnancy and pre-gestational type 2 diabetes will become more difficult to control. However, an increasing number of women with type 2 diabetes have had bariatric surgery. In this group, the effect of pregnancy on glucose metabolism is unknown. We report two women with type 2 diabetes who underwent laparoscopic gastric bypass surgery with normalization of plasma glucose levels. During subsequent pregnancy, maternal blood glucose levels remained completely normal throughout. This is remarkable given the predisposition to abnormal glucose tolerance and the ongoing obesity, in the face of the insulin resistance of pregnancy. Women with prior type 2 diabetes reversed by gastric bypass surgery are not at high risk for gestational diabetes.

  6. Preconception counseling after bariatric surgery.

    PubMed

    Riordan, Joan Katherine

    2016-06-19

    Obesity has increased exponentially in the United States, affecting over 78 million individuals. As the rates of obesity increase, providers encounter more women with a history of bariatric surgery. Certain bariatric procedures can change how essential nutrients are absorbed. Preconception counseling assists in identifying potential deficiencies early. PMID:27203454

  7. Skin changes after bariatric surgery*

    PubMed Central

    Manzoni, Ana Paula Dornelles da Silva; Weber, Magda Blessmann

    2015-01-01

    Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses. PMID:25830984

  8. Bariatric Surgery for Severe Obesity

    MedlinePlus

    ... Jul;114(1):217-23. 2. Wilson ST, Thomas HI, Randall SB. Bariatric surgery in adolescents: recent ... School of Medicine at East Carolina University; and Thomas Inge, M.D., Ph.D., FACS, FAAP, Assistant ...

  9. Reduction of the risk of rhabdomyolysis after bariatric surgery with lower fluid administration in the perioperative period: a cohort study.

    PubMed

    Matłok, Maciej; Major, Piotr; Małczak, Piotr; Wysocki, Michał; Hynnekleiv, Leif; Nowak, Mateusz; Karcz, Konrad; Pędziwiatr, Michał; Budzyński, Andrzej

    2016-04-13

    INTRODUCTION    Obesity is a growing worldwide problem. One of the most effective treatments is a bariatric procedure; however, surgery is associated with the risk of complications, such as staple line leakage, suture line bleeding, and rhabdomyolysis (RML). OBJECTIVES    The objective of our study was to assess the risk of RML after bariatric surgery related to intravenous fluid administration in the perioperative period. PATIENTS AND METHODS    The study involved 194 patients who underwent a bariatric surgery (laparoscopic sleeve gastrectomy or laparoscopic gastric bypass). We studied an association between the development of RML and sex, age, weight, duration of surgery, type of surgery, and the volume of intravenously administered fluids during the perioperative period. RESULTS    The median duration of surgery was 132.5 minutes. The median volume of administered fluids was 3150 ml from the introduction of anesthesia to 24 hours after surgery. Biochemical RML (creatine phosphokinase >1000 U/l) was observed in 30 patients (15.46%). RML with clinical manifestations developed in 6 patients. Multivariate logistic regression revealed an increase in the odds ratio of biochemical RML with an increase of weight on the day of surgery, operative time, and volume of intravenous fluids. A multiple regression model showed that every 500 ml of transfused fluid over the median volume increases creatine phosphokinase concentrations in the first postoperative day by 241.77 U/l over the median level, with the operative time and patient's weight remaining at median values. CONCLUSIONS    We observed an association between the administration of lower fluid volumes and a lower risk of RML. We postulate that decreasing intravenous fluid administration may reduce the risk of RML after bariatric surgery. PMID:27074693

  10. Childhood verbal abuse: a risk factor for depression in pre-bariatric surgery psychological evaluations.

    PubMed

    Salwen, Jessica K; Hymowitz, Genna F; O'Leary, K Daniel; Pryor, Aurora D; Vivian, Dina

    2014-09-01

    The present study evaluated the importance of multimodal assessment of childhood verbal abuse (CVA) in pre-bariatric surgery psychological evaluations, and the role of CVA as a predictor of depression. Data from the psychological evaluations of 184 pre-bariatric surgery patients were retrospectively examined. Using two self-report measures and an interview-based screen, 52.2 % of participants reported experiencing some form of CVA; conversely, assessments of CVA based on only one measure yielded significantly lower prevalence rates. Endorsement of CVA on multiple measures was associated with more severe depressive symptomatology and greater likelihood of mood disorder diagnosis. Based on these data, a self-report measure and interview-based screen for CVA should be included in pre-bariatric psychological evaluations; either of these assessments may be conducted via a single-item screen. Lastly, patients who endorse CVA on multiple measures should be monitored closely for symptoms of depression post-surgery. PMID:24858597

  11. Stone formation and management after bariatric surgery.

    PubMed

    Tarplin, Sarah; Ganesan, Vishnu; Monga, Manoj

    2015-05-01

    Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population. PMID:25850790

  12. Influence of obesity and bariatric surgery on gastric cancer

    PubMed Central

    Dantas, Anna Carolina Batista; Santo, Marco Aurelio; de Cleva, Roberto; Sallum, Rubens Antônio Aissar; Cecconello, Ivan

    2016-01-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery. PMID:27458534

  13. Bone Metabolism after Bariatric Surgery

    PubMed Central

    Yu, Elaine W.

    2014-01-01

    Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery. PMID:24677277

  14. Endocrine and Nutritional Management After Bariatric Surgery

    MedlinePlus

    Endocrine and Nutritional Management After Bariatric Surgery A Patient’s Guide Bariatric (weight loss) surgery is a treatment ... This guide for patients is based on The Endocrine Society’s practice guidelines for physicians that focus on ...

  15. Treatment of Adult Obesity with Bariatric Surgery.

    PubMed

    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery. PMID:26760838

  16. Update on Adolescent Bariatric Surgery.

    PubMed

    Desai, Nirav K; Wulkan, Mark L; Inge, Thomas H

    2016-09-01

    Childhood obesity remains a significant public health issue. Approximately 8% of adolescent girls and 7% of adolescent boys have severe (≥class 2) obesity. Adolescent severe obesity is associated with numerous comorbidities, and persists into adulthood. Bariatric surgery is the most effective treatment available, resulting in major weight loss and resolution of important comorbid conditions. Clinical practice guidelines for pediatric obesity treatment recommend consideration of surgery after failure of behavioral approaches. Careful screening and postoperative management of patients by a multidisciplinary team is required. Long-term studies are needed to assess the impact of adolescent bariatric surgery. PMID:27519138

  17. Gastrointestinal changes after bariatric surgery.

    PubMed

    Quercia, I; Dutia, R; Kotler, D P; Belsley, S; Laferrère, B

    2014-04-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  18. Gastrointestinal changes after bariatric surgery

    PubMed Central

    Quercia, I.; Dutia, R.; Kotler, D.P.; Belsley, S.; Laferrère, B.

    2015-01-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  19. Treatment of adult obesity with bariatric surgery.

    PubMed

    Schroeder, Robin; Garrison, Jordan M; Johnson, Mark S

    2011-10-01

    Bariatric surgery procedures, including laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, result in an average weight loss of 50 percent of excess body weight. Remission of diabetes mellitus occurs in approximately 80 percent of patients after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Obesity Surgery Mortality Risk Score can help identify patients with increased mortality risk from bariatric surgery. Complications and adverse effects are lowest with laparoscopic surgery, and vary by procedure and presurgical risk. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with standard nutritional supplementation. Outcomes are also influenced by the experience of the surgeon and surgical facility. Overall, these procedures have a mortality risk of less than 0.5 percent. Although there have been no long-term randomized controlled trials, existing studies show that bariatric surgery has a beneficial effect on mortality. The family physician is well positioned to care for obese patients by discussing surgery as an option for long-term weight loss. Counseling about the procedure options, risks and benefits of surgery, and the potential reduction in comorbid conditions is important. Patient selection, presurgical risk reduction, and postsurgical medical management, with nutrition and exercise support, are valuable roles for the family physician. PMID:22010619

  20. Receptivity to Bariatric Surgery in Qualified Patients

    PubMed Central

    Fung, Michael; Wharton, Sean; Macpherson, Alison

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m2, P = 0.03) and believed that they would lose more weight with surgery (51 versus 44 kg, P = 0.0069). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery. PMID:27516900

  1. Pregnancy after bariatric surgery: no problem?

    PubMed Central

    Gidiri, Muchabayiwa; Greer, Ian A

    2009-01-01

    Bariatric surgery is highly effective for weight loss in morbid obesity. With the high prevalence of severe obesity in the developed world, and the acknowledgement of the effectiveness of these procedures by National Institute for Clinical Excellence (in the UK) and the Food and Drug Administration (in the USA), women with severe obesity will increasingly seek such treatment. As the majority of these patients are women of reproductive age, obstetricians will encounter these patients frequently during pregnancy. It is therefore important for obstetricians to gain an insight into the types of surgery performed, the potential complications, including nutritional deficiency, and appropriate management of pregnancy following weight-loss surgery. In general, bariatric surgery is associated with a reduction in obesity related complication, with no apparent increased risk of adverse perinatal outcomes.

  2. Improved Memory Function Two Years After Bariatric Surgery

    PubMed Central

    Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Paul, Robert; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2014-01-01

    Objective Obesity is as an independent risk factor for poor neurocognitive outcomes, including Alzheimer’s disease. Bariatric surgery has recently been shown to result in improved memory at 12-weeks post-operatively. However, the long-term effects of bariatric surgery on cognitive function remain unclear. Design and Methods 86 individuals (63 bariatric surgery patients, 23 obese controls) were recruited from a prospective study examining the neurocognitive effects of bariatric surgery. All participants completed self-report measurements and a computerized cognitive test battery prior to surgery and at 12-week and 24-month follow-up; obese controls completed measures at equivalent time points. Results Bariatric surgery patients exhibited high rates of pre-operative cognitive impairments in attention, executive function, memory, and language. Relative to obese controls, repeated measures ANOVA showed improvements in memory from baseline to 12-weeks and 24-months post-operatively (p < .05). Regression analyses controlling for baseline factors revealed that a lower BMI at 24-months demonstrated a trend toward significance for improved memory (β = -.30, p = .075). Conclusion These findings suggest that cognitive benefits of bariatric surgery may extend to 24-months post-operatively. Larger prospective studies with extended follow-up periods are needed to elucidate whether bariatric surgery decreases risk for cognitive decline and possibly the development of dementia. PMID:23625587

  3. Adding Chemoprophylaxis to Sequential Compression May Not Reduce the Risk of Venous Thromboembolism in Bariatric Surgery Patients

    PubMed Central

    Gagner, Michel; Selzer, Faith; Belle, Steve H.; Bessler, Marc; Courcoulas, Anita P.; Dakin, Gregory; Davis, Dan; Inabnet, William B.; Mitchell, James E.; Pomp, Alfons; Strain, Gladys; Pories, Walter J.; Wolfe, Bruce

    2012-01-01

    Background Anticoagulation, the use of sequential compression devices on lower extremities peri-operatively, and early ambulation are thought to reduce venous thromboembolism (VTE) postoperatively and are recommended to reduce VTE risk. However, the evidence upon which this recommendation is based is not particularly strong. We demonstrate that even a large, multi-center cohort with carefully collected prospective data is inadequate to provide sufficient evidence to support, or refute, this recommendation. Methods The Longitudinal Assessment of Bariatric Surgery (LABS) participants from 10 centers in the United States who underwent their first bariatric surgery between March, 2005 and December, 2007 comprise the study group. We examined the ability to address the question of whether anti-coagulation therapy, in addition to sequential compression, reduces the 30 day incidence of VTE or death sufficiently to recommend the use of prophylactic anticoagulation, a therapy that is not without risk. Results Of 4416 patients, 396 (9.0%) received sequential compression alone, while the others also received anticoagulation therapy. The incidence of VTE within 30 days of surgery was small (0.25% among those receiving sequential compression alone, 0.47% when anticoagulation therapy was added), and the 30 days incidence of death was also small (0.25% vs. 0.34%, p = 0.76, for sequential compression alone vs. sequential compression plus anticoagulation therapy). Estimates of the number of cases required to address the question of whether there is a difference in outcome related to VTE chemoprophylaxis, or whether the outcome rates are equivalent, range from 13,680 to at least 35,760 patients, depending upon whether superiority or equivalence is being analyzed. Conclusion Sufficient evidence from a clinical trial study to determine whether prophylactic anticoagulation added to compression devices further prevents VTEs is not available and such a trial is likely to be impractical

  4. [Assessment of bariatric surgery results].

    PubMed

    Barros, Lívia Moreira; Frota, Natasha Marques; Moreira, Rosa Aparecida Nogueira; de Araújo, Thiago Moura; Caetano, Joselany Áfio

    2015-03-01

    The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results. PMID:26098798

  5. A role for exercise after bariatric surgery?

    PubMed

    Coen, Paul M; Goodpaster, Bret H

    2016-01-01

    Obesity predisposes an individual to develop numerous comorbidities, including type 2 diabetes, and represents a major healthcare issue in many countries worldwide. Bariatric surgery can be an effective treatment option, resulting in profound weight loss and improvements in metabolic health; however, not all patients achieve similar weight loss or metabolic improvements. Exercise is an excellent way to improve health, with well-characterized physiological and psychological benefits. In the present paper we review the evidence to determine whether there may be a role for exercise as a complementary adjunct therapy to bariatric surgery. Objectively measured physical activity data indicate that most patients who undergo bariatric surgery do not exercise enough to reap the health benefits of exercise. While there is a dearth of data on the effects of exercise on weight loss and weight loss maintenance after surgery, evidence from studies of caloric restriction and exercise suggest that similar adjunctive benefits may be extended to patients who perform exercise after bariatric surgery. Recent evidence from exercise interventions after bariatric surgery suggests that exercise may provide further improvements in metabolic health compared with surgery-induced weight loss alone. Additional randomized controlled exercise trials are now needed as the next step to more clearly define the potential for exercise to provide additional health benefits after bariatric surgery. This valuable evidence will inform clinical practice regarding much-needed guidelines for exercise after bariatric surgery. PMID:26228356

  6. Psychosocial Interventions Pre and Post Bariatric Surgery.

    PubMed

    Kalarchian, Melissa A; Marcus, Marsha D

    2015-11-01

    Despite positive results overall, a substantial number of patients experience poor long-term outcomes following bariatric surgery. One reason for variability in weight loss may be difficulty in making and sustaining changes in dietary intake and physical activity; post-surgery binge eating has also been associated with poorer weight outcomes. In this paper, we review available evidence on adjunctive psychosocial interventions for bariatric surgery patients. Although the literature is limited, evidence suggests that bariatric surgery patients may benefit from a comprehensive approach targeting diet, activity and psychological factors. We think the optimal time to initiate adjunctive intervention is after surgery, but before significant weight regain has occurred. Adaptive interventions incorporating advances in technology may prove to be effective for promoting behavioural self-management and psychosocial adjustment following bariatric surgery. For some patients, pharmacotherapy and reoperation may also play a role in a personalized approach to post-surgery care. PMID:26364715

  7. [Bariatric surgery--indication and contraindication].

    PubMed

    Kasama, Kazunori; Seki, Yosuke

    2013-02-01

    The field of obesity surgery (bariatric surgery) expands as a consequence of the rapid increase of overweight and obesity not only in the western countries but also in Asia. Japan is still far behind the western progression but the problem of obesity is rising in our country so that necessity for bariatric surgery will also rise in Japan. A few statements of indication of bariatric surgery for Asian are published recently. According to the statements from IFSO-APC (International Federation of Surgery for Obesity and Metabolic Disorders, Asian Pacific Chapter) consensus 2011, bariatric surgery for Asian should be considered for the patient with BMI over 35 without co-morbidity and for the patient with BMI over 30 with co-morbidities. PMID:23631217

  8. Effects of bariatric surgery on bone.

    PubMed

    Uebelhart, Brigitte

    2016-05-01

    Bariatric surgery currently relies on combinations of restrictive and malabsorptive procedures. Early decreases in bone mineral density (BMD) have been reported. However, the accuracy of dual-energy X-ray absorptiometry used to measure BMD can be diminished by the major weight loss, whereas quantitative computed tomography (QCT) measurements are less affected. The nutritional deficiencies induced by mixed bariatric surgery procedures, together with changes in hormones produced by adipocytes and/or the gastrointestinal tract, are often associated with elevations in serum levels of bone resorption markers. Although the data are limited, the incidence of fractures does not seem higher after bariatric surgery than in non-operated obese patients. PMID:26992952

  9. Bariatric surgery: the indications in metabolic disease.

    PubMed

    Neff, K J; le Roux, C W

    2014-01-01

    As well as the pronounced effect on body mass index (BMI), bariatric surgery is increasingly recognized as being associated with improvements in morbidity and mortality in a range of conditions, from airways disease to cancer. In metabolic disease, the impact of bariatric surgery is particularly obvious with marked improvements in glycemic control in patients with type 2 diabetes mellitus, to the point of effecting diabetes remission in some. Hypertension and dyslipidemia, key components of the metabolic syndrome, also respond to bariatric surgery. Despite the increasing evidence of benefit in metabolic disease, the major national guidelines for selecting candidates for bariatric surgery retain their emphasis on body weight. In these guidelines, a BMI ≥35 kg/m(2) is needed to indicate surgery, even in those with profound metabolic disturbance. The recent International Diabetes Federation guidelines have identified the need to reorientate our focus from BMI to metabolic disease. In this review, we examine the developing indications for the use of bariatric surgery in metabolic disease. We will focus on type 2 diabetes mellitus and the metabolic syndrome. Within this, we will outline the data for using bariatric surgery as metabolic surgery, including those with a BMI <35 kg/m(2). PMID:23838610

  10. Nephrolithiasis after bariatric surgery for obesity

    PubMed Central

    Lieske, John C.; Kumar, Rajiv; Collazo-Clavell, Maria L.

    2010-01-01

    Surgical intervention has become an accepted therapeutic alternative for the patient with medically complicated obesity. Multiple investigators have reported significant and sustained weight loss after bariatric surgery that is associated with improvement of many weight related medical co-morbidities, and statistically-significant decreased overall mortality for surgically-treated as compared to medically-treated subjects. Although the Roux-en-Y Gastric bypass (RYGB) is considered an acceptably safe treatment, an increasing number of patients are being recognized with nephrolithiasis after this, the most common bariatric surgery currently performed. The main risk factor appears to be hyperoxaluria, although low urine volume and citrate concentrations may contribute. The incidence of these urinary risk factors amongst the total post-RYGB population is unknown, but may be more than previously suspected based upon small pilot studies. The etiology of the hyperoxaluria is unknown, but may be related to subtle and seemingly sub clinical fat malabsorption. Clearly, further study is needed, especially to define better treatment options than the standard advice for a low fat, low oxalate diet, and use of calcium as an oxalate binder. PMID:18359397

  11. Metabolic Syndrome Prevalence and Associations in a Bariatric Surgery Cohort from the Longitudinal Assessment of Bariatric Surgery-2 Study

    PubMed Central

    Selzer, Faith; Smith, Mark D.; Berk, Paul D.; Courcoulas, Anita P.; Inabnet, William B.; King, Wendy C.; Pender, John; Pomp, Alfons; Raum, William J.; Schrope, Beth; Steffen, Kristine J.; Wolfe, Bruce M.; Patterson, Emma J.

    2014-01-01

    Abstract Background: Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. Methods: Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. Results: The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. Conclusions: Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes. PMID:24380645

  12. Role of endoscopy in the bariatric surgery of patients.

    PubMed

    De Palma, Giovanni D; Forestieri, Pietro

    2014-06-28

    Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett's esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett's esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients. PMID:24976715

  13. New-Onset Mania Following Bariatric Surgery

    PubMed Central

    Bhattarai, Mukul; Agustin, Erie T.

    2015-01-01

    Obesity has become a major public health problem over the past two decades. Non-surgical management of obesity does not often achieve its long term goals. Surgical treatment is roaring in popularity because of dramatic and durable results. However, outcomes from bariatric surgery have become a significant area of scrutiny because it is also associated with several medical and psychological complications. Out of those complications, there are descriptions of neuropsychiatric disorders and psycho-behavioral symptoms after surgery. Meanwhile, few reports of acute psychosis are described but to our knowledge, our case is the first case report of primary mania following bariatric surgery. We present an unusual and challenging case of primary mania in a 57 year old female who underwent bariatric surgery two months ago. Patient responded well initially to antipsychotic followed by mood stabilizer. PMID:25670960

  14. Bariatric surgery: assessing opportunities for value innovation.

    PubMed

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage. PMID:15846452

  15. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    ERIC Educational Resources Information Center

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  16. Bariatric surgery, safety and type 2 diabetes.

    PubMed

    Spanakis, Elias; Gragnoli, Claudia

    2009-03-01

    Obesity and type 2 diabetes (T2D) represent major health concerns in the USA. Weight loss is the most important aspect in T2D management, as it reduces both morbidity and mortality. Available lifestyle, behavioral, and pharmacological strategies provide just mild to moderate weight loss. The greatest degree of T2D prevention or T2D amelioration in obese subjects has been reported in subjects who underwent bariatric surgery. In the current review, we will describe various types of bariatric surgery, related safety profiles, and their effect on T2D, as well as the potential mechanisms involved in the remission of T2D. Finally, we hereby examine whether bariatric surgery may be considered a treatment for T2D in pregnant women, children, adolescents and subjects at least 65 years old. PMID:18830788

  17. Bariatric Surgery: Overview of Procedures and Outcomes.

    PubMed

    Azagury, Dan E; Morton, John Magaña

    2016-09-01

    Bariatric surgery is the most efficient and long-lasting weight loss therapy available. Its safety has improved over tenfold over the last decade. With the advent of laparoscopy, mortality rates of are now under 1 per 1400 cases in accredited centers. Gastric bypass reduces diabetes-related mortality by 92% over 7 years and long lasting remission has been demonstrated in observational studies covering >10,000 patients and multiple randomized control trials. The benefit of bariatric surgery on diabetes is so substantial that these procedures should be considered in all type 2 diabetic patients with a BMI > 35 kg/m(2). PMID:27519136

  18. Parkinsonism as a Complication of Bariatric Surgery

    PubMed Central

    Kamel, Walaa A.; Hashel, Jasem Y. Al; Kilany, Ayman; Altailji, Samira

    2015-01-01

    BACKGROUND: The association between Parkinsonism and BS has already been reported in only three patients worldwide. CASE SUMMARY: We report a 39-years old Kuwaiti female who presented with parkinsonian features and mononeuropathy (carpal tunnel syndrome) 3 years after a vertical sleeve gastrectomy operation. CONCLUSION: We conclude that with the increasing popularity of bariatric surgery, clinicians will need to recognize and manage neurologic complications that may appear soon after or years to decades later. Thorough evaluation is essential for any patient who has undergone bariatric surgery and develops neurologic symptoms.

  19. Pregnancy Following Bariatric Surgery-Medical Complications and Management.

    PubMed

    Narayanan, Ram Prakash; Syed, Akheel A

    2016-10-01

    Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12-24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis. PMID:27488114

  20. Bariatric surgery for obesity and metabolic conditions in adults.

    PubMed

    Arterburn, David E; Courcoulas, Anita P

    2014-01-01

    This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process. PMID:25164369

  1. Bariatric surgery for obesity and metabolic conditions in adults

    PubMed Central

    Courcoulas, Anita P

    2014-01-01

    This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process. PMID:25164369

  2. Treatment of Obesity: Weight Loss and Bariatric Surgery.

    PubMed

    Wolfe, Bruce M; Kvach, Elizaveta; Eckel, Robert H

    2016-05-27

    This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated. PMID:27230645

  3. Nutrition and Pregnancy after Bariatric Surgery

    PubMed Central

    Kaska, Lukasz; Kobiela, Jarek; Abacjew-Chmylko, Anna; Chmylko, Lukasz; Wojanowska-Pindel, Magdalena; Kobiela, Paulina; Walerzak, Anna; Makarewicz, Wojciech; Proczko-Markuszewska, Monika; Stefaniak, Tomasz

    2013-01-01

    Obesity is an escalating problem in all age groups and it is observed to be more common in females than males. About 25% of women meet the criteria of obesity and one-third of them are in the reproductive age. Because morbid obesity requiring surgical treatment is observed with increasing frequency, surgeons and gynecologists are undergoing new challenges. It is not only a matter of women's health and their quality of life but also proper development of the fetus, which should be a concern during bariatric treatment. Therefore complex perinatal care has to be provided for morbid obesity patients. The paper reviews pregnancy and fertility issues in bariatric surgery patients. PMID:24555146

  4. Bariatric surgery and implications for stoma care.

    PubMed

    Swash, Carolyn

    In the UK, 62% of the population are now described as being either overweight or obese. People with weight-management issues are more likely to suffer from cardiovascular disease and diabetes, as well as having an increased risk of cancer, including bowel cancer. Following the initial National Institute for Health and Care Excellence guidance in 2006, revised in 2014, health professionals have a more proactive role in identifying people with weight-management issues and supporting them to achieve a weight that helps reduce their health risks. This includes referrals to bariatric surgeons for consideration for surgery if appropriate. One particular surgical procedure, the Roux-en-Y, is not reversible and alters the capacity of the stomach and function of the small bowel in order to achieve weight loss. Using a case study, this article will highlight the role of the stoma nurse in managing a patient, who previously had a Roux-en-Y procedure for weight loss and subsequently needed formation of a loop ileostomy after surgery for bowel cancer. PMID:26973009

  5. The Intestinal Microbiome in Bariatric Surgery Patients

    PubMed Central

    Peat, Christine M.; Kleiman, Susan C.; Bulik, Cynthia M.; Carroll, Ian M.

    2016-01-01

    With nearly 39% of the worldwide adult population classified as obese, much of the globe is facing a serious public health challenge. Increasing rates of obesity, coupled with the failure of many behavioral and pharmacological interventions, have contributed to a rise in popularity of bariatric surgery as a treatment for obesity. Surgery-mediated weight loss was initially thought to be a direct result of mechanical alterations causing restriction and calorie malabsorption. However, the mounting evidence suggests that indirect factors influence the accumulation and storage of fat in patients that have undergone this procedure. Given the established impact the intestinal microbiota has on adiposity, it is likely that this complex enteric microbial community contributes to surgery-mediated weight loss and maintenance of weight loss post-surgery. In this review, we discuss the physiological and psychological traits exhibited by bariatric surgery candidates that can be influenced by the intestinal microbiota. Additionally, we detail the studies that investigated the impact of bariatric surgery on the intestinal microbiota in humans and mouse models of this procedure. PMID:26426680

  6. The Intestinal Microbiome in Bariatric Surgery Patients.

    PubMed

    Peat, Christine M; Kleiman, Susan C; Bulik, Cynthia M; Carroll, Ian M

    2015-11-01

    With nearly 39% of the worldwide adult population classified as obese, much of the globe is facing a serious public health challenge. Increasing rates of obesity, coupled with the failure of many behavioural and pharmacological interventions, have contributed to a rise in popularity of bariatric surgery as a treatment for obesity. Surgery-mediated weight loss was initially thought to be a direct result of mechanical alterations causing restriction and calorie malabsorption. However, the mounting evidence suggests that indirect factors influence the accumulation and storage of fat in patients that have undergone this procedure. Given the established impact the intestinal microbiota has on adiposity, it is likely that this complex enteric microbial community contributes to surgery-mediated weight loss and maintenance of weight loss postsurgery. In this review, we discuss the physiological and psychological traits exhibited by bariatric surgery candidates that can be influenced by the intestinal microbiota. Additionally, we detail the studies that investigated the impact of bariatric surgery on the intestinal microbiota in humans and mouse models of this procedure. PMID:26426680

  7. Does bariatric surgery improve adipose tissue function?

    PubMed

    Frikke-Schmidt, H; O'Rourke, R W; Lumeng, C N; Sandoval, D A; Seeley, R J

    2016-09-01

    Bariatric surgery is currently the most effective treatment for obesity. Not only do these types of surgeries produce significant weight loss but also they improve insulin sensitivity and whole body metabolic function. The aim of this review is to explore how altered physiology of adipose tissue may contribute to the potent metabolic effects of some of these procedures. This includes specific effects on various fat depots, the function of individual adipocytes and the interaction between adipose tissue and other key metabolic tissues. Besides a dramatic loss of fat mass, bariatric surgery shifts the distribution of fat from visceral to the subcutaneous compartment favoring metabolic improvement. The sensitivity towards lipolysis controlled by insulin and catecholamines is improved, adipokine secretion is altered and local adipose inflammation as well as systemic inflammatory markers decreases. Some of these changes have been shown to be weight loss independent, and novel hypothesis for these effects includes include changes in bile acid metabolism, gut microbiota and central regulation of metabolism. In conclusion bariatric surgery is capable of improving aspects of adipose tissue function and do so in some cases in ways that are not entirely explained by the potent effect of surgery. © 2016 World Obesity. PMID:27272117

  8. Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases

    PubMed Central

    Colabianchi, Vincenzo; de Bernardinis, Giancarlo; Giovannini, Matteo; Langella, Marika

    2015-01-01

    Surgical treatment of obese patients is much debated in the literature because of the significant intraoperative risks related to comorbidities presented by this type of patients. Recent literature suggests that panniculectomy should follow bariatric surgery after the patient's weight loss has been stabilized. However, when performed by laparotomy, bariatric surgery can be combined with panniculectomy. This paper presents the analysis of 325 cases of patients undergoing abdominal panniculectomy combined with bariatric surgery. The study highlights the risks, complications, and benefits of the combined procedure and describes a standardized technique for excision of a large abdominal panniculus in a short operating time. PMID:26682282

  9. [Clinical Practice after Bariatric Surgery: Problems and Complications].

    PubMed

    Gebhart, Martina

    2015-12-01

    The number of patients undergoing bariatric surgery because of morbid obesity is increasing rapidly. Therefore, it is an important issue to be aware of outcome and complications after bariatric surgery. This mini-review presents a compilation of important gastrointestinal symptoms, as pain, diarrhea and dumping, and includes treatment options. It characterizes possible micronutrient deficiencies, gives instructions concerning the adaptation of drugs and illustrates possible adverse outcomes, such as excessive weight loss, insufficient weight loss and weight gain after bariatric surgery. PMID:26649955

  10. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: EXECUTIVE SUMMARY.

    PubMed

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2-part scientific statement examines the potential lipid benefits of bariatric procedures and represents contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on data published through June 2015. Part 1 of this 2-part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on cardiovascular disease; and finally (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the executive summary of part 1. PMID:26892119

  11. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: FULL REPORT.

    PubMed

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2 part scientific statement examines the potential lipid benefits of bariatric procedures and represents the contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on published data through June 2015. Part 1 of this 2 part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the full report of part 1. PMID:26892120

  12. MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery.

    PubMed

    Corcelles, Ricard; Daigle, Christopher R; Schauer, Philip R

    2016-01-01

    Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality. PMID:26340972

  13. Recent advances in metabolic and bariatric surgery

    PubMed Central

    Albaugh, Vance L.; Flynn, C. Robb; Tamboli, Robyn A.; Abumrad, Naji N.

    2016-01-01

    Obesity and its associated medical conditions continue to increase and add significant burden to patients, as well as health-care systems, worldwide. Bariatric surgery is the most effective treatment for severe obesity and its comorbidities, and resolution of diabetes is weight loss-independent in the case of some operations. Although these weight-independent effects are frequently described clinically, the mechanisms behind them are not well understood and remain an intense area of focus in the growing field of metabolic and bariatric surgery. Perceptions of the mechanisms responsible for the beneficial metabolic effects of metabolic/bariatric operations have shifted from being mostly restrictive and malabsorption over the last 10 to 15 years to being more neuro-hormonal in origin. In this review, we describe recent basic and clinical findings of the major clinical procedures (adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion) as well as other experimental procedures (ileal interposition and bile diversion) that recapitulate many of the metabolic effects of these complex operations in a simpler fashion. As the role of bile acids and the gut microbiome on metabolism is becoming increasingly well described, their potential roles in these improvements following metabolic surgery are becoming better appreciated. Bile acid and gut microbiome changes, in light of recent developments, are discussed in the context of these surgical procedures, as well as their implications for future study. PMID:27239296

  14. Recent advances in metabolic and bariatric surgery.

    PubMed

    Albaugh, Vance L; Flynn, C Robb; Tamboli, Robyn A; Abumrad, Naji N

    2016-01-01

    Obesity and its associated medical conditions continue to increase and add significant burden to patients, as well as health-care systems, worldwide. Bariatric surgery is the most effective treatment for severe obesity and its comorbidities, and resolution of diabetes is weight loss-independent in the case of some operations. Although these weight-independent effects are frequently described clinically, the mechanisms behind them are not well understood and remain an intense area of focus in the growing field of metabolic and bariatric surgery. Perceptions of the mechanisms responsible for the beneficial metabolic effects of metabolic/bariatric operations have shifted from being mostly restrictive and malabsorption over the last 10 to 15 years to being more neuro-hormonal in origin. In this review, we describe recent basic and clinical findings of the major clinical procedures (adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion) as well as other experimental procedures (ileal interposition and bile diversion) that recapitulate many of the metabolic effects of these complex operations in a simpler fashion. As the role of bile acids and the gut microbiome on metabolism is becoming increasingly well described, their potential roles in these improvements following metabolic surgery are becoming better appreciated. Bile acid and gut microbiome changes, in light of recent developments, are discussed in the context of these surgical procedures, as well as their implications for future study. PMID:27239296

  15. The effect of bariatric surgery on echocardiographic indices: a review of the literature.

    PubMed

    Grapsa, Julia; Tan, Timothy C; Paschou, Stavroula A; Kalogeropoulos, Andreas S; Shimony, Avi; Kaier, Thomas; Demir, Ozan M; Mikhail, Sameh; Hakky, Sherif; Purkayastha, Sanjay; Ahmed, Ahmed R; Cousins, Jonathan; Nihoyannopoulos, Petros

    2013-11-01

    Obesity is the new epidemic and is associated with an increased risk of diastolic and systolic heart failure. Effective treatment options with drastic results such as bariatric surgery have raised interest in the possible reversal of some of the cardiovascular sequelae. Many studies have assessed individually the effect of weight loss on specific echocardiographic indices, mostly employing nonhomogeneous groups. The purpose of this narrative review is to summarise the effect of bariatric surgery on echocardiographic indices of biventricular function and to help in the understanding of the expected echocardiographic changes in bariatric patients after weight-loss surgery. PMID:24117129

  16. Effects of Bariatric Surgery on Facial Features

    PubMed Central

    Papoian, Vardan; Mardirossian, Vartan; Hess, Donald Thomas

    2015-01-01

    Background Bariatric surgeries performed in the USA has increased twelve-fold in the past two decades. The effects of rapid weight loss on facial features has not been previously studied. We hypothesized that bariatric surgery will mimic the effects of aging thus giving the patient an older and less attractive appearance. Methods Consecutive patients were enrolled from the bariatric surgical clinic at our institution. Pre and post weight loss photographs were taken and used to generate two surveys. The surveys were distributed through social media to assess the difference between the preoperative and postoperative facial photos, in terms of patients' perceived age and overall attractiveness. 102 respondents completed the first survey and 95 respondents completed the second survey. Results Of the 14 patients, five showed statistically significant change in perceived age (three more likely to be perceived older and two less likely to be perceived older). The patients were assessed to be more attractive postoperatively, which showed statistical significance. Conclusions Weight loss does affect facial aesthetics. Mild weight loss is perceived by survey respondents to give the appearance of a younger but less attractive patient, while substantial weight loss is perceived to give the appearance of an older but more attractive patient. PMID:26430627

  17. Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery

    PubMed Central

    Noel, Olivier F.; Still, Christopher D.; Argyropoulos, George; Edwards, Michael; Gerhard, Glenn S.

    2016-01-01

    Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D) mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs) as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR) transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes. PMID:27006824

  18. Management and Prevention of Surgical and Nutritional Complications After Bariatric Surgery.

    PubMed

    Marcotte, Eric; Chand, Bipan

    2016-08-01

    Bariatric surgery is well-recognized for its effects on health, beyond weight-loss. It underwent a revolution recently with the growing performance of laparoscopic procedures, leading to enhanced recovery and a reduction in procedural risk. However, surgical complications, although rare, do develop. It is important to recognize the complications, and ideally prevent them from happening. This article reviews the risks of the four most commonly performed bariatric procedures, with an emphasis on technique and management in the intraoperative and postoperative period. The nutritional aspect of bariatric surgery is of the utmost importance, because catastrophic consequences have been linked to malnutrition and vitamin deficiencies. PMID:27473805

  19. Development of a Pilot Telehealth Bariatric Surgery Support Group

    ERIC Educational Resources Information Center

    Schofield, Carin K.

    2013-01-01

    The prevalence of obesity in the United States continues to grow. Bariatric surgery is becoming more common and accepted in the treatment of obesity. Clinical candidates for bariatric surgery should have a BMI > 40 kg/m[superscript 2] alone, or a BMI > 35 kg/m[superscript 2] plus one comorbidity. A trend is emerging in the literature showing…

  20. Bariatric Surgery as Potential Treatment for Nonalcoholic Fatty Liver Disease: A Future Treatment by Choice or by Chance?

    PubMed Central

    Hafeez, Shuja; Ahmed, Mohamed H.

    2013-01-01

    Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB). The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i) the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii) the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD. PMID:23431426

  1. Walking Capacity of Bariatric Surgery Candidates

    PubMed Central

    King, WC; Engel, SG; Elder, KA; Chapman, WH; Eid, GM; Wolfe, BM; Belle, SH

    2011-01-01

    Background This study characterizes the walking limitations of bariatric surgery candidates by age and body mass index (BMI) and determines factors independently associated with walking capacity. Setting Multi-institutional at research university hospitals in the United States. Methods 2458 participants of the Longitudinal Assessment of Bariatric Surgery study (age: 18-78 y, BMI: 33-94 kg/m2) attended a pre-operative research visit. Walking capacity was measured via self-report and the 400 meter Long Distance Corridor Walk (LDCW). Results Almost two-thirds (64%) of subjects reported limitations walking several blocks, 48% had an objectively-defined mobility deficit, and 16% reported at least some walking aid use. In multivariable analysis, BMI, older age, lower income and greater bodily pain were independently associated (p<.05) with walking aid use, physical discomfort during the LDCW, inability to complete the LDCW, and slower time to complete the LDCW. Female sex, Hispanic ethnicity (but not race), higher resting heart rate, history of smoking, several comoribidities (history of stroke, ischemic heart disease, diabetes, asthma, sleep apnea, venous edema with ulcerations), and depressive symptoms were also independently related (p<.05) to at least one measure of reduced walking capacity. Conclusions Walking limitations are common in bariatric surgery candidates, even among the least severely obese and youngest patients. Physical activity counseling must be tailored to individuals' abilities. While several factors identified in this study (e.g., BMI, age, pain, comorbidities) should be considered, directly assessing walking capacity will facilitate appropriate goal-setting. PMID:21937285

  2. Bariatric surgery is associated with improvement in kidney outcomes.

    PubMed

    Chang, Alex R; Chen, Yuan; Still, Christopher; Wood, G Craig; Kirchner, H Lester; Lewis, Meredith; Kramer, Holly; Hartle, James E; Carey, David; Appel, Lawrence J; Grams, Morgan E

    2016-07-01

    Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this we compared the risk of estimated glomerular filtration rate (eGFR) decline of ≥30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who did not undergo such surgery. Patients were matched on demographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean age was 45 years, 97% were white, 80% were female, and 33% had baseline eGFR <90 ml/min per 1.73 m(2). Mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had an eGFR decline of ≥30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177 patients in the matched cohort had an eGFR decline of ≥30% (50 had doubling of serum creatinine/ESRD). In adjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and 57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR <90 ml/min per 1.73 m(2), hypertension, and diabetes. Thus, bariatric surgery may be an option to prevent kidney function decline in severely obese individuals. PMID:27181999

  3. [Bariatric surgery and pregnancy: literature review].

    PubMed

    Ferrand Miranda, Pedro; Contreras Rivas, Tomas; Leigh Pacciarini, Stephanie

    2014-01-01

    Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy. PMID:25192021

  4. Review of nutritional guidelines for patients undergoing bariatric surgery.

    PubMed

    Leahy, Cheri Rebecca; Luning, Alyssa

    2015-08-01

    Health care providers often supply patients who are undergoing bariatric surgery with varying and sometimes conflicting information regarding nutrition before and after surgery. Nurses and other care providers can benefit from applying current nutritional guidelines to increase patients' understanding, compliance, nutrition, hydration, protein needs, and satisfaction. This article summarizes basic recommendations to help health care providers understand the patients' nutritional requirements and diet recommendations from two weeks before bariatric surgery to four to six weeks after surgery. PMID:26227519

  5. Major Increase in Microbiota-Dependent Proatherogenic Metabolite TMAO One Year After Bariatric Surgery

    PubMed Central

    Hov, Johannes R.; Nestvold, Torunn Kristin; Thoresen, Hanne; Berge, Rolf K.; Svardal, Asbjørn; Lappegård, Knut Tore

    2016-01-01

    Abstract Background: Trimethylamine-N-oxide (TMAO) is formed in the liver from trimethylamine (TMA), a product exclusively generated by the gut microbiota from dietary phosphatidylcholine and carnitine. An alternative pathway of TMAO formation from carnitine is via the microbiota-dependent intermediate γ-butyrobetaine (γBB). Elevated TMAO levels are associated with cardiovascular disease (CVD), but little is known about TMAO in obesity. Given the proposed contribution of microbiota alterations in obesity and type 2 diabetes (T2D), we investigated the potential impact of obesity, lifestyle-induced weight loss, and bariatric surgery on plasma levels of TMAO, its microbiota-dependent intermediate γBB, and its diet-dependent precursors carnitine and choline. Methods: TMAO, γBB, carnitine, and choline were measured by high-performance liquid chromatography in 34 obese individuals (17 with and 17 without T2D) undergoing bariatric surgery and 17 controls. Results: TMAO was not elevated in obese patients or reduced by lifestyle interventions but increased approximately twofold after bariatric surgery. Similar to TMAO, plasma levels of γBB were not influenced by lifestyle interventions but increased moderately after bariatric surgery. In contrast, carnitine and choline, which are abundant in nutrients, such as in red meat and eggs, and not microbiota dependent, were reduced after lifestyle interventions and rebounded after bariatric surgery. Conclusions: The major increase in TMAO after bariatric surgery was unexpected because high TMAO levels have been linked to CVD, whereas bariatric surgery is known to reduce CVD risk. Prospective studies of gut microbiota composition and related metabolites in relation to long-term cardiovascular risk after bariatric surgery are warranted. PMID:27081744

  6. Internet marketing of bariatric surgery: contemporary trends in the medicalization of obesity.

    PubMed

    Salant, Talya; Santry, Heena P

    2006-05-01

    In the context of political, economic, and scientific anxiety around the 'epidemic' rise in obesity in the US, the social and historical forces engendering the medicalization of obesity have been widely discussed. However, the recent growth of bariatric-weight loss-surgery and the expanding presence of advertising for bariatric surgery on the Internet suggest the possible emergence of new loci and languages of medicalization. We sought to identify the nature and extent to which web advertising of bariatric surgery contributes to the medicalization of obesity by examining the design and textual content of 100 bariatric surgery center websites. We found that websites, through strategic use of text and images, consistently describe obesity as a serious disease that requires professional ascertainment and supervision, entails substantial individual suffering, and is remedied through the transformative yet low risk effects of bariatric surgery. In the process, social normalcy and risk reduction come to replace physical criteria as the basis for determining health. Further, websites draw upon contradictory discourses of medicalization; that is, they insist upon 'external' (e.g. genetics, environment) causes of obesity to legitimize surgical intervention while implicating individual behaviors in surgical failure. From this, we suggest that the economic and professional motivations underlying website advertisements for bariatric surgery may result in confusing messages being sent to prospective patients as well as the perpetuation of gendered notions of obesity and the entrenchment of health disparities. PMID:16289735

  7. Ethical issues in the psychosocial assessment of bariatric surgery candidates.

    PubMed

    Rouleau, Codie R; Rash, Joshua A; Mothersill, Kerry J

    2016-07-01

    Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments. PMID:25411197

  8. Malabsorption as a Therapeutic Approach in Bariatric Surgery

    PubMed Central

    Billeter, Adrian T.; Fischer, Lars; Wekerle, Anna-Laura; Senft, Jonas; Müller-Stich, Beat

    2014-01-01

    Summary Background The increasing prevalence of obese patients will lead to a more frequent use of bariatric procedures in the future. Compared to conservative medical therapy, bariatric procedures achieve greater weight loss and superior control of comorbidities, resulting in improved overall mortality. Methods A search for current literature regarding mechanisms, indications, and outcomes of bariatric surgery was performed. Results In order to care for patients after bariatric surgery properly, it is important to understand its mechanisms of action and effects on gastrointestinal physiology. Recent investigations indicate that the beneficial effects of bariatric procedures are much more complex than simply limiting food intake or an associated malabsorption. Changes in gastrointestinal hormone secretion, energy expenditure, intestinal bacterial colonization, bile acid metabolism, and epigenetic modifications resulting in altered gene expression are likely responsible for the majority of the beneficial effects of bariatric surgery. Malabsorptive bariatric procedures divert the flow of bile and pancreatic enzymes from food and therefore limit the digestion and absorption of nutrients, resulting in reduced calorie intake and subsequent weight loss. Essential micronutrients such as vitamins and trace elements are also absorbed to a lesser extent, potentially leading to severe side effects. Conclusion To prevent malnutrition, dietary supplementation and regular control of micronutrient levels are mandatory for patients undergoing malabsorptive bariatric procedures, in whom the fat-soluble vitamins A and D are commonly deficient. PMID:26288594

  9. Temperament and Personality in Bariatric Surgery-Resisting Temptations?

    PubMed

    Claes, Laurence; Müller, Astrid

    2015-11-01

    Temperament and personality traits can serve as both risk factors as well as protective factors in the development of morbid obesity. In the present review, we present an overview of studies focusing on the relationship between temperament/personality and morbid obesity in pre-operative and postoperative bariatric surgery patients. We consider studies that focus on both a categorical and dimensional point of view on temperament/personality, as well as studies based on cross-sectional and longitudinal designs. Finally, we will integrate the research findings, discuss the implications for assessment and treatment and formulate suggestions for future research. PMID:26290134

  10. Adolescent bariatric surgery--thoughts and perspectives from the UK.

    PubMed

    Penna, Marta; Markar, Sheraz; Hewes, James; Fiennes, Alberic; Jones, Niall; Hashemi, Majid

    2014-01-01

    Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI) >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥ 16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways. PMID:24384777

  11. 30-day Mortality after Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery

    PubMed Central

    Smith, Mark D.; Patterson, Emma; Wahed, Abdus S.; Belle, Steven H.; Berk, Paul D.; Courcoulas, Anita P.; Dakin, Gregory F.; Flum, David R.; Machado, Laura; Mitchell, James E.; Pender, John; Pomp, Alfons; Pories, Walter; Ramanathan, Ramesh; Schrope, Beth; Staten, Myrlene; Ude, Akuezunkpa; Wolfe, Bruce M.

    2011-01-01

    Purpose Mortality following bariatric surgery is a rare event in contemporary series, making it difficult for any single center to draw meaningful conclusions as to cause of death. Nevertheless, much of the published mortality data come from single center case series and reviews of administrative databases. These sources tend to produce lower mortality estimates than those obtained from controlled clinical trials. Furthermore, information about the causes of death and how they were determined is not always available. The aim of the present report is to describe in detail all deaths occurring within 30-days of surgery in the Longitudinal Assessment of Bariatric Surgery (LABS). Methods LABS is a 10-center observational cohort study of bariatric surgical outcomes. Data were collected prospectively for bariatric surgeries performed between March 2005 and April 2009. All deaths occurring within 30-days of surgery were identified, and cause of death assigned by an independent Adjudication Subcommittee, blinded to operating surgeon and site. Results 6118 patients underwent primary bariatric surgery. 18 deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%) and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information. Conclusions This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths. PMID:21866378

  12. Acute Abdominal Pain in the Bariatric Surgery Patient.

    PubMed

    Lewis, Kyle D; Takenaka, Katrin Y; Luber, Samuel D

    2016-05-01

    Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients. PMID:27133251

  13. Imaging of patients treated with bariatric surgery

    PubMed Central

    Lemanowicz, Adam; Serafin, Zbigniew

    2014-01-01

    Summary Over the past few years, obesity has become a major clinical and population concern in the majority of developed countries. Obesity leads to significant systemic disorders, such as hypertension, hypercholesterolemia, hypertriglyceridemia and insulin resistance, and also increases the risk of developing cardiovascular diseases (ischemic heart disease, ischemic stroke), metabolic diseases (type 2 diabetes), certain types of cancer, and degenerative bone disorders (osteoarthritis). Health hazards associated with epidemic of obesity and potential benefits of weight loss have spurred interest in new treatment methods. Bariatric surgical procedures constitute a recognized alternative in cases where conservative management of obesity fails. Several bariatric operations can be distinguished: restrictive procedures, such as adjustable gastric band (AGB) and vertical banded gastroplasty (VBG); predominantly malabsorptive procedures, such as biliopancreatic diversion (BPD), and a combination of both methods, such as Roux-en-Y gastric bypass. The adverse consequences of surgical treatment of obesity include i.a.: intestinal anastomotic leakage, impaired intestinal permeability and internal hernia, dilatation of the stomach, gastrointestinal anastomotic stenosis, marginal ulceration, incisional hernia. Basic knowledge of procedures in the surgical treatment of obesity is of vital importance for the radiologist during evaluation of upper gastrointestinal tract in the early and late postoperative period, allowing correct interpretation of acquired images as well as recognition of typical complications. PMID:24497896

  14. The Meaning of Awaiting Bariatric Surgery Due to Morbid Obesity

    PubMed Central

    Engström, My; Wiklund, Malin; Olsén, Monika Fagevik; Lönroth, Hans; Forsberg, Anna

    2011-01-01

    Background: The understanding of the association between the objective conditions of health and the subjective perceptions of morbidly obese patients appears to be poor. The use of objective indicators alone produces results totally unrelated to the feelings and experiences of the bariatric patients studied. No study has approached the bariatric patient from both an inside and a preoperative perspective. Purpose: The aim of this study was to investigate the meaning of awaiting bariatric surgery due to morbid obesity. Method: Twenty-three patients admitted to a Swedish University Hospital for bariatric surgery were included. Data were collected by interviews and the analysis was performed using the phenomenological hermeneutics method developed by Lindseth and Norberg. Main Findings: Two structural thematic analyses revealed six main themes: experiencing food as a complex element in life, feeling hopeless regarding weight loss, living in fear of future sickness and death, living a restricted life, being ignored by health care professionals and hoping for control and opportunities. The informants experienced addiction to food and dependence on others for managing their daily life, which constituted an infringement of their freedom. Loss of control meant giving in to the desire for food, but also being subjected to stigmatizing remarks from persons in their environment or uncaring approaches from health care professionals. Conclusion: Being scheduled for bariatric surgery meant developing an awareness of how completely dependent they were on surgery for their survival and prospective health. The scheduled bariatric surgery constituted tangible confirmation that weight loss and restored health were possible. PMID:21660178

  15. Bariatric surgery and diabetes remission: Who would have thought it?

    PubMed Central

    Singh, Awadhesh Kumar; Singh, Ritu; Kota, Sunil Kumar

    2015-01-01

    Type 2 diabetes mellitus (T2DM) and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes) study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms. PMID:26425464

  16. Bariatric surgery and diabetes remission: Who would have thought it?

    PubMed

    Singh, Awadhesh Kumar; Singh, Ritu; Kota, Sunil Kumar

    2015-01-01

    Type 2 diabetes mellitus (T2DM) and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes) study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1(st) year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms. PMID:26425464

  17. Emotional and Affective Temperaments in Smoking Candidates for Bariatric Surgery

    PubMed Central

    Mombach, Karin Daniele; de Souza Brito, Cesar Luis; Padoin, Alexandre Vontobel; Casagrande, Daniela Schaan; Mottin, Claudio Cora

    2016-01-01

    Introduction The prevalence of smoking habits in severe obesity is higher than in the general population. There is some evidence that smokers have different temperaments compared to non-smokers. The aim of this study is to evaluate the associations between smoking status (smokers, ex-smokers and non-smokers) and temperament characteristics in bariatric surgery candidates. Methods We analyzed data on temperament of 420 bariatric surgery candidates, as assessed by the AFECTS scale, in an exploratory cross-sectional survey of bariatric surgery candidates who have been grouped into smokers, ex-smokers and non-smokers. Results We detected significant statistical differences in temperament related to the smoking status in this population after controlling the current use of psychiatric medication. Smokers had higher anxiety and lower control than non-smokers. Ex-smokers with BMI >50 kg/m2 presented higher coping and control characteristics than smokers. Conclusions Smoking in bariatric surgery candidates was associated with lower control and higher anxious temperament, when controlled by current use of psychiatric medication. Smokers with BMI >50 kg/m2 presented lower coping and control than ex-smokers. Assessment of temperament in bariatric surgery candidates may help in decisions about smoking cessation treatment and prevention of smoking relapse after surgery. PMID:26987115

  18. Review of contemporary role of robotics in bariatric surgery

    PubMed Central

    Bindal, Vivek; Bhatia, Parveen; Dudeja, Usha; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj; Wadhera, Sushant

    2015-01-01

    With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery. PMID:25598594

  19. Bariatric surgery in elderly patients: a systematic review

    PubMed Central

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. PMID:26508845

  20. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    PubMed

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P < 0.05). The prevalence of comorbidities was not different by surgical interest (P = 0.17). Despite the effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature. PMID:26910303

  1. Energetic adaptations persist after bariatric surgery in severely obese adolescents

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents. At baseline and at 1.5, 6, and...

  2. Prevalence and Predictors of Atrial Fibrillation among Patients Undergoing Bariatric Surgery

    PubMed Central

    Shoemaker, M. Benjamin; Gidfar, Sanaz; Pipilas, Daniel C.; Tamboli, Robyn A.; Galimberti, Eleonora Savio; Williams, D. Brandon; Clements, Ronald H.; Darbar, Dawood

    2013-01-01

    Introduction/Purpose While AF is a disease of the elderly, it can occur earlier in the presence of risk factors such as obesity. Bariatric surgery patients are significantly younger and more obese than previously described populations with AF. Therefore, it remains to be determined whether current estimates of the prevalence and predictors for AF remain true in the bariatric surgery population. Materials and Methods We performed a cross-sectional analysis of 1341 consecutive patients who underwent bariatric surgery from 1/2008 to 10/2012. Baseline characteristics were compared between patients with and without AF. For additional comparison, 176 patients with AF and body mass index (BMI) >40 kg/m2 were identified from the Vanderbilt AF Registry. A multivariable logistic regression was performed to identify predictors of AF within the bariatric surgery cohort. Results The prevalence of AF in the bariatric surgery cohort was 1.9% (25/1341). Patients with AF were older (median 56 years (Interquartile range [52-64) vs.46 [38-56] years, p<0.001), were more often male (48% vs. 23%, p=0.004), had more comorbidities, but had no difference in BMI (50 kg/m2 [44-58] vs. 48 [43-54], p=0.4). In multivariable analysis, the odds of AF increased 2.2-fold by age per decade (95% CI: 1.4-3.5, p<0.001) and 2.4-fold by male gender (1.1-5.4, p=0.03) when adjusted for BMI. BMI was not independently associated with AF (OR 1.15 [95% CI: 0.98-1.41], p=0.09). Conclusions The prevalence of AF is 1.9% among patients undergoing bariatric surgery. Risk of AF was found to increase with age and male gender, but not with higher BMI. PMID:24214203

  3. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis.

    PubMed

    Black, J A; White, B; Viner, R M; Simmons, R K

    2013-08-01

    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. PMID:23577666

  4. Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches.

    PubMed

    Mulla, Christopher M; Storino, Alessandra; Yee, Eric U; Lautz, David; Sawnhey, Mandeep S; Moser, A James; Patti, Mary-Elizabeth

    2016-04-01

    Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1-3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms. PMID:26846121

  5. Binge Eating Disorder and Medical Comorbidities in Bariatric Surgery Candidates

    PubMed Central

    Mitchell, James E.; King, Wendy C.; Pories, Walter; Wolfe, Bruce; Flum, David R.; Spaniolas, Konstatinos; Bessler, Mark; Devlin, Michael; Marcus, Marsha D.; Kalarchian, Melissa; Engel, Scott; Khandelwal, Saurobh; Yanovski, Susan

    2016-01-01

    Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from 6 clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days prior to their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal P-values (p<.05). Holm-adjusted P-values were also reported. Results After adjusting for age, sex, education and body mass index, BED status was independently associated with 4 of 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR]=1.45 (95%CI: 1.12–1.87), high triglycerides (OR=1.28 (95%CI: 1.002–1.63) and urinary incontinence (OR=1.30 (95%CI: 1.02,1.66) all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR=0.53 (95%CI: 0.29–0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with 3 comorbidities (impaired glucose levels (OR=1.36 (95%CI: 1.04–1.79), cardiovascular disease (OR=0.50 (95%CI: 0.30–0.86) and severe walking limitations (OR=0.38 (95%CI: 0.19–0.77)). However, Holm’s adjusted P-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. PMID:25778499

  6. Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA).

    PubMed

    Bays, Harold; Kothari, Shanu N; Azagury, Dan E; Morton, John M; Nguyen, Ninh T; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures generally improve dyslipidemia, sometimes substantially so. Bariatric procedures also improve other major cardiovascular risk factors. This 2-part Scientific Statement examines the lipid effects of bariatric procedures and reflects contributions from authors representing the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and the Obesity Medicine Association (OMA). Part 1 was published in the Journal of Clinical Lipidology, and reviewed the impact of bariatric procedures upon adipose tissue endocrine and immune factors, adipose tissue lipid metabolism, as well as the lipid effects of bariatric procedures relative to bile acids and intestinal microbiota. This Part 2 reviews: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies, that may occur after bariatric procedures. PMID:27050404

  7. Bariatric surgery versus medications in the treatment of type 2 diabetes.

    PubMed

    Fanin, A; Benetti, A; Ceriani, V; Pontiroli, A E

    2015-12-01

    Type 2 diabetes mellitus (T2DM) is associated with increased risk of severe comorbidities and mortality; its prevalence is increasing worldwide, linked with the increasing prevalence of obesity. Weight loss prevents the development of T2DM in obese subjects, and can reverse T2DM in morbid obesity. This paper reviews bariatric surgery as a means for prevention and treatment of T2DM and its complications, in comparison with medical treatment, and analyzes the possible mechanisms involved. In morbidly obese patients bariatric surgery results in stable weight loss and long-term reduction in incidence and prevalence of obesity-related comorbidities, especially T2DM. The efficacy of bariatric surgery in improving and normalizing glucose levels has been confirmed by a large number of studies, comparing surgery with medical therapy. When compared to each other, malabsorptive and mixed malabsorptive/restrictive surgery techniques have shown better outcomes than restrictive techniques in terms of T2DM remission. However it is demonstrated that T2DM can reappear in the following years, especially in patients with advanced age, female sex, longer duration of T2DM, poorer glycemic control, use of insulin before surgery and weight regain. Bariatric surgery is superior to conventional medical therapy in inducing significant weight loss and control of T2DM. Weight loss has pleiotropic effects: T2DM can disappear and then re-appear as a result of persistent beta-cells impairment, while other effects last much longer, as reduction of blood pressure and improvement of lipids and of kidney function. This is probably the reason for long-term prevention of cardiovascular events and of mortality in obese and in obese-diabetic patients. The effect of bariatric surgery on diabetic retinopathy is still controversial. PMID:26365477

  8. The Night Eating Syndrome (NES) in Bariatric Surgery Patients.

    PubMed

    de Zwaan, Martina; Marschollek, Michael; Allison, Kelly C

    2015-11-01

    The night eating syndrome (NES) has been included into the Diagnostic and Statistical Manual of Mental Disorders 5 as an example of an 'other-specified feeding or eating disorder'. The prevalence of NES has found to be higher in obese populations than in the general population and seems to rise with increasing body mass index. Recent studies suggest a prevalence of 2%-20% in bariatric surgery samples. Given that the core feature of this eating disorder may involve a shift in the circadian pattern of eating that disrupts sleep, and not the ingestion of objectively large amounts of food, it is a pattern that can continue after bariatric surgery. Nonetheless, symptoms of NES appear to decrease after weight loss surgery, and there is no evidence that pre-surgery NES negatively impacts weight loss following surgery. Prospective and longitudinal studies of the course of night eating symptoms are warranted using clear criteria and standardized assessment instruments. PMID:26395455

  9. Gastrointestinal Hormones and Bariatric Surgery-induced Weight Loss

    PubMed Central

    Ionut, Viorica; Burch, Miguel; Youdim, Adrienne; Bergman, Richard N.

    2015-01-01

    Obesity continues to be a major public health problem in the United States and worldwide. While recent statistics have demonstrated that obesity rates have begun to plateau, more severe classes of obesity are accelerating at a faster pace with important implications in regards to treatment. Bariatric surgery has a profound and durable effect on weight loss, being to date one of the most successful interventions for obesity. Objective To provide updates to the possible role of gut hormones in post bariatric surgery weight loss and weight loss maintenance. Design and Methods The current review examines the changes in gastro-intestinal hormones with bariatric surgery and the potential mechanisms by which these changes could result in decreased weight and adiposity. Results The mechanism by which bariatric surgery results in body weight changes is incompletely elucidated, but it clearly goes beyond caloric restriction and malabsorption. Conclusion Changes in gastro-intestinal hormones, including increases in GLP-1, PYY, and oxyntomodulin, decreases in GIP and ghrelin, or the combined action of all these hormones might play a role in induction and long-term maintenance of weight loss. PMID:23512841

  10. Bariatric surgery for obesity-associated decline in kidney function: filling the knowledge gap?

    PubMed

    Agrawal, Varun; Navaneethan, Sankar D

    2016-07-01

    Chang et al. (2016) report a significantly lower risk of decline in estimated glomerular filtration rate among obese adults who underwent bariatric surgery compared with a matched nonsurgical cohort. In this propensity-matched analysis, data on confounding variables such as albuminuria, psychosocial, and medical conditions that precluded surgery in the comparator arm and health insurance are lacking. Furthermore, creatinine-based estimated glomerular filtration rate is not an accurate measure of kidney function after intentional weight loss. Although the study is interesting, physicians need to carefully weigh the risks versus benefits of bariatric surgery among obese adults at risk of kidney disease. PMID:27312446

  11. The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

    PubMed

    Warman, Juanita L

    2005-01-01

    The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population. PMID:16041228

  12. Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery.

    PubMed

    Batterham, Rachel L; Cummings, David E

    2016-06-01

    More than 20 years ago, Pories et al. published a seminal article, "Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus." This was based on their observation that bariatric surgery rapidly normalized blood glucose levels in obese people with type 2 diabetes mellitus (T2DM), and 10 years later, almost 90% remained diabetes free. Pories et al. suggested that caloric restriction played a key role and that the relative contributions of proximal intestinal nutrient exclusion, rapid distal gut nutrient delivery, and the role of gut hormones required further investigation. These findings of T2DM improvement/remission after bariatric surgery have been widely replicated, together with the observation that bariatric surgery prevents or delays incident T2DM. Over the ensuing two decades, important glucoregulatory roles of the gastrointestinal (GI) tract have been firmly established. However, the physiological and molecular mechanisms underlying the beneficial glycemic effects of bariatric surgery remain incompletely understood. In addition to the mechanisms proposed by Pories et al., changes in bile acid metabolism, GI tract nutrient sensing and glucose utilization, incretins, possible anti-incretin(s), and the intestinal microbiome are implicated. These changes, acting through peripheral and/or central pathways, lead to reduced hepatic glucose production, increased tissue glucose uptake, improved insulin sensitivity, and enhanced β-cell function. A constellation of factors, rather than a single overarching mechanism, likely mediate postoperative glycemic improvement, with the contributing factors varying according to the surgical procedure. Thus, different bariatric/metabolic procedures provide us with experimental tools to probe GI tract physiology. Embracing this approach through the application of detailed phenotyping, genomics, metabolomics, and gut microbiome studies will enhance our understanding of

  13. Effects of Bariatric Surgery on Human Small Artery Function

    PubMed Central

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A.; Soran, Handrean; Heagerty, Anthony M.

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneous artery and perivascular fat were harvested from severely obese individuals before (n = 20) and 6 months after bariatric surgery (n = 15). Small artery contractile function was examined in vitro with wire myography, and perivascular adipose tissue (PVAT) morphology was assessed with immunohistochemistry. Results The anticontractile activity of PVAT was lost in obese patients before surgery when compared with healthy volunteers and was restored 6 months after bariatric surgery. In vitro protocols with superoxide dismutase and catalase rescued PVAT anticontractile function in tissue from obese individuals before surgery. The improvement in anticontractile function after surgery was accompanied by improvements in insulin sensitivity, serum glycemic indexes, inflammatory cytokines, adipokine profile, and systolic blood pressure together with increased PVAT adiponectin and nitric oxide bioavailability and reduced macrophage infiltration and inflammation. These changes were observed despite the patients remaining severely obese. Conclusions Bariatric surgery and its attendant improvements in weight, blood pressure, inflammation, and metabolism collectively reverse the obesity-induced alteration to PVAT anticontractile function. This reversal is attributable to reductions in local adipose inflammation and oxidative stress with improved adiponectin and nitric oxide bioavailability. PMID:23665100

  14. Resolution of Comorbidities and Impact on Longevity Following Bariatric and Metabolic Surgery.

    PubMed

    Fouse, Tammy; Brethauer, Stacy

    2016-08-01

    Bariatric surgery is the most effective and durable treatment of severe obesity. In addition to weight loss, these operations result in significant improvement or resolution of many obesity-related comorbid diseases. There are now numerous studies demonstrating that bariatric surgery decreases all-cause mortality long-term compared with cohorts of patients who did not undergo surgery. Decreases in cancer, diabetes, and cardiovascular-related mortality are major contributors to this overall effect on life expectancy after bariatric surgery. PMID:27473797

  15. [Treatment of anemia in patients undergoing bariatric surgery].

    PubMed

    Basora Macaya, M

    2015-06-01

    Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations. PMID:26320349

  16. NUTRITIONAL REPERCUSSIONS IN PATIENTS SUBMITTED TO BARIATRIC SURGERY

    PubMed Central

    SILVEIRA-JÚNIOR, Sérgio; de ALBUQUERQUE, Maurício Mendes; do NASCIMENTO, Ricardo Reis; da ROSA, Luisa Salvagni; HYGIDIO, Daniel de Andrade; ZAPELINI, Raphaela Mazon

    2015-01-01

    Background Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. Aim To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. Method A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. Results The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. Conclusions Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight. PMID:25861070

  17. Complications of bariatric surgery: Presentation and emergency management.

    PubMed

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. PMID:26808323

  18. Bariatric surgery for obese children and adolescents: a review of the moral challenges

    PubMed Central

    2013-01-01

    Background Bariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process. Discussion A wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed. Summary Performing bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents. PMID:23631445

  19. Metabolic Effects of Bariatric Surgery in Mouse Models of Circadian Disruption

    PubMed Central

    Arble, Deanna M.; Sandoval, Darleen A.; Turek, Fred W.; Woods, Stephen C.; Seeley, Randy J.

    2015-01-01

    Background/Objectives Mounting evidence supports a link between circadian disruption and metabolic disease. Humans with circadian disruption (e.g., night-shift workers) have an increased risk of obesity and cardiometabolic diseases compared to the non-disrupted population. However, it is unclear if the obesity and obesity-related disorders associated with circadian disruption respond to therapeutic treatments as well as individuals with other types of obesity. Subjects/Methods Here, we test the effectiveness of the commonly used bariatric surgical procedure, Vertical Sleeve Gastrectomy (VSG) in mouse models of genetic and environmental circadian disruption. Results VSG led to a reduction in body weight and fat mass in both ClockΔ19 mutant and constant-light mouse models (P < .05), resulting in an overall metabolic improvement independent of circadian disruption. Interestingly, the decrease in body weight occurred without altering diurnal feeding or activity patterns (P > .05). Within circadian-disrupted models, VSG also led to improved glucose tolerance and lipid handling (P < .05). Conclusions Together these data demonstrate that VSG is an effective treatment for the obesity associated with circadian disruption, and that the potent effects of bariatric surgery are orthogonal to circadian biology. However, since the effects of bariatric surgery are independent of circadian disruption, VSG cannot be considered a cure for circadian disruption. These data have important implications for circadian-disrupted obese patients. Moreover, these results reveal new information about the metabolic pathways governing the effects of bariatric surgery as well as of circadian disruption. PMID:25869599

  20. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study.

    PubMed

    Elbanna, Abduh; Eldin, Mohammed Tag; Fathy, Mohammad; Osman, Osama; Abdelfattah, Mohammed; Safwat, Abdelrahman; Elkader, Mohammed Sedki Abd; Bilasy, Shymaa E; Salama, Khaled; Elnour, Asim A; Shehab, Abdullah; Baghdady, Shazly; Amer, Mohamed; Alboraie, Mohamed; Ragb, Aly; Abd Elrazek, Abd Elrazek

    2015-12-01

    Children obesity has become one of the most important public health problems in many countries worldwide. Although the awareness of childhood obesity as a modifiable health risk is high, but many societies do not prioritize this issue as a health care problem, which may lead to comorbidities and even premature death. Despite the rising interest in bariatric surgery for children, only laparoscopic sleeve gastrectomy (LSG) is being considered in resolving childhood obesity who failed other dietary or drug therapies; however many of LSG procedures failed to reduce the weight in children or resulted in complications postsurgery.Here, we present a novel bariatric procedure to clue out a female child 13 years old presented with Legg-Calvé-Perthes disease-associated morbid obesity. The surgical bariatric technique applied both fundal resection and surgical bypass in pediatric obesity using the Elbanna novel bariatric technique.Bariatric surgical bypass may be considered in complicated-childhood cases who failed all other options. PMID:26656361

  1. Weighing in on bariatric surgery: who and when?

    PubMed Central

    Lodhia, N A; Morton, J M

    2012-01-01

    Over two-thirds of the United States is overweight or obese, and over 5% of the country is morbidly obese. Numerous public health preventative measures have been established to help battle this public health epidemic. Surgical obesity treatment, although now gaining popularity, has been an underutilized treatment option for obesity. Patients with a body mass index (BMI) of >40 or >35 kg m−2 with two or more comorbid conditions are eligible for bariatric surgery. Currently, the three most popular bariatric surgeries are Roux-en-y gastric bypass, sleeve gastrectomy and gastric banding procedures, all overwhelmingly performed laparoscopically. The purpose of this article is to discuss the heterogeneity of bariatric surgery. In our practice, among 834 patients operated over a 4-year period (2006–2010), patients were of an average age of 45 years (16–73 years), 80.4% were female patients, 82.5% had private insurance, 61% were White, 17% were Hispanic and 9% were Black. Patients had an average BMI of 46.2 kg m−2 (30.1–75.3 kg m−2), waist circumference of 133.6 cm (68.6–207.8 cm) and four preoperative comorbidities (0–11 comorbidities). Variation exists in surgeon practice patterns for preoperative weight-loss recommendations and complication rates based on surgery case volume. Despite variation in patient, surgeon and hospital characteristics, bariatric surgery outcomes are generally highly safe and effective. PMID:25018871

  2. Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases?

    PubMed

    Cañas, Carlos A; Echeverri, Andrés F; Ospina, Fabio E; Suso, Juan-Pablo; Agualimpia, Andrés; Echeverri, Alex; Bonilla-Abadía, Fabio; Tobón, Gabriel J

    2016-03-01

    Bariatric procedures are an effective option for weight loss and control of comorbidities in obese patients. Obesity is a proinflammatory condition in which some cytokines such as leptin, a proinflammatory protein, is elevated and adiponectin, an anti-inflammatory protein, is decreased. In patients undergoing weight reduction surgeries, these hormone levels behave paradoxically. It is not known whether bariatric surgery protects against development of autoinflammatory or autoimmune conditions; nevertheless, changes occurring in the immune system are incompletely understood. In this case series, we describe 4 patients undergoing bariatric surgery, who subsequently developed systemic autoimmune diseases. Patients in our case series were asymptomatic before surgery and developed an autoimmune disease within 11.2 months. Two women fulfilled criteria for systemic lupus erythematosus (one associated with antiphospholipid syndrome), and 2 men developed rheumatoid arthritis. A causal relationship is difficult to establish because factors that could trigger these diseases are multiple, including genetic susceptibility, time elapsed until achievement of ideal weight, and vitamin deficiencies, among others. However, clinicians must be attentive to this possible association. PMID:26906303

  3. Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?

    PubMed

    Ma, Pearl; Reddy, Subhash; Higa, Kelvin D

    2016-07-01

    Bariatric/metabolic surgery is currently the only effective long-term treatment for morbid obesity- and obesity-related diseases such as diabetes, heart disease, hypertension, obstructive sleep apnea, and dyslipidemia. In addition, bariatric/metabolic surgery has been shown to significantly reduce the incidence of diabetes and cancer and prolong life when compared to non-surgical therapies. However, as obesity is a chronic disease, recidivism of weight and comorbid conditions can occur. In addition, the surgical construct can lead to long-term consequences such as marginal ulceration, bowel obstruction, reflux, and nutritional deficiencies. Despite these drawbacks, prospective randomized controlled studies and long-term longitudinal population-based comparative studies greatly favor surgical intervention as opposed to traditional lifestyle, diet, and exercise programs. Revisional surgery can be quite complex and technically challenging and may offer the patient a wide variety of solutions for treatment of weight recidivism and complications after primary operations. Given the paucity of high quality published data, we have endeavored to provide indications for revisions after bariatric surgery. PMID:27221504

  4. Economic considerations for bariatric surgery and morbid obesity

    PubMed Central

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  5. Economic considerations for bariatric surgery and morbid obesity.

    PubMed

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  6. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    PubMed

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. PMID:22420449

  7. STAMPEDE: Bariatric surgery gains more evidence based support

    PubMed Central

    Al Suwaidi, Jassim

    2014-01-01

    Diabetes mellitus (DM) and obesity are associated with significant morbidity and mortality. Recent large-scale trials of intensive medical management for obesity and diabetes have been disappointing. Observational studies and small-scale trials of bariatric surgery on DM patients have shown promising results. The effects of sleeve gastrectomy and gastric bypass in a larger cohort of patients with DM and obesity was tested in the STAMPEDE trial over a 3-year follow-up. PMID:25054119

  8. Vitamin, Mineral, and Drug Absorption Following Bariatric Surgery

    PubMed Central

    Sawaya, Ronald Andari; Jaffe, Jane; Friedenberg, Lindsay; Friedenberg, Frank K.

    2013-01-01

    The prevalence of obesity continues to rise throughout the world. Increasingly, bariatric surgery is used for those with morbid obesity as a pivotal approach to achieve weight loss. Along with substantial weight loss, malabsorption of essential vitamins, minerals, and drugs also occurs. Therefore, more than ever, a better understanding of the physiology and mechanisms by which these deficiencies occur is essential. We review the normal physiology of vitamin, mineral, and drug absorption. This is followed by a description of currently performed bariatric surgeries in the United States. A detailed review of specific nutrient and mineral deficiency states is presented, based on the most significant studies published in the last two decades. Of note, screening and supplementation recommendations have been included. Drug absorption data after these procedures is presented and discussed. Studies were identified by searching the Cochrane Registry and MEDLINE using relevant search terms, as well as through review of the reference section of included manuscripts. Conclusions Bariatric surgery can be effectively used to achieve sustainable weight-loss in morbidly obese patients. It simultaneously brings forth important functional consequences on nutrient deficiencies and drug absorption that clinician’s must be aware of. Further prospective, randomized research on specific procedures and deficiencies is required. PMID:22746302

  9. Retraction Note: Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis.

    PubMed

    Yang, Xiang-Wu; Li, Peng-Zhou; Zhu, Li-Yong; Zhu, Shaihong

    2016-01-01

    In the article entitled, "Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis" which was published in Medical Science Monitor 2015;21: 1350-1357, sections in the text have been directly copied from a previously published article, entitled, "The Effects of Bariatric Surgery on Colorectal Cancer Risk: Systematic Review and Meta-Analysis", Sorena Afshar, Seamus B. Kelly, Keith Seymour, Jose Lara, Sean Woodcock, John C. Mathers  in Obesity Surgery 2014; 24(10):1793-1799. Thus owing to duplicity of text, the article is being retracted. Reference: 1. Xiang-wu Yang, Peng-zhou Li, Li-yong Zhu, Shaihong Zhu Effects of Bariatric Surgery on Incidence of Obesity-Related Cancers: A Meta-Analysis Medical Science Monitor 2015;21: 1350-1357 DOI: 10.12659/MSM.893553. PMID:27215479

  10. Through Thick and Thin: Identifying Barriers to Bariatric Surgery, Weight Loss Maintenance, and Tailoring Obesity Treatment for the Future

    PubMed Central

    Westerveld, Donevan; Yang, Dennis

    2016-01-01

    More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity. PMID:27314062

  11. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study.

    PubMed

    Proczko, Monika; Kaska, Lukasz; Twardowski, Pawel; Stepaniak, Pieter

    2016-02-01

    While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change. PMID:26499320

  12. Genetic modifiers of obesity and bariatric surgery outcomes.

    PubMed

    Sevilla, Samantha; Hubal, Monica J

    2014-02-01

    Obesity is a highly heritable trait. While acute and chronic changes in body weight or obesity-related comorbidities are heavily influenced by environmental factors, there are still strong genomic modifiers that help account for inter-subject variability in baseline traits and in response to interventions. This review is intended to provide an up-to-date overview of our current understanding of genetic influences on obesity, with emphasis on genetic modifiers of baseline traits and responses to intervention. We begin by reviewing how genetic variants can influence obesity. We then examine genetic modifiers of weight loss via different intervention strategies, focusing on known and potential modifiers of surgical weight loss outcomes. We will pay particular attention to the effects of patient age on outcomes, addressing the risks and benefits of adopting early intervention strategies. Finally, we will discuss how the field of bariatric surgery can leverage knowledge of genetic modifiers to adopt a personalized medicine approach for optimal outcomes across this widespread and diverse patient population. PMID:24491368

  13. Chronic Dieting Among Extremely Obese Bariatric Surgery Candidates

    PubMed Central

    Masheb, Robin M.; White, Marney A.; Rothschild, Bruce S.; Burke-Martindale, Carolyn H.; Grilo, Carlos M.

    2013-01-01

    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. PMID:19495894

  14. Impact of commissioning weight-loss surgery for bariatric patients.

    PubMed

    Petty, Natasha

    Obesity is a major UK public health issue that is increasingly costly to an individual's personal health, the NHS and society. It requires an immediate intervention, as well as a long-term strategy to decrease the rising rates of obesity. NHS England (2013) has published a policy to commission bariatric surgery for carefully selected individuals according to National Institute for Health and Care Excellence (NICE) guidelines (NICE, 2006). This has been shown to be a clinically and cost effective weight-loss treatment option (Picot et al, 2009), but is invasive and expensive compared with non-surgical weight-loss programmes. In addition, there remains inequality in access to bariatric care services across England, thereby preventing potentially eligible patients from getting the treatment they need. Further clarity is required regarding the commissioning responsibilities across the four tiers of the obesity care services. This clarity would help to achieve a more 'joined-up' clinical pathway that is focused at a local level to improve access. However, there is criticism that too much funding is currently being invested in the provision of bariatric surgery when it could be better spent on national roll-out programmes for intensive lifestyle interventions that promote more sustainable weight loss across England. PMID:26266444

  15. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy

    PubMed Central

    Kumari, Archana

    2015-01-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient’s status and the type of bariatric surgery performed. PMID:26672514

  16. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy.

    PubMed

    Kumari, Archana; Nigam, Aruna

    2015-11-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514

  17. Patient Expectations of Bariatric and Body Contouring Surgery

    PubMed Central

    Klassen, Anne; Jhanwar, Sabrina; Pusic, Andrea; Roessler, Kirsten K.; Rose, Michael; Sørensen, Jens Ahm

    2016-01-01

    Background: Patient expectations are important in bariatric and body contouring surgery because the goals include improvements in health-related quality of life, appearance, and body image. The aim of this study was to identify patient expectations along the weight loss journey and/or body contouring surgery. Methods: This qualitative study took an interpretive description approach. Between September 2009 and February 2012, 49 patients were interviewed postbody contouring surgery. Data were analyzed using a line-by-line approach whereby expectations were identified and labeled as expected, unexpected, or neutral. Constant comparison was used to ensure coding was done consistently. Interviews continued until no new themes emerged. Results: Participants described expectations according to appearance, health-related quality of life, and patient experience of care. Two areas stood out in terms of unmet expectations and included appearance and physical health, ie, recovery from body contouring surgery. Most participants, who underwent bariatric surgery, expected neither the extent of excess skin after weight loss nor how the excess skin would make them look and feel. For recovery, participants did not expect that it would be as long or as hard as it was in reality. Conclusions: A full understanding of outcomes and expectations for this patient population is needed to enhance patient education and improve shared medical decision making. Education materials should be informed by the collection of evidence-based patient-reported outcome information using measures such as the BODY-Q. A patient-reported outcome scale measuring patient expectations is needed for obese and bariatric patients. PMID:27200256

  18. Bariatric surgery: an IDF statement for obese Type 2 diabetes

    PubMed Central

    Dixon, J B; Zimmet, P; Alberti, K G; Rubino, F

    2011-01-01

    The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m2 or more. PMID:21480973

  19. Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis.

    PubMed

    Kaw, Roop; Pasupuleti, Vinay; Wayne Overby, D; Deshpande, Abhishek; Coleman, Craig I; Ioannidis, John P A; Hernandez, Adrian V

    2014-01-01

    Background: Pulmonary embolism(PE)accounts for almost 40% of perioperative deaths after bariatric surgery.Placement of prophylactic inferior vena cava(IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate post- operative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28,2013.Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis(DVT),pulmonary embolism (PE),and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity,and Sidik- Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks(RR) and 95% Confidence Intervals(CI). Results: Seven observational studies were identified (n=102,767), with weighted average inci- dences of DVT(0.9%),PE(1.6%),and mortality(1.0%)for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR2.81,95%CI 1.33-5.97, p=0.007; and RR 3.27,95%CI0.78-13.64, p=0.1, respectively);there was no difference in the risk of PE(RR1.02,95%CI0.31-3.77,p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery Is associated with higher risk of postoperative DVT and mortality. A similar risk of PE inpatients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline.Ran- domized trials are needed before IVC placement can be recommended. (SurgObesRelatDis 2015;11:268-269.) r 2015 American Society for Metabolic and

  20. Bariatric Surgery for People with Diabetes and Morbid Obesity

    PubMed Central

    2009-01-01

    Executive Summary In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry’s newly released Diabetes Strategy. After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report. To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/masabout.html, Diabetes Strategy Evidence Platform: Summary of Evidence-Based Analyses Continuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based Analysis Behavioural Interventions for Type 2 Diabetes: An Evidence-Based Analysis Bariatric Surgery for People with Diabetes and Morbid Obesity: An Evidence-Based Summary Community-Based Care for the Management of Type 2 Diabetes: An Evidence-Based Analysis Home Telemonitoring for Type 2 Diabetes: An Evidence-Based Analysis Application of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario Objective The purpose of this evidence-based analysis was to examine the effectiveness and cost-effectiveness of bariatric surgery for the management of diabetes in morbidly obese people. This report summarized evidence specific

  1. Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid.

    PubMed

    Soares, Fernando Lucas; Bissoni de Sousa, Larissa; Corradi-Perini, Carla; Ramos da Cruz, Magda Rosa; Nunes, Mario Gilberto Jesus; Branco-Filho, Alcides José

    2014-09-01

    Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies. PMID:24500225

  2. The influence of methods of bariatric surgery for treatment of type 2 diabetes mellitus

    PubMed Central

    Bužga, Marek; Maresova, Petra; Seidlerova, Adela; Zonča, Pavel; Holéczy, Pavol; Kuča, Kamil

    2016-01-01

    The constantly growing incidence of obesity represents a risk of health complications for individuals, and is a growing economic burden for health care systems and society. The aim of this study was to evaluate the efficacy of bariatric surgery, specifically laparoscopic greater curve plication, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, in patients with type 2 diabetes mellitus. The effect of bariatric surgery on the changes in blood pressure before, and 12 months after, surgery and in pharmacotherapy in the 12 months after surgery was analyzed. For achieving this purpose, 74 patients from the Obesity and Surgery Department of Vitkovice Hospital in Ostrava in the Czech Republic, were monitored. They were operated in 2011 and 2012. The Bonferroni method was used to test hypotheses about the impact of surgery on blood pressure and pharmacotherapy. One year after the surgery, systolic and diastolic blood pressure values decreased, both with no statistically significant difference between surgery types. Improvement was observed in 68% of cases, with 25% of patients discontinuing pharmacotherapy entirely. PMID:27143901

  3. Actual Situation of Thromboembolic Prophylaxis in Obesity Surgery: Data of Quality Assurance in Bariatric Surgery in Germany

    PubMed Central

    Stroh, Christine; Luderer, D.; Weiner, R.; Horbach, T.; Ludwig, K.; Benedix, F.; Wolff, Stefanie; Knoll, C.; Lippert, H.; Manger, T.

    2012-01-01

    Background. Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk. Methods. Since 2005 the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up. Results. Overall, 11,835 bariatric procedures were performed between January 2005 and December 2010. Most performed procedures were 2730 gastric banding (GB); 4901 Roux-en-Y-gastric bypass (RYGBP) procedures, and 3026 sleeve gastrectomies (SG). Study collective includes 72.5% (mean BMI 48.1 kg/m2) female and 27.5% (mean BMI 50.5 kg/m2) male patients. Incidence of VTE was 0.06% and of PE 0.08%. Conclusion. VTE prophylaxis regimen depends on BMI and the type of procedure. Despite the low incidence of VTE and PE there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients. PMID:22848807

  4. Baropodometric analyses of patients before and after bariatric surgery

    PubMed Central

    Bacha, Ivan Leo; Benetti, Fernanda Antico; Greve, Júlia Maria D'Andréa

    2015-01-01

    OBJECTIVE: The aim of this study was to evaluate the vertical component of the ground reaction force, plantar pressure, contact area of the feet and double-support time using static and dynamic (gait) baropodometry before and after bariatric surgery. METHODS: Sixteen individuals with a body mass index of between 35 and 55 were evaluated before and after bariatric surgery. Thirteen patients (81.3%) were female and three (18.8%) male and their average age was 46±10 (21-60) years. An FSCAN system (version 3848) was used for baropodometric analyses (1 km/h and 3 km/h). The peak plantar pressure and ground reaction force were measured for the rear foot and forefoot. The double-support time and foot contact area were measured during gait. RESULTS: There were reductions in the ground reaction force in the forefoot and rear foot and in the foot contact area in all evaluations and of the double-support time at 3 km/h, as well as a significant reduction in the body mass index at six months post-surgery. The peak pressure did not vary at 1 km/h and at 3 km/h, reductions in peak pressure were observed in the left and right rear feet and left forefoot. CONCLUSIONS: Weight loss after bariatric surgery resulted in decreases in the ground reaction force and contact area of the foot. Plantar pressure was decreased at 3 km/h, especially in the forefoot. There was an increase in rhythm because of a reduction in the double-support time at 3 km/h. PMID:26602521

  5. The Importance of Pre and Postoperative Physical Activity Counseling in Bariatric Surgery

    PubMed Central

    King, Wendy C; Bond, Dale S

    2012-01-01

    There is increasing evidence that physical activity (PA) can enhance weight loss and other outcomes after bariatric surgery. However, most preoperative patients are insufficiently active, and without support, fail to make substantial increases in their PA postoperatively. This review provides the rationale for PA counseling in bariatric surgery and describes how to appropriately tailor strategies to pre- and postoperative patients. PMID:22710705

  6. Confirmatory Factor Analysis of the Beck Depression Inventory-II in Bariatric Surgery Candidates

    ERIC Educational Resources Information Center

    Hall, Brian J.; Hood, Megan M.; Nackers, Lisa M.; Azarbad, Leila; Ivan, Iulia; Corsica, Joyce

    2013-01-01

    Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples,…

  7. Total Knee Arthroplasty in Morbidly Obese Patients Treated with Bariatric Surgery: A Comparative Study

    PubMed Central

    Severson, Erik P.; Singh, Jasvinder A.; Browne, James A.; Trousdale, Robert T.; Sarr, Michael; Lewallen, David G.

    2012-01-01

    Our objective was to compare outcomes (anesthesia time, total operative time, tourniquet time, duration of hospital stay, 90-day complication rate and transfusion rates) of patients with total knee arthroplasty (TKA) who underwent bariatric surgery before or after TKA. One-hundred-twenty-five patients were included: TKA before bariatric surgery (group 1; n=39); TKA within two years of bariatric surgery (group 2; n=25); and TKA more than 2 years after bariatric surgery (group 3; n=61). Patients with TKA more than 2 years after bariatric surgery had shorter anesthesia, total operative and tourniquet times than other groups; differences were significant between groups. Ninety-day complication and transfusion rates approached but did not meet statistical significance. Ninety-day complication rates and duration of hospital stay did not differ significantly between the three groups. PMID:22554730

  8. Family history of Alzheimer’s disease limits improvement in cognitive function after bariatric surgery

    PubMed Central

    Alosco, Michael L; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Crosby, Ross D; Mitchell, James E

    2014-01-01

    Background/Objective: Bariatric surgery can reverse cognitive impairments associated with obesity. However, such benefits may be attenuated in individuals with a predisposing risk for cognitive impairment such as family history of Alzheimer’s disease. Methods: In all, 94 bariatric surgery participants completed a computerized cognitive test battery before and 12 weeks after surgery. Family history of Alzheimer’s disease was obtained through self-report. Results: In the overall sample, cognitive function improved in memory and attention/executive function 12 weeks post-surgery. Repeated measures showed similar rates of improvements in attention/executive function between patients with and without a family history of Alzheimer’s disease. In contrast, only individuals without a family history of Alzheimer’s disease exhibited post-operative improvements in memory. A family history of Alzheimer’s disease was associated with greater post-surgery rates of cognitive impairment. Conclusions: Family history of Alzheimer’s disease may limit post-surgery cognitive benefits. Future studies should examine whether weight loss can modify the course of cognitive decline in patients at-risk for Alzheimer’s disease. PMID:26770731

  9. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    PubMed

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes. PMID:26328531

  10. Wishing for deburdening through a sustainable control after bariatric surgery

    PubMed Central

    Engström, My; Forsberg, Anna

    2011-01-01

    The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants' relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome. PMID:21339891

  11. [Dealing with surgical complications after bariatric gastric bypass surgery].

    PubMed

    Schlesinger, Nis Hallundbæk; Naver, Lars

    2013-11-25

    The subject of this article is surgical complications to Roux-en-Y-gastric bypass and how to deal with them. The article addresses doctors, who are on duty in hospitals without bariatric surgery and who often deal with this patient category in the acute situation. Managing complications is challenging due to both the patient's physiognomy and the wide-ranged change in anatomy. The article gives a review of the literature and hands-on-recommendations for treating anastomotic leak, post-operative bleeding, internal herniation, bowel obstruction and biliary complications. PMID:24629437

  12. Lithium toxicity after Roux-en-Y bariatric surgery.

    PubMed

    Musfeldt, Deanna; Levinson, Andrew; Nykiel, Jennifer; Carino, Gerardo

    2016-01-01

    A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day. She was discharged 8 days postoperatively on the same lithium dose, but presented to the emergency department 12 days postoperatively with signs of lithium toxicity. Her lithium level was elevated to 1.51 mEq/L and she was treated for lithium toxicity with supportive care and, ultimately, reduction of her lithium dose. Clinicians should be aware that dramatic and poorly understood changes in drug absorption may occur after bariatric surgery. PMID:26994048

  13. An Untargeted Metabolomics Approach to Characterize Short-Term and Long-Term Metabolic Changes after Bariatric Surgery.

    PubMed

    Narath, Sophie H; Mautner, Selma I; Svehlikova, Eva; Schultes, Bernd; Pieber, Thomas R; Sinner, Frank M; Gander, Edgar; Libiseller, Gunnar; Schimek, Michael G; Sourij, Harald; Magnes, Christoph

    2016-01-01

    Bariatric surgery is currently one of the most effective treatments for obesity and leads to significant weight reduction, improved cardiovascular risk factors and overall survival in treated patients. To date, most studies focused on short-term effects of bariatric surgery on the metabolic profile and found high variation in the individual responses to surgery. The aim of this study was to identify relevant metabolic changes not only shortly after bariatric surgery (Roux-en-Y gastric bypass) but also up to one year after the intervention by using untargeted metabolomics. 132 serum samples taken from 44 patients before surgery, after hospital discharge (1-3 weeks after surgery) and at a 1-year follow-up during a prospective study (NCT01271062) performed at two study centers (Austria and Switzerland). The samples included 24 patients with type 2 diabetes at baseline, thereof 9 with diabetes remission after one year. The samples were analyzed by using liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS, HILIC-QExactive). Raw data was processed with XCMS and drift-corrected through quantile regression based on quality controls. 177 relevant metabolic features were selected through Random Forests and univariate testing and 36 metabolites were identified. Identified metabolites included trimethylamine-N-oxide, alanine, phenylalanine and indoxyl-sulfate which are known markers for cardiovascular risk. In addition we found a significant decrease in alanine after one year in the group of patients with diabetes remission relative to non-remission. Our analysis highlights the importance of assessing multiple points in time in subjects undergoing bariatric surgery to enable the identification of biomarkers for treatment response, cardiovascular benefit and diabetes remission. Key-findings include different trend pattern over time for various metabolites and demonstrated that short term changes should not necessarily be used to identify important long

  14. [Is the morbid obesity surgery profitable in times of crisis? A cost-benefit analysis of bariatric surgery].

    PubMed

    Sánchez-Santos, Raquel; Sabench Pereferrer, Fátima; Estévez Fernandez, Sergio; del Castillo Dejardin, Daniel; Vilarrasa, Nuria; Frutos Bernal, Dolores; Ruiz de Adana, Juan Carlos; Masdevall Noguera, Carlos; Torres García, Antonio

    2013-10-01

    Morbid obesity is a serious health problem whose prevalence is increasing. Expensive co-morbidities are associated to these patients, as well as a reduction in the survival. Bariatric surgery resolves the co-morbidities (type 2 diabetes mellitus, 86.6%; cardiovascular risk, 79.0%; obstructive sleep apnea syndrome, 83.6%; hypertension, 61.7%), reduces the mortality rate (among 31-40%), and increases the morbid obese patients survival over a 10-years period. It provides significant savings for the National Health System. The obese patients consume a 20% plus of health resources and 68% plus of drugs than general population. Bariatric surgery requires an initial investment (diagnosis-related group cost: 7,468 €), but it is recovered in a cost-effectiveness ratio of 2.5 years. Significant savings are obtained from the third year. To the direct economic benefits associated with reduced health expenditures it should be added an increase in tax collection (sick leave and unemployment reduction is estimated in 18%, with a productivity increase of 57% for self-employed people). Bariatric surgery is one of the most cost-effective procedures in the healthcare system. PMID:23628503

  15. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    PubMed Central

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    hypertension, with a HR of 5.64 (95% CI 2.65–11.99). No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66–1.43). The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes. Conclusions Bariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese. PMID:26694640

  16. Adiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease?

    PubMed Central

    Bays, H E; Laferrère, B; Dixon, J; Aronne, L; González-Campoy, J M; Apovian, C; Wolfe, B M

    2009-01-01

    Objective: To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or ‘sick fat’), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia. Methods: A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery. Results: Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion. Conclusions: In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease. PMID:19691612

  17. IMPACT OF DEFICIENT NUTRITION IN BONE MASS AFTER BARIATRIC SURGERY

    PubMed Central

    COSTA, Tatiana Munhoz da Rocha Lemos; PAGANOTO, Mariana; RADOMINSKI, Rosana Bento; BORBA, Victoria Zeghbi Cochenski

    2016-01-01

    Background: Essential nutrients are considered for the prevention of the bone loss that occurs after bariatric surgery. Aim: Evaluate nutrients involved in bone metabolism, and relate to serum concentrations of calcium, vitamin D, and parathyroid hormone, and the use of supplements and sun exposure on the bone mass of patients who had undergone gastric bypass surgery. Methods: An observational study, with patients who had undergone the surgery 12 or more months previously, operated group (OG), compared to a control group (CG). Results: Were included 56 in OG and 27 in the CG. The mean age was 36.4±8.5 years. The individuals in the OG, compared to CG, consumed inadequate amounts of protein and daily calcium. The OG had a higher prevalence of low sun exposure, lower levels of 25OH Vitamin D (21.3±10.9 vs. 32.1±11.8 ng/dl), and increased serum levels of parathyroid hormone (68.1±32.9 vs. 39.9±11.9 pg/ml, p<0.001). Secondary hyperparathyroidism was present only in the OG (41.7%). The mean lumbar spine bone mineral density was lower in the OG. Four individuals from the OG had low bone mineral density for chronological age, and no one from the CG. Conclusion: The dietary components that affect bone mass in patients undergoing bariatric surgery were inadequate. The supplementation was insufficient and the sun exposure was low. These changes were accompanied by secondary hyperparathyroidism and a high prevalence of low bone mass in lumbar spine in these subjects. PMID:27120738

  18. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery.

    PubMed

    Yamamoto, Hiroshi; Kaida, Sachiko; Yamaguchi, Tsuyoshi; Murata, Satoshi; Tani, Masaji; Tani, Tohru

    2016-03-01

    Conservative medical treatment for morbid obesity generally fails to sustain weight loss. On the other hand, surgical operations, so-called bariatric surgery, have evolved due to their long-term effects. The global increase in the overweight population and the introduction of laparoscopic surgery have resulted in the use of bariatric surgery spreading quickly worldwide in recent years. Recent clinical evidence suggests that bariatric surgery not only reduces body weight, but also improves secondary serious diseases, including type 2 diabetes mellitus, in so-called metabolic surgery. Moreover, several potential mechanisms mediating the improvement in glycemic control after bariatric/metabolic surgery have been proposed based on the animal and human studies. These mechanisms include changes in the levels of gastrointestinal hormones, bacterial flora, bile acids, intestinal gluconeogenesis and gastrointestinal motility as well as adipose tissue and inflammatory mediators after surgery. The mechanisms underlying improved glycemic control are expected to accelerate the promotion of both metabolic and bariatric surgery. This article describes the current status of bariatric surgery worldwide and in Japan, reviews the accumulated data for weight loss and diabetic improvements after surgery and discusses the potential mechanisms mediating improved glycemic control. PMID:25700844

  19. The Use of Rat and Mouse Models in Bariatric Surgery Experiments

    PubMed Central

    Lutz, Thomas A.; Bueter, Marco

    2016-01-01

    Animal models have been proven to be a crucial tool for investigating the physiological mechanisms underlying bariatric surgery in general and individual techniques in particular. By using a translational approach, most of these studies have been performed in rodents and have helped to understand how bariatric surgery may or may not work. However, data from studies using animal models should always be critically evaluated for their transferability to the human physiology. It is, therefore, the aim of this review to summarize both advantages and limitations of data generated by animal based experiments designed to investigate and understand the physiological mechanisms at the root of bariatric surgery. PMID:27547753

  20. School and Cognitive Functioning Problems in Adolescent Bariatric Surgery Candidates

    PubMed Central

    Freidl, Eve Khlyavich; Sysko, Robyn; Devlin, Michael J.; Zitsman, Jeffrey L.; Kaplan, Simona C.; Timothy Walsh, B.

    2013-01-01

    Background Prior studies have found that students with overweight and obesity have impairments in performance IQ and executive function, and worse school functioning in comparison to normal weight peers. Objectives The current study assessed school and cognitive functioning in a sample of adolescents with severe obesity being evaluated for laparoscopic adjustable gastric banding. Setting: Psychiatry Department, University Medical Center, United States. Methods Eligible candidates for bariatric surgery were referred for psychiatric evaluation which included a semi-structured clinical interview measuring school functioning and the vocabulary and matrix reasoning subtests of the Wechsler Abbreviated Scale of Intelligence (WASI). Results Self-reported school problems were common, with 55.5% of adolescents failing a grade or subject, 38.7% attending summer school, and 17.8% failing a citywide exam. A significant relationship was observed between body mass index (BMI),estimated WASI IQ(r= −0.250, p=0.005), and the vocabulary subtest (r= −0.241, p=0.006), but not matrix reasoning (r= −0.126, p=NS). Conclusions Even among a sample of adolescents with severe obesity, increased BMI was associated with lower WASI IQ and vocabulary subtest scores. Increasing awareness of potential cognitive and school problems in bariatric candidates among teachers, school counselors, and other mental health providers is an important first step to improving academic support and educational systems deficiencies for students with overweight and obesity. PMID:23932993

  1. Effect of Weight Loss, Diet, Exercise, and Bariatric Surgery on Nonalcoholic Fatty Liver Disease.

    PubMed

    Hannah, William N; Harrison, Stephen A

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. NAFLD is the most common liver disease in developed countries. Weight reduction of 3% to 5% is associated with improved steatosis; reductions of 5% to 7% are necessary for decreased inflammation; with 7% to 10%, individuals may experience NAFLD/NASH remission and regression of fibrosis. No specific dietary intervention has proven beneficial beyond calorie restriction. Physical activity without weight loss seems to decrease hepatic steatosis. Bariatric surgery is associated with decreased cardiovascular risk and improved overall mortality in addition to reduction in hepatic steatosis, inflammation, and fibrosis. PMID:27063273

  2. Mandatory weight loss during the wait for bariatric surgery.

    PubMed

    Glenn, Nicole M; Raine, Kim D; Spence, John C

    2015-01-01

    Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies. PMID:25185162

  3. Nutritional Optic Neuropathy Caused by Copper Deficiency After Bariatric Surgery.

    PubMed

    Rapoport, Yuna; Lavin, Patrick J M

    2016-06-01

    A 47-year-old woman developed severe bilateral visual loss 4 years after a Roux-en-Y gastric bypass and 24 years after vertical banded gastroplasty. Her serum copper level was 35 μg/dL (normal, 80-155 μg/dL). She was prescribed elemental copper tablets. Because her methylmalonic acid was slightly elevated, she received vitamin B12 injections as well. Five weeks later, she reported that her vision had improved and, at 10 months, her vision had recovered from 20/400 bilaterally to 20/25 in each eye. This case highlights the importance of checking copper levels in addition to the "more routine" vitamin levels, such as B1, B6, B12, E, and serum folate in patients with suspected nutritional optic neuropathy after bariatric surgery, particularly if it involved a bypass procedure. PMID:26828841

  4. Appetite and body weight regulation after bariatric surgery

    PubMed Central

    Münzberg, Heike; Laque, Amanda; Yu, Sangho; Rezai-Zadeh, Kavon; Berthoud, Hans-Rudolf

    2016-01-01

    Bariatric surgery continues to be remarkably efficient in treating obesity and T2DM and a debate has started whether it should remain the last resort only or also be used for the prevention of metabolic diseases. Intense research efforts in humans and rodent models are underway to identify the critical mechanisms underlying the beneficial effects with a view towards non-surgical treatment options. This non-systematic review summarizes and interprets some of this literature, with an emphasis on changes in the controls of appetite. Contrary to earlier views, surgery-induced reduction of energy intake and subsequent weight loss appear to be the main drivers for rapid improvements of glycemic control. The mechanisms responsible for suppression of appetite, particularly in the face of the large weight loss, are not well understood. Although a number of changes in food choice, taste functions, hedonic evaluation, motivation, and self-control have been documented in both humans and rodents after surgery, their importance and relative contribution to diminished appetite has not yet been demonstrated. Furthermore, none of the major candidate mechanisms postulated in mediating surgery induced changes from the gut and other organs to the brain, such as gut hormones and sensory neuronal pathways, have been confirmed yet. Future research efforts should focus on interventional rather than descriptive approaches in both humans and rodent models. PMID:25614206

  5. PS3-54: Effect of Bariatric Surgery on Chronic Use of Opioid Medications

    PubMed Central

    Raebel, Marsha; Newcomer, Sophia; Boudreau, Denise; Elliott, Thomas; Debar, Lynn; Ahmed, Ameena; Bayliss, Elizabeth

    2013-01-01

    Background/Aims Opioids are used to manage chronic painful conditions associated with obesity. It is unknown whether weight loss attained after bariatric surgery results in a change in chronic opioid use and if so, over what timeframe. We explored the effect of bariatric surgery and associated weight loss on chronic opioid use. Methods This retrospective cohort study included patients from ten Scalable Partnering Network for Comparative Effectiveness Research (SPAN) sites who had bariatric surgery between 1/1/2005 and 12/31/2009. Patients had health plan enrollment and a drug benefit during the year before and after surgery. Patients were classified based on total oral or transdermal opioid days’ supply dispensed during the year prior to surgery as having no, some, or chronic use. To assess change in opioid use in the year following surgery relative to the year prior to surgery, total opioid use for each user was determined using morphine equivalents. Dispensings within 30 days post-surgery were excluded. Longitudinal mixed effects models were used to assess change in morphine equivalents dispensed before/after surgery. Results The cohort included 11,719 patients. Overall, 1016 had chronic opioid use in the year before surgery and 1222 had chronic opioid use in the year after surgery. Of the chronic users pre-surgery, 760 (74.8%) remained chronic users post-surgery. Of the 10,703 with some or no opioid use pre-surgery, 462 (4.3%) became chronic users post-surgery. The most commonly dispensed opioids were hydrocodone combinations, oxycodone, and codeine combinations. Among pre-surgery chronic users, median daily morphine equivalents increased from 22.36 pre-surgery to 25.22 post-surgery (paired sign test P <.0001). Conclusions During the year after bariatric surgery opioid use appears to increase in the overall bariatric surgery population or in those with pre-surgery chronic opioid use. Longer timeframes should also be evaluated.

  6. The effects of bariatric surgeries on type 2 diabetes mellitus

    NASA Astrophysics Data System (ADS)

    Lerd Ng, Jia; Ortiz, Roberto; Hughes, Tyler; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah; Allen, Roland

    2012-10-01

    We consider a scientific mystery which is of central importance in treating the most rapidly emerging national and global health threat: type 2 diabetes mellitus. The mystery involves a surprising effect of certain bariatric surgeries, and specifically Roux-en-Y gastric bypass (RYGB), a procedure which bypasses most of the stomach and upper intestine. An unanticipated result is that RYGB is usually found to contribute within only a few days to glucose homeostasis. This means the surgery can immediately cure patients even before they start losing weight. We are investigating this wondrous biochemical response with a quantitative model which includes the most important mechanisms. One of the major contributors is glucagon-like peptide 1 (GLP-1), an incretin whose concentration is found to increase by a large amount right after the RYGB surgical procedure. However, our results, in conjunction with the experimental and medical data, indicate that other substances must also contribute. If these substances can be definitively identified, it may be possible to replace the surgery with pharmaceuticals as the preferred treatment for type 2 diabetes.

  7. Place of upper endoscopy before and after bariatric surgery: A multicenter experience with 3219 patients

    PubMed Central

    Abd Ellatif, Mohamed E; Alfalah, Haitham; Asker, Walid A; El Nakeeb, Ayman E; Magdy, Alaa; Thabet, Waleed; Ghaith, Mohamed A; Abdallah, Emad; Shahin, Rania; Shoma, Asharf; Dawoud, Ibraheim E; Abbas, Ashraf; Salama, Asaad F; Ali Gamal, Maged

    2016-01-01

    AIM: To study the preoperative and postoperative role of upper esophagogastroduodenoscopy (EGD) in morbidly obese patients. METHODS: This is a multicenter retrospective study by reviewing the database of patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux en Y gastric bypass, or laparoscopic minigastric bypass) in the period between 2001 June and 2015 August (Jahra Hospital-Kuwait, Hafr Elbatin Hospital and King Saud Medical City-KSA, and Mansoura University Hospital - Egypt). Patients with age 18-65 years, body mass index (BMI) > 40, or > 35 with comorbidities after failure of many dietetic regimen and acceptable levels of surgical risk were included in the study after having an informed signed consent. We retrospectively reviewed the medical charts of all morbidly obese patients. The patients’ preoperative data included clinical history including upper digestive symptoms and preoperative full workup including EGD. Only patients whose charts revealed weather they were symptomatic or not were studied. We categorized patients accordingly into two groups; with (group A) or without (group B) upper digestive symptoms. The endoscopic findings were categorized into 4 groups based on predetermined criteria. The medical record of patients who developed stricture, leak or bleeding after bariatric surgery was reviewed. Logestic regression analysis was used to identify preoperative predictors that might be associated with abnormal endoscopic findings. RESULTS: Three thousand, two hundred and nineteen patients in the study period underwent bariatric surgery (75% LSG, 10% LRYDB, and 15% MGB). Mean BMI was 43 ± 13, mean age 37 ± 9 years, 79% were female. Twenty eight percent had presented with upper digestive symptoms (group A). EGD was considered normal in 2414 (75%) patients (9% group A vs 66% group B, P = 0.001). The abnormal endoscopic findings were found high in those patients with upper digestive symptoms. Abnormal findings (one

  8. Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

    PubMed Central

    Natvik, Eli; Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid

    2015-01-01

    Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences. PMID:26066518

  9. New obesity classification criteria as a tool for bariatric surgery indication.

    PubMed

    De Lorenzo, Antonino; Soldati, Laura; Sarlo, Francesca; Calvani, Menotti; Di Lorenzo, Nicola; Di Renzo, Laura

    2016-01-14

    Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy (''sick fat'') clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or "at risk" obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention. PMID:26811617

  10. Country of origin and bariatric surgery in Sweden during 2001–2010

    PubMed Central

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2016-01-01

    Background The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. Methods A closed cohort of all individuals aged 20–64 years was followed during 2001–2010. Further analyses were performed in 2 periods separately (2001–2005 and 2006–2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. Results A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. Conclusions Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients’ preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences. PMID:25979207

  11. Pre-Operative History of Depression and Cognitive Changes in Bariatric Surgery Patients

    PubMed Central

    Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2016-01-01

    Obesity associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. 67 bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12-months post-operatively. The Structured Clinical Interview for the DSM-IV Axis I disorders assessed Major Depressive Disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12-months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g., older age) that may modify cognitive changes following surgery. PMID:25222138

  12. Bariatric Surgery: A Potential Treatment for Type 2 Diabetes in Youth.

    PubMed

    Shah, Amy S; D'Alessio, David; Ford-Adams, Martha E; Desai, Ashish P; Inge, Thomas H

    2016-06-01

    Type 2 diabetes, once referred to as "adult-onset" diabetes, has now emerged as a formidable threat to the health of obese adolescents. Although there is growing evidence regarding the epidemiology of type 2 diabetes in youth and its multisystem health consequences, treatment options have lagged and progression of disease occurs even with aggressive medical therapy. Increasing interest in the application of bariatric surgery for adolescents with type 2 diabetes has evolved in part because of the evidence demonstrating improvement or remission in many adults with diabetes after surgery. Here, we review the burden of type 2 diabetes in youth including its associated complications, discuss the outcomes and complications of bariatric surgery in adolescents with diabetes, and conclude with recommendations for future research and options for refinement of the use of bariatric surgery in this patient population. PMID:27222551

  13. [Changes in the pattern of substance use after bariatric surgery: report of one case].

    PubMed

    Quevedo, Yamil; Kirsten, Kurt; Ponce de León, Consuelo; Fernández, Alejandro

    2015-01-01

    Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances. PMID:25860278

  14. A review of psychological assessment instruments for use in bariatric surgery evaluations.

    PubMed

    Marek, Ryan J; Heinberg, Leslie J; Lavery, Megan; Merrell Rish, Julie; Ashton, Kathleen

    2016-09-01

    Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a presurgical psychological evaluation that includes reviewing patients' medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about 2/3 of clinics actively use psychological testing-some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a presurgical psychological evaluation in bariatric surgery settings are also provided. (PsycINFO Database Record PMID:27537008

  15. Psychometric Evaluation of the Eating Disorder Examination-Questionnaire for Bariatric Surgery Candidates

    PubMed Central

    Hrabosky, Joshua I.; White, Marney A.; Masheb, Robin M.; Rothschild, Bruce S.; Burke-Martindale, Carolyn H.; Grilo, Carlos M.

    2013-01-01

    Objective Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates. Methods and Procedures Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures. Results Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology. Discussion Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients. PMID:18379561

  16. Micronutrient Levels and Supplement Intake in Pregnancy after Bariatric Surgery: A Prospective Cohort Study

    PubMed Central

    Devlieger, Roland; Guelinckx, Isabelle; Jans, Goele; Voets, Willy; Vanholsbeke, Caroline; Vansant, Greet

    2014-01-01

    Background Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery. Objective To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery. Design A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy. Results The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002). The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030). Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%). In the second and third trimester, the majority took additional supplements (69.4 and 73.5%). No associations were found between supplement intake and micronutrient deficiencies. Conclusion Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients. PMID:25470614

  17. The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome.

    PubMed

    Aguilar-Olivos, Nancy E; Almeda-Valdes, Paloma; Aguilar-Salinas, Carlos A; Uribe, Misael; Méndez-Sánchez, Nahum

    2016-08-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. NAFLD is strongly associated with obesity and metabolic syndrome (MetS). Current treatment of NAFLD is based on weight reduction. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. There is evidence indicating that bariatric surgery improves histological and biochemical parameters of NAFLD, but currently is not considered a treatment option for NAFLD. The aim of this work is to review the evidence for the effects of bariatric surgery on NAFLD and the MetS. We found that insulin resistance, alterations in glucose metabolism, hypertension, plasma lipids, transaminases, liver steatosis, steatohepatitis and fibrosis improve after bariatric surgery. Weight loss and improvement of NAFLD are greater after RYGB than after other interventions. These findings were obtained from retrospective or cohort studies. There are no studies designed to evaluate liver-specific mortality, liver transplantation, or quality of life. Patients with indications for bariatric surgery will benefit from the improvements in the MetS and NAFLD. PMID:26435078

  18. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery.

    PubMed

    Opolski, M; Chur-Hansen, A; Wittert, G

    2015-08-01

    It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology. PMID:26173752

  19. Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

    PubMed

    Sarwer, David B; Steffen, Kristine J

    2015-11-01

    This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown. PMID:26608946

  20. Analyses of balance and flexibility of obese patients undergoing bariatric surgery

    PubMed Central

    Benetti, Fernanda Antico; Bacha, Ivan Leo; Junior, Arthur Belarmino Garrido; Greve, Júlia Maria D'Andréa

    2016-01-01

    OBJECTIVE: To assess the postural control and flexibility of obese subjects before and both six and 12 months after bariatric surgery. To verify whether postural control is related to flexibility following weight reductions resulting from bariatric surgery. METHODS: The sample consisted of 16 subjects who had undergone bariatric surgery. All assessments were performed before and six and 12 months after bariatric surgery. Postural balance was assessed using an Accusuway® portable force platform, and flexibility was assessed using a standard chair sit and reach test (Wells' chair). RESULTS: With the force platform, no differences were observed in the displacement area or velocity from the center of pressure in the mediolateral and anteroposterior directions. The displacement speed from the center of pressure was decreased at the six month after the surgery; however, unchanged from baseline at 12 months post-surgery. Flexibility increased over time according to the three measurements tested. CONCLUSIONS: Static postural balance did not change. The velocity of postural adjustment responses were increased at six months after surgery. Therefore, weight loss promotes increased flexibility. Yet, improvements in flexibility are not related to improvements in balance. PMID:26934236

  1. KIDNEY STONE INCIDENCE AND METABOLIC URINARY CHANGES AFTER MODERN BARIATRIC SURGERY: REVIEW OF CLINICAL STUDIES, EXPERIMENTAL MODELS, AND PREVENTION STRATEGIES

    PubMed Central

    Canales, Benjamin K.; Hatch, Marguerite

    2014-01-01

    Bariatric surgery has been associated with increased metabolic kidney stone risk and post-operative stone formation. A MEDLINE search, performed for articles published between January 2005 and November 2013, identified 24 pertinent studies containing 683 bariatric patients with 24-hour urine profiles, 6,777 bariatric patients with kidney stone incidence, and 7,089 non-stone forming controls. Of all procedures reviewed, only Roux-en-Y gastric bypass (RYGB) was linked to post-operative kidney stone development, increasing stone incidence two-fold in non-stone formers (8.5%) and four-fold in patients with previous stone history (16.7%). High quality evidence from 7 studies (n=277 patients) before and after RYGB identified the following post-RYGB urinary lithogenic risk factors: 30% reduction in urine volume (the main driver of urinary crystal saturation), 40% reduction in urinary citrate (a potent stone inhibitor), and 50% increase in urinary oxalate (a stone promotor). Based on this, a summary of strategies to reduce calcium oxalate stone risk following RYGB is provided. Furthermore, recent experimental RYGB studies are assessed for insights into the pathophysiology of oxalate handling, and the literature in gut anion (oxalate) transport is reviewed. Finally, as a potential probiotic therapy for hyperoxaluria, primary data from our laboratory is presented, demonstrating a 70% reduction in urinary oxalate levels in four experimental RYGB animals after colonization with Oxalobacter formigines, a non-pathogenic gut commensal that uses oxalate as an energy source. Overall, urine profiles and kidney stone risk following bariatric surgery appear modifiable by dietary adjustments, appropriate supplementation, and lifestyle changes. For hyperoxaluria resistant to dietary oxalate restriction and calcium binding, well-designed human investigations are needed to identify additional means of lowering urinary oxalate, such as Oxalobacter colonization or empiric pyridoxine therapy

  2. Using lifestyle medicine in U.S. health care to treat obesity: too many bariatric surgeries?

    PubMed

    Trilk, Jennifer L; Kennedy, Ann Blair

    2015-01-01

    More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity. PMID:25757003

  3. Weight loss by calorie restriction versus bariatric surgery differentially regulates the HPA axis in male rats

    PubMed Central

    Grayson, Bernadette E.; Hakala-Finch, Andrew P.; Kekulawala, Melani; Laub, Holly; Egan, Ann E.; Ressler, Ilana B.; Woods, Stephen C.; Herman, James P.; Seeley, Randy J.; Benoit, Stephen C.; Ulrich-Lai, Yvonne M.

    2015-01-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in 5 groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n=7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n=11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n=11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n=11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n=12). Compared to Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentrations and increased hypothalamic corticotropin releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results suggest that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  4. Reoperative bariatric surgery. Lessons learned to improve patient selection and results.

    PubMed Central

    Behrns, K E; Smith, C D; Kelly, K A; Sarr, M G

    1993-01-01

    OBJECTIVE: The purpose of this study was to determine the spectrum of presentation, safety, and efficacy of operative bariatric surgery. SUMMARY BACKGROUND DATA: The only lasting therapy for medically complicated clinically severe obesity is bariatric surgery. Several operative approaches have resulted in disappointing long-term weight loss or an unacceptable incidence of complications that require revisionary surgery. METHODS: Sixty-one consecutive patients who underwent reoperative bariatric surgery from 1985 to 1990 were observed prospectively. One, two, or three previous bariatric procedures had been performed in 77%, 18%, and 5% of patients, respectively. Reoperation was required for unsatisfactory weight loss after gastroplasty or gastric bypass (61%), metabolic complications of jejunoileal bypass (23%), or other complications (16%), including stomal obstruction, alkaline- or acid-reflux esophagitis, and anastomotic ulcer. Revisionary procedures included conversion to vertical banded gastroplasty (33% of operations) and vertical Roux-en-Y gastric bypass (52% of operations); partial pancreato-biliary bypass was used selectively in four patients with severe, medically complicated obesity. RESULTS: A single patient died postoperatively of a pulmonary embolus; serious morbidity occurred in 11%. Weight loss (mean +/- SEM) after reoperation for unsuccessful weight loss was greater with gastric bypass than with vertical banded gastroplasty (54 +/- 6% versus 24 +/- 6% of excess body weight). Metabolic complications of jejunoileal bypass were corrected, but 67% of the patients were dissatisfied with their postoperative lifestyle because of changes in eating habits or weight gain (64% of patients). Stomal complications and esophageal reflux symptoms were reversed in all patients. CONCLUSIONS: Reoperative bariatric surgery in selected patients is safe and effective for unsatisfactory weight loss or for complications of previous bariatric procedures. Conversion to

  5. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    PubMed Central

    Abusnana, Salah; Abdi, Sarah; Tagure, Brigette; Elbagir, Murtada; Maleckas, Almantas

    2015-01-01

    Background Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking. Methods We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy) at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively. Results Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01) at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c) levels decreased significantly (P<0.001) in patients with type 2 diabetes, with an average reduction of 73%. Conclusion Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether the favorable impacts of bariatric surgery can be sustained over the long term. PMID:26425103

  6. Postprandial GLP-1 Secretion After Bariatric Surgery in Three Cases of Severe Obesity Related to Craniopharyngiomas.

    PubMed

    Bretault, Marion; Laroche, Suzanne; Lacorte, Jean-Marc; Barsamian, Charles; Polak, Michel; Raffin-Sanson, Marie-Laure; Touraine, Philippe; Bouillot, Jean-Luc; Czernichow, Sebastien; Carette, Claire

    2016-05-01

    Craniopharyngiomas are rare cerebral tumors associated with severe obesity after hypothalamic surgery. A meta-analysis showed significant weight loss at 1 year after bariatric surgery in these patients even though more modest than in common causes of obesity. We hypothesized that this discrepancy could be partly explained by differences in GLP-1 secretion after surgery since patients with craniopharyngioma present a significantly higher degree of insulin resistance and hyperinsulinism than common obese control. We report three cases of bariatric surgery in patients presenting with hypothalamique obesity related to craniopharyngiomas. At 18 months, the mean weight loss was 20 kg with expected insulin resistance decrease. Before surgery, standardized test meal shows abolition of postprandial GLP-1 secretion in all patients with a progressive restoration in the patients with gastric bypass (GBP) surgery. PMID:26922186

  7. Perioperative Outcome of Adolescents Undergoing Bariatric Surgery: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

    PubMed Central

    Inge, T.H.; Zeller, M.H.; Jenkins, T.M.; Helmrath, M.; Brandt, M.L.; Michalsky, M.P.; Harmon, C.M.; Courcoulas, A.; Horlick, M.; Xanthakos, S.A.; Dolan, L.; Mitsnefes, M.; Barnett, S.J.; Buncher, C.R.

    2014-01-01

    -term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery. PMID:24189578

  8. Complications of bariatric surgery - What the general surgeon needs to know.

    PubMed

    Healy, Paul; Clarke, Christopher; Reynolds, Ian; Arumugasamy, Mayilone; McNamara, Deborah

    2016-04-01

    Obesity is an important cause of physical and psychosocial morbidity and it places a significant burden on health system costs and resources. Worldwide an estimated 200 million people over 20 years are obese and in the UK the Department of Health report that 61.3% of people in the UK are either overweight or obese. Surgery for obesity (bariatric surgery) is being performed with increasing frequency in specialist centres both in the UK and Ireland and abroad due to the phenomenon of health tourism. Its role and success in treating medical conditions such as diabetes mellitus and hypertension in obese patients will likely lead to an even greater number of bariatric surgery procedures being performed. Patients with early postoperative complications may be managed in specialist centres but patients with later complications, occurring months or years after surgery, may present to local surgical units for assessment and management. This review will highlight the late complications of the 3 most commonly performed bariatric surgery procedures that the emergency general surgeon may encounter. It will also highlight the complications that require urgent intervention by the emergency general surgeon and those that can be safely referred to a bariatric surgeon for further management after initial assessment and investigations. PMID:26344739

  9. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    PubMed Central

    Sarosiek, Konrad; Pappan, Kirk L.; Gandhi, Ankit V.; Saxena, Shivam; Kang, Christopher Y.; McMahon, Heather; Chipitsyna, Galina I.; Tichansky, David S.; Arafat, Hwyda A.

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery. PMID:26881244

  10. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study.

    PubMed

    Sarosiek, Konrad; Pappan, Kirk L; Gandhi, Ankit V; Saxena, Shivam; Kang, Christopher Y; McMahon, Heather; Chipitsyna, Galina I; Tichansky, David S; Arafat, Hwyda A

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery. PMID:26881244

  11. Hepatic Pathology Among Patients Without Known Liver Disease Undergoing Bariatric Surgery: Observations and a Perspective from the Longitudinal Assessment of Bariatric Surgery (LABS) Study

    PubMed Central

    Kleiner, David E.; Berk, Paul D.; Hsu, Jesse Y.; Courcoulas, Anita P.; Flum, David; Khandelwal, Saurabh; Pender, John; Pomp, Alfons; Roerig, James; Machado, Laura L.; Wolfe, Bruce M.; Belle, Steven H.

    2014-01-01

    Background Liver biopsy is not routine during bariatric surgery. Alanine aminotransferase (ALT) is widely used to screen for liver disease. We assessed the relationship between ALT and pathology in biopsies from Longitudinal Assessment of Bariatric Surgery (LABS) patients with normal preoperative ALTs. Methods Biopsies from the LABS-1 and LABS-2 studies were scored using the NASH CRN and Ishak systems. Diagnosis and histology were examined in relation to ALT. Results 693 suitable biopsies were evaluated. Biopsied patients had a median age of 45 years; 78.6% were female and 35.1% diabetic; median BMI was 46 kg/m2. 635 biopsied patients had preoperative ALTs. Median ALT was 25 IU/L, (IQR 19–36 IU/L); 26.6% had an ALT >35 IU/L and 29.9% exceeded the more restrictive Prati criteria for normal. Using the Prati criteria, 7.9% of participants with normal ALT had steatohepatitis and 5.3% had ≥stage 2 fibrosis. Logistic regression models were used to predict the probabilities of having bridging fibrosis/cirrhosis or a diagnosis of borderline/definite steatohepatitis in the unbiopsied LABS-2 sample. The proportion of biopsied participants with these findings was very similar to the modeled results from the unbiopsied cohorts. We estimated that 86.0% of participants with advanced fibrosis and 88.1% of participants with borderline/definite steatohepatitis were not biopsied and went undiagnosed. Conclusion As ALT did not reliably exclude significant obesity-related liver disease in bariatric surgery patients, consideration should be given to routine liver biopsy during bariatric surgery and medical follow-up of significant hepatic pathology. PMID:24782263

  12. Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study

    PubMed Central

    Homer, Catherine Verity; Thompson, Andrew R; Allmark, Peter; Goyder, Elizabeth

    2016-01-01

    Objectives This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions. Design A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques. Setting Areas served by two bariatric surgery multidisciplinary teams in the north of England. Participants 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams. Results The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of ‘normality’. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed. Conclusions The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period. PMID:26857104

  13. Post-Bariatric Surgery Changes in Quinolinic and Xanthurenic Acid Concentrations Are Associated with Glucose Homeostasis

    PubMed Central

    Pigeyre, Marie; Caiazzo, Robert; Raverdy, Violeta; Verkindt, Hélène; Leloire, Audrey; Guillemin, Gilles J.; Yengo, Loïc; Allorge, Delphine; Froguel, Philippe; Pattou, François

    2016-01-01

    Background An increase of plasma kynurenine concentrations, potentially bioactive metabolites of tryptophan, was found in subjects with obesity, resulting from low-grade inflammation of the white adipose tissue. Bariatric surgery decreases low-grade inflammation associated with obesity and improves glucose control. Objective Our goal was to determine the concentrations of all kynurenine metabolites after bariatric surgery and whether they were correlated with glucose control improvement. Design Kynurenine metabolite concentrations, analysed by liquid or gas chromatography coupled with tandem mass spectrometry, circulating inflammatory markers, metabolic traits, and BMI were measured before and one year after bariatric surgery in 44 normoglycemic and 47 diabetic women with obesity. Associations between changes in kynurenine metabolites concentrations and in glucose control and metabolic traits were analysed between baseline and twelve months after surgery. Results Tryptophan and kynurenine metabolite concentrations were significantly decreased one year after bariatric surgery and were correlated with the decrease of the usCRP in both groups. Among all the kynurenine metabolites evaluated, only quinolinic acid and xanthurenic acid were significantly associated with glucose control improvement. The one year delta of quinolinic acid concentrations was negatively associated with the delta of fasting glucose (p = 0.019) and HbA1c (p = 0.014), whereas the delta of xanthurenic acid was positively associated with the delta of insulin sensitivity index (p = 0.0018). Conclusion Bariatric surgery has induced a global down-regulation of kynurenine metabolites, associated with weight loss. Our results suggest that, since kynurenine monoxygenase diverts the kynurenine pathway toward the synthesis of xanthurenic acid, its inhibition may also contribute to glucose homeostasis. PMID:27327770

  14. Bariatric Surgery for Morbid Obesity: Tehran Obesity Treatment Study (TOTS) Rationale and Study Design

    PubMed Central

    Hosseinpanah, Farhad; Motamedi, Mohammad Ali; Shapoori, Parvin; Arian, Peyman; Daneshpour, Maryam Alsadat; Asghari, Golale; Teymoornejad, Ahmad; Eslamifar, Ali; Khalili, Davood; Jodeiri, Behzad; Alamdari, Shahram; Azizi, Fereidoun

    2016-01-01

    Background Obesity is a major health concern in the Middle East and worldwide. It is among the leading causes of morbidity, mortality, health care utilization, and costs. With bariatric surgery proving to be a more effective treatment option for overweight and obesity, the need for systematic assessment of different procedures and their outcomes becomes necessary. These procedures have not yet been described in detail in our region. Objective We aim to undertake a prospective study evaluating and comparing several surgical bariatric procedures in an Iranian population of morbid obese patients presenting to a specialized bariatric center. Methods In order to facilitate and accelerate understanding of obesity and its complications, the Tehran Obesity Treatment Study (TOTS) was planned and developed. This study is a longitudinal prospective cohort study in consecutive patients undergoing bariatric surgery. TOTS investigators use standardized definitions, high-fidelity data collection system, and validated instruments to gather data preoperatively, at the time of surgery, postoperatively, and in longer-term follow-up. Results This study has recruited 1050 participants as of September 2015 and is ongoing. Conclusions This study will ensure creation of high-level evidence to enable clinicians to make meaningful evidence-based decisions for patient evaluation, selection for surgery, and follow-up care. PMID:26792554

  15. 'Eisenbergiella massiliensis', a new species isolated from human stool collected after bariatric surgery.

    PubMed

    Togo, A H; Khelaifia, S; Bittar, F; Maraninchi, M; Raoult, D; Million, M

    2016-09-01

    We report the principal characteristics of 'Eisenbergiella massiliensis' sp. nov. strain AT11 (CSURP = P2120, DSM = 101499) that was isolated from a stool sample collected after bariatric surgery of a 56-year-old obese French woman. PMID:27358742

  16. Eating Disorder Examination-Questionnaire Factor Structure and Construct Validity In Bariatric Surgery Candidates

    PubMed Central

    Grilo, Carlos M.; Henderson, Kathryn E.; Bell, Robert L.; Crosby, Ross D.

    2012-01-01

    Objective The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates. Methods Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures. Results Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a 7-item, 3-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures. Conclusions These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed. PMID:23229951

  17. 'Negativicoccus massiliensis', a new species identified from human stool from an obese patient after bariatric surgery.

    PubMed

    Togo, A H; Khelaifia, S; Valero, R; Cadoret, F; Raoult, D; Million, M

    2016-09-01

    We report here the main characteristics of 'Negativicoccus massiliensis' strain AT7 (CSURP = P2082, DSM = 100853) isolated from a stool sample collected from a 47-year-old obese French man before bariatric surgery. PMID:27408741

  18. Effective Ventilation Strategies for Obese Patients Undergoing Bariatric Surgery: A Literature Review.

    PubMed

    Hu, Xin Yan

    2016-02-01

    Obesity causes major alterations in pulmonary mechanics. Obese patients undergoing bariatric surgery present mechanical ventilation-related challenges that may lead to perioperative complications. Databases were systematically searched for clinical trials of ventilation maneuvers for obese patients and bariatric surgery. Thirteen randomized controlled trials were selected. The quality of the studies was evaluated with the Critical Appraisal Skills Programme tool, and a matrix was developed to present the essential components of the studies. Eight strategies of ventilation maneuvers were identified. Recruitment maneuvers followed by positive end-expiratory pressure (PEEP) consistently demonstrated effectiveness in obese patients undergoing bariatric surgery. Pressure-controlled ventilation and volume-controlled ventilation did not differ significantly in their efficacy. Noninvasive positive pressure ventilation (NIPPV) during induction was effective in preventing atelectasis and increasing the duration of safe apnea. Equal ratio ventilation can be a useful ventilation strategy. Recruitment maneuvers followed by PEEP are effective ventilation strategies for obese patients undergoing bariatric surgery. During induction, NIPPV provides further benefit. Future studies are needed to examine the postoperative effects of recruitment maneuvers with PEEP as well as the efficacy and safety of equal ratio ventilation. PMID:26939387

  19. An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

    PubMed Central

    Verdam, Froukje J.; Schouten, Ruben; Greve, Jan Willem; Koek, Ger H.; Bouvy, Nicole D.

    2012-01-01

    Obesity (BMI 30–35 kg/m2) and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35–50 kg/m2), bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet) eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication), by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation), or by partial exclusion of the small intestine (duodenal-jejunal sleeve). In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity. PMID:22957215

  20. Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery-Seeking Individuals

    ERIC Educational Resources Information Center

    Chen, Eunice Y.; Fettich, Karla C.; Tierney, Megan; Cummings, Hakeemah; Berona, Johnny; Weissman, Jessica; Ward, Amanda; Christensen, Kara; Southward, Matthew; Gordon, Kathryn H.; Mitchell, James; Coccaro, Emil

    2012-01-01

    There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of…

  1. Course of Depressive Symptoms and Treatment in the Longitudinal Assessment of Bariatric Surgery (LABS-2) Study

    PubMed Central

    Mitchell, James E.; King, Wendy C.; Chen, Jia-Yuh; Devlin, Michael J.; Flum, David; Garcia, Luis; Pender, John R.; Kalarchian, Melissa A.; Khandelwal, Saurabh; Marcus, Marsha D.; Schrope, Beth; Strain, Gladys; Wolfe, Bruce; Yanovski, Susan

    2014-01-01

    Objective To examine changes in depressive symptoms and treatment in the first three years following bariatric surgery. Design and Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study of adults (n=2,458) who underwent a bariatric surgical procedure at one of ten US hospitals between 2006–9. This study includes 2,148 participants who completed the Beck Depression Inventory (BDI) at baseline and ≥ one follow-up visit in years 1–3. Results At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score≥10) were reported by 28.3%; moderate (BDI score 19–29) and severe (BDI score ≥30) symptoms were uncommon (4.2% and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR=1.75; p=.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1yr; 12.2%, 2yrs; 15.6%, 3yrs; ps<.001), but increased between 1 and 3 years postoperatively (p<.01). Change in depressive symptoms was significantly related to change in body mass index (r=.42; p<0001). Conclusion Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year. PMID:24634371

  2. Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study: Erratum.

    PubMed

    2016-05-01

    In the article ''Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity: Case Report Study'', which appeared in Volume 94, Issue 49 of Medicine, Dr. Elrazek's name was incorrectly presented as Abd Elrazek M. Ali Hussein when it should have read Abd Elrazek Abd Elrazek. The article has since been corrected online. PMID:27231816

  3. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    PubMed

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  4. A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

    ERIC Educational Resources Information Center

    Nakamura, Tracy; Mamary, Edward

    2013-01-01

    Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews…

  5. Reduced Survival in Bariatric Surgery Candidates Delayed or Denied by Lack of Insurance Approval.

    PubMed

    Flanagan, Eleisha; Ghaderi, Iman; Overby, D Wayne; Farrell, Timothy M

    2016-02-01

    Bariatric surgery reduces mortality for Americans who meet candidacy criteria and have insurance coverage. Unfortunately, some medically suitable candidates are denied or delayed during insurance approval processes. The long-term impact of such care delays on survival is unknown. Using a prospectively maintained bariatric intake database, we identified consecutive applicants who were evaluated and medically cleared by our multidisciplinary care team and for whom insurance approval was requested. We compared survival in those who were initially approved by their insurance carriers (controls) and those who were initially denied coverage (subjects). Mortality was determined using the Social Security Death Index. Kaplan-Meier survival curves were plotted and the log-rank test for significance was applied. From August 2003 to December 2008, 463 patients (391 females, mean age 45 ± 10 years, mean body mass index 52.5 ± 9.4 kg/m(2)) were medically cleared for a bariatric procedure. Of these, 363 were approved by insurance on initial request, whereas 100 were denied. Given the study's intention to measure the aggregate impact of delays and denials, nine patients who later came to operation after appeal or coverage change were maintained in the subject cohort. During 0- to 113-month follow-up, six subjects (6%) died compared with seven controls (1.9%), corresponding to a statistically significant survival benefit for patients initially approved for bariatric surgery without delay or denial (P < 0.001). In conclusion, access to bariatric surgical care was impeded by insurance certification processes in 22 per cent of medically acceptable candidates. Processes that delay or restrict efficient access to bariatric surgery are associated with a 3-fold mortality increase. PMID:26874141

  6. Association between nutrient adequacy and psychosocial factors with overall rate of weight loss after bariatric surgery.

    PubMed

    Vanoh, Divya; Shahar, Suzana; Mahmood, Nik Ritza Kosai Nik

    2015-01-01

    This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (p<0.05, R²=0.52). Binge eating disorder (BED) and depression were also closely associated with each other after bariatric surgery (p<0.001, R²=0.46). Subjects with good compliance to dietary advice had lower scores on the binge eating scale. The mean caloric and protein intake was very low, only 562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery. PMID:26693745

  7. [Bariatric surgery for morbid obesity in childhood and adolescence: where do we stand in 2008?].

    PubMed

    Till, Holger; Bluher, Susann; Kiess, Wiel

    2009-01-01

    Bariatric surgery for children and adolescents with morbid obesity has not gained broad acceptance in Germany yet.Nevertheless, these children often fail to reduce weight despite intensive weight loss programmes and suffer from an associate metabolic syndrome, just like adults. Thus, bariatric surgery may be a favourable option. The present article compares national and international experiences concerning guidelines, surgical procedures, and results. It becomes obvious that Germany has neither specific guidelines for children and adolescents nor a central registry. Internationally,the recommendation from the Bariatric Scientific Collaborative Group (BSCG) should be taken as the standard. As in adults, most surgeons perform Roux-Y gastric bypass or gastric banding. Additionally, sleeve gastrectomy is gaining some popularity. These procedures are performed in designated pediatric centres especially in the US. Their success and complication rates are similar to those found in adults.The overall long-term consequences, however, remain unclear.Thus, for bariatric surgery in children and adolescents it may be concluded that a) these patients should be treated in designated centres that offer the full range of therapeutic options,b) specific guidelines should be established, especially in Germany, and c) a long-term postoperative study of all patients is necessary to collect all data and refine the techniques used. PMID:20124776

  8. Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation.

    PubMed

    Shakory, Sharry; Van Exan, Jessica; Mills, Jennifer S; Sockalingam, Sanjeev; Keating, Leah; Taube-Schiff, Marlene

    2015-08-01

    Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates. PMID:25828596

  9. Biological effects of bariatric surgery on obesity-related comorbidities.

    PubMed

    Noria, Sabrena F; Grantcharov, Teodor

    2013-02-01

    The prevalence of obesity has increased so rapidly over the last few decades that it is now considered a global epidemic. Obesity, defined as a body mass index (BMI) of 30 or more, is associated with several comorbid conditions that decrease life expectancy and increase health care costs. Diet therapies have been reported to be ineffective in the long-term treatment of obesity, and guidelines for the surgical therapy of morbid obesity (BMI ≥ 40 or BMI ≥ 35 in the presence of substantial comorbidities) have since been established. Considering the number of bariatric surgical procedures has dramatically increased since these guidelines were established, we review the types of bariatric surgical procedures and their impact on diabetes, sleep apnea, dyslipidemia and hypertension - 4 major obesity-related comorbidities. PMID:23351555

  10. The anaesthetic assessment, management and risk factors of bariatric surgical patients requiring postoperative intensive care support: a state-wide, five-year cohort study.

    PubMed

    Morgan, D J R; Ho, K M

    2016-03-01

    Bariatric surgery is a rapidly growing and dynamic discipline necessitating a specialised anaesthetic approach coordinating high-risk patients with appropriate post-operative intensive care (ICU) support. The relationship between the anaesthetic and ICU utilisation after bariatric surgery is poorly understood. All adult bariatric surgery patients admitted to any ICU over a five-year period between 2007 and 2011 in Western Australia were identified from hospital admission records and cross-referenced against the Western Australian Department of Health Data Linkage Unit database. During the study period 12,062 patients under went bariatric surgery with 581 (4.8%) patients admitted to ICU immediately following surgery. The mean pre-operative ASA score was 3.3 [standard deviation 1.1] with 76.9% of patients were assessed by their anaesthetist for the first time on the day-of-surgery. Blood pathology (75%) and ECG (46.3%) were the most common preoperative investigations. Intra-operatively, 2.1% of patients had a grade 4 intubation with only 3.4% of patients requiring a videoscopic assisted intubation. Despite being deemed at high risk, 23.6% of patients were managed with 20 gauge or smaller intravenous access. Anaesthetic complications were extremely uncommon (0.5% of all bariatric cases) but accounted for 9.7% of all postoperative ICU admissions. Smoking history, but not body-mass-index (P=0.46), was the only significant prognostic factor for respiratory or airway related anaesthetic complications (P=0.012). In summary, the anaesthesia management of bariatric surgery varied widely in Western Australia, with smoking as the only significant preoperative risk factor for respiratory or airway related anaesthesia complications. PMID:27029656

  11. Bariatric to metabolic surgery: management options and experience at a tertiary centre.

    PubMed

    Raj, P Praveen; Chandramaliteeswaran, C; Senthilnathan, P; Asokan, S; Palanivelu, C

    2010-10-01

    Obesity proves to be a growing pandemic with severe health and economic implications. Bariatric surgeries are now recognised as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. This concept of metabolic surgery is now applied to non-obese population with metabolic disorders. The type II diabetes mellitus remission rates as high as 95% have been reported, least with restrictive procedures and maximum with malabsorptive procedures and such effect occurs even before substantial weight loss. This has led to increased understanding of diabetes pathophysiology and formulation of foregut and hindgut hypothesis. The aim of this study was to briefly review the management options for morbid obesity and present the results at a high volume centre. Data from 518 patients who underwent laparoscopic bariatric surgeries at this institute since 2002 were taken up for analysis retrospectively. Study population included 518 patients with 310 males and 208 females. Excess body weight loss and comorbidity resolution rates were analysed. Laparoscopic bariatric surgery is safe and effective for excess body weight loss and confers excellent resolution of associated comorbidities. PMID:21510546

  12. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery

    PubMed Central

    Groven, Karen Synne; Galdas, Paul; Solbrække, Kari Nyheim

    2015-01-01

    Background To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Findings Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value. PMID:26641203

  13. Guidelines for the follow-up of patients undergoing bariatric surgery.

    PubMed

    O'Kane, Mary; Parretti, Helen M; Hughes, Carly A; Sharma, Manisha; Woodcock, Sean; Puplampu, Tamara; Blakemore, Alexandra I; Clare, Kenneth; MacMillan, Iris; Joyce, Jacqueline; Sethi, Su; Barth, Julian H

    2016-06-01

    Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important. PMID:27166136

  14. The association between reduced inflammation and cognitive gains after bariatric surgery

    PubMed Central

    Hawkins, Misty A.W.; Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2014-01-01

    Objective Bariatric surgery is associated with improved cognitive function, though the mechanisms are unclear. Elevated inflammation is common in obesity and associated with impaired cognition. Inflammation decreases after bariatric surgery, implicating it as a possible mechanism for cognitive improvement. The objective of this study was to examine whether reduced inflammation is a possible mechanism for post-operative cognitive improvement in bariatric surgery patients. Methods Participants were 77 bariatric surgery patients who completed cognitive testing before surgery and one year post-surgery. Cognitive domains assessed were attention/executive function, language, and memory. High-sensitivity C-reactive protein (hs-CRP) was assessed at both time points. Results Patients exhibited pre-operative cognitive impairment, though attention/executive (M±SDbaseline= 53.57 ± 8.68 vs.M±SDfollow-up= 60.32 ± 8.19) and memory (M±SDbaseline= 44.96 ± 7.98 vs.M±SDfollow-up= 51.55 ± 8.25) improved one year post-surgery. CRP was elevated at baseline and fell into the normative range post-surgery (M±SDbaseline= 0.9 ± 0.7vs.M±SDfollow-up= 0.2 ± 0.3 mg/dL). Pre-operative CRP was not associated with baseline cognitive function (β-values = -0.10 to 0.02) and changes in CRP also did not correspond to changes in cognition post-surgery (β-values = 0.02 to β = 0.11; ps>0.05 for all domains). A trend was detected for smaller improvements in memory among participants with elevated baseline CRP (>0.30 mg/dL) versus those with normal levels (Group x Time: p=0.083). Conclusions Improvements in hs-CRP were not associated with post-operative cognitive benefits. Future studies are needed to explore other inflammatory markers and potential mechanisms of cognitive improvement after bariatric surgery, including improved glycemic control and neurohormone changes. PMID:25478707

  15. Differential Effects of Bariatric Surgery Versus Exercise on Excessive Visceral Fat Deposits.

    PubMed

    Wu, Fu-Zong; Huang, Yi-Luan; Wu, Carol C; Wang, Yen-Chi; Pan, Hsiang-Ju; Huang, Chin-Kun; Yeh, Lee-Ren; Wu, Ming-Ting

    2016-02-01

    The aim of the present study was to compare differential impacts of bariatric surgery and exercise-induced weight loss on excessive abdominal and cardiac fat deposition.Excessive fat accumulation around the heart may play an important role in the pathogenesis of cardiovascular disease. Recent evidences have suggested that bariatric surgery results in relatively less decrease in epicardial fat compared with abdominal visceral fat and paracardial fat.Sixty-four consecutive overweight or obese subjects were enrolled in the study. Clinical characteristics and metabolic profiles were recorded. The volumes of abdominal visceral adipose tissue (AVAT), abdominal subcutaneous adipose tissue (ASAT), epicardial (EAT), and paracardial adipose tissue (PAT) were measured by computed tomography in the bariatric surgery group (N = 25) and the exercise group (N = 39) at baseline and 3 months after intervention. Subjects in both the surgery and exercise groups showed significant reduction in body mass index (15.97%, 7.47%), AVAT (40.52%, 15.24%), ASAT (31.40, 17.34%), PAT (34.40%, 12.05%), and PAT + EAT (22.31%, 17.72%) (all P < 0.001) after intervention compared with baseline. In both the groups, the decrease in EAT was small compared with the other compartments (P < 0.01 in both groups). Compared with the exercise group, the surgery group had greater loss in abdominal and cardiac visceral adipose tissue (AVAT, ASAT, PAT, EAT+PAT) (P < 0.001), but lesser loss in EAT (P = 0.037).Compared with the exercise group, bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for EAT. EAT, but not PAT, was relatively preserved despite weight reduction in both the groups. The physiological impact of persistent EAT deserves further investigation. PMID:26844473

  16. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial

    PubMed Central

    2014-01-01

    Background The increasing prevalence of obesity in both developed and developing countries is one of the most serious public health problems and has led to a global epidemic. Obesity is one of the greatest risk factors of obstructive sleep apnea (OSA), which is found in 60 to 70% of obese patients mainly due to the buildup of fat tissue in the upper portion of the thorax and neck. The aim of the present randomized clinical trial is to assess daytime sleepiness, sleep architecture and pulmonary function in patients with severe obesity before and after bariatric surgery. Methods This randomized, controlled trial, was designed, conducted, and reported in accordance with the standards of The CONSORT (Consolidated Standards of Reporting Trials) Statement. Patients were divided into a bariatric surgery group and control group. The clinical evaluation was performed at the Sleep Laboratory of the Nove de JulhoUniversity (Sao Paulo, Brazil) and consisted of the collection of clinical data, weight, height, body mass index (BMI), measurements of neck and abdomen circumferences, spirometry, maximum ventilatory pressure measurements, standard overnight polysomnography (PSG) and the administration of the Berlin Questionnaire and Epworth Sleepiness Scale. Results Fifty-two patients participated in the present study and performed PSG. Out of these, 16 underwent bariatric surgery. After surgery, mean BMI decreased from 48.15 ± 8.58 to 36.91 ± 6.67 Kg/m2. Significant differences were found between the preoperative and postoperative periods regarding neck (p < 0.001) and waist circumference (p < 0.001), maximum inspiratory pressure (p = 0.002 and p = 0.004) and maximum expiratory pressure (p = 0.001 and p = 0.002) for women and men, respectively, as well as sleep stage N3 (p < 0.001), REM sleep (p = 0.049) and the apnea-hypopnea index (p = 0.008). Conclusions Bariatric surgery effectively reduces neck and waist circumference, increases maximum ventilatory pressures, enhances sleep

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

    PubMed Central

    Lynch, Cheryl Sterling; Chang, Judy C.; Ford, Angela F.

    2007-01-01

    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. PMID:17447097

  18. [Beriberi after bariatric surgery: not an unusual complication. Report of two cases and literature review].

    PubMed

    Alves, Lilian F A; Gonçalves, Ricardo M; Cordeiro, Giovana V; Lauria, Márcio W; Ramos, Adauto V

    2006-06-01

    The number of patients submitted to bariatric surgery to treat morbid obesity is increasing, therefore, some nutritional deficiencies, with which many physicians are no longer familiarized, are reappearing. Postoperatively, many nutritional disorders may occur, one of them is thiamine deficiency (beriberi). The thiamine and/or vitamin B12 deficiency can correspond to 40% of the neuropathy cases after bariatric surgery. Two patients with the clinic of peripheral neuropathy and Wernicke-Korsakoff syndrome will be reported. Some months after the surgery, they presented prostration, depression, mental confusion and nystagmus, associated with pain and paresthesia in limbs (especially lower limbs). With the diagnostic hypothesis of beriberi, the treatment with thiamine started. One of the patients presented complete improvement of the neurological symptoms, however the other one remained with motor deficiency, exactly the one who spent a longer period of time between the symptoms appearance and the treatment beginning. These cases serve to alert us about the importance of nutritional vigilance after bariatric surgery. PMID:16936999

  19. Association between Binge Eating Disorder and Changes in Cognitive Functioning Following Bariatric Surgery

    PubMed Central

    Lavender, Jason M.; Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Paul, Robert; Crosby, Ross D.; Mitchell, James E.; Wonderlich, Stephen A.; Gunstad, John

    2014-01-01

    Evidence suggests that both obesity and binge eating disorder (BED) may be associated with deficits in cognitive functioning. The purpose of this study was to examine whether a lifetime history of BED would be associated with changes in several domains of cognitive functioning (attention, executive function, language, and memory) following bariatric surgery. Participants were 68 bariatric surgery patients who completed a computerized battery of cognitive tests within 30 days prior to undergoing surgery and again at a 12-month postoperative follow-up. Results revealed that on the whole, participants displayed improvements from baseline to follow-up in attention, executive function, and memory, even after controlling for diagnostic history of depression; no changes were observed for language. However, individuals with and without a history of BED did not differ in changes in body mass index or in the degree of improvement in cognitive functioning from baseline to follow-up. Such results suggest that a history of BED does not influence changes in cognitive functioning following bariatric surgery. Future research will be needed to further clarify the role of BED in predicting cognitive function over time. PMID:25201638

  20. Financial costs and patients’ perceptions of medical tourism in bariatric surgery

    PubMed Central

    Kim, David H.; Sheppard, Caroline E.; de Gara, Christopher J.; Karmali, Shahzeer; Birch, Daniel W.

    2016-01-01

    Summary Many Canadians pursue surgical treatment for severe obesity outside of their province or country — so-called “medical tourism.” We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients’ motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources. PMID:26574702

  1. High flow insufflation for the maintenance of the pneumoperitoneum during bariatric surgery.

    PubMed

    Daskalakis, Markos; Scheffel, Oliver; Weiner, Rudolf A

    2009-01-01

    Minimally invasive bariatric procedures next to becoming more and more popular have established a new field of applications for carbon dioxide (CO2) insufflators. In laparoscopic bariatric procedures, gas is used to insufflate the peritoneal cavity and increase the intra-abdominal pressure up to 15 mm Hg for optimal exposure and a suitable operating field. The increased intra-abdominal pressure during pneumoperitoneum can reduce femoral venous flow, intra-operative urine output, portal venous flow, respiratory compliance,and cardiac output. However, clinical complications related to these effects are rare. Yet, surgeons should be constantly aware that the duration of an operation is an important factor in reducing the patient's exposure to CO2 pneumoperitoneum and its adverse effects. The optimized performance of the bariatric high flow insufflator allows reaching stable abdominal pressure conditions quicker and at a higher level than a common insufflator. Therefore, high flow insufflators offer great advantages in maintaining intra-abdominal pressure and temperature in comparison to conventional insufflators and thus enhance laparoscopic bariatric surgery by potentially reducing the operating time and the undesirable effects of CO2 pneumoperitoneum. PMID:20124777

  2. ANALYSIS OF FOOD TOLERANCE IN PATIENTS SUBMITTED TO BARIATRIC SURGERY USING THE QUESTIONNAIRE QUALITY OF ALIMENTATION

    PubMed Central

    STUMPF, Matheo Augusto Morandi; RODRIGUES, Marcos Ricardo da Silva; KLUTHCOVSKY, Ana Claudia Garabeli Cavalli; TRAVALINI, Fabiana; MILLÉO, Fábio Quirillo

    2015-01-01

    Background : Due to the increased prevalence of obesity in many countries, the number of bariatric surgeries is increasing. They are considered the most effective treatment for obesity. In the postoperative there may be difficulties with the quality of alimentation, tolerance to various types of food, as well as vomiting and regurgitation. Few surveys are available to assess these difficulties in the postoperative. Aim : To perform a systematic literature review about food tolerance in patients undergoing bariatric surgery using the questionnaire "Quality of Alimentation", and compare the results between different techniques. Method : A descriptive-exploratory study where the portals Medline and Scielo were used. The following headings were used in english, spanish and portuguese: quality of alimentation, bariatric surgery and food tolerance. A total of 88 references were found, 14 used the questionnaire "Quality of Alimentation" and were selected. Results : In total, 2745 patients were interviewed of which 371 underwent to gastric banding, 1006 to sleeve gastrectomy, 1113 to Roux-en-Y gastric bypass, 14 to biliopancreatic diversion associated with duodenal switch, 83 were non-operated obese, and 158 non-obese patients. The questionnaire showed good acceptability. The biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared to other techniques, but it was evaluated in a single article with a small sample. The longer the time after the operation, the better is the food tolerance. Comparing the sleeve gastrectomy and the Roux-en-Y gastric bypass, there are still controversial results in the literature. The gastric banding had the worst score of food tolerance among all the techniques evaluated. Conclusion: The questionnaire is easy and fast to assess the food tolerance in patients after bariatric surgery. Biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared

  3. Iron deficiency before and after bariatric surgery: the need for iron supplementation.

    PubMed

    ten Broeke, R; Bravenboer, B; Smulders, F J F

    2013-10-01

    Hepcidin inhibits the iron export from duodenal cells and liver cells into the plasma and therefore plays a key role in controlling iron homeostasis. In obese patients, elevated cytokine production stimulates hepcidin synthesis, causing iron to be retained as ferritin in e.g. macrophages (functional iron deficiency). In addition, patients often develop iron deficiency after bariatric surgery due to malabsorption, which may cause anaemia and thereby lead to complaints such as fatigue. In these patients, the absorption of iron may be disrupted because the reduction of Fe3+ by gastric acid into Fe2+ (the form that is easily absorbed) is not so effective after stomach reduction. Iron absorption is further reduced after malabsorptive interventions as a result of bypassing the duodenum and the proximal part of the small intestine, where the absorption takes place. Oral iron supplements often have little effect after bariatric surgery. Intravenous supplements of iron can restore the iron status rapidly after bariatric surgery, resulting in fewer symptoms such as fatigue. PMID:24127501

  4. Salt taste after bariatric surgery and weight loss in obese persons.

    PubMed

    Ekmekcioglu, Cem; Maedge, Julia; Lam, Linda; Blasche, Gerhard; Shakeri-Leidenmühler, Soheila; Kundi, Michael; Ludvik, Bernhard; Langer, Felix B; Prager, Gerhard; Schindler, Karin; Dürrschmid, Klaus

    2016-01-01

    Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies. PMID:27330856

  5. Salt taste after bariatric surgery and weight loss in obese persons

    PubMed Central

    Maedge, Julia; Lam, Linda; Blasche, Gerhard; Shakeri-Leidenmühler, Soheila; Kundi, Michael; Ludvik, Bernhard; Langer, Felix B.; Prager, Gerhard; Schindler, Karin; Dürrschmid, Klaus

    2016-01-01

    Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies. PMID:27330856

  6. Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery.

    PubMed

    Cătoi, Adriana Florinela; Pârvu, Alina; Mureşan, Adriana; Busetto, Luca

    2015-01-01

    Obesity and the related diabetes epidemics represent a real concern worldwide. Bariatric/metabolic surgery emerged in last years as a valuable therapeutic option for obesity and related diseases, including type 2 diabetes mellitus (T2DM). The complicated network of mechanisms involved in obesity and T2DM have not completely defined yet. There is still a debate on which would be the first metabolic defect leading to metabolic deterioration: insulin resistance or hyperinsulinemia? Insight into the metabolic effects of bariatric/metabolic surgery has revealed that, beyond weight loss and food restriction, other mechanisms can be activated by the rearrangements of the gastrointestinal tract, such as the incretinic/anti-incretinic system, changes in bile acid composition and flow, and modifications of gut microbiota; all of them possibly involved in the remission of T2DM. The complete elucidation of these mechanisms will lead to a better understanding of the pathogenesis of this disease. Our aim was to review some of the metabolic mechanisms involved in the development of T2DM in obese patients as well as in the remission of this condition in patients submitted to bariatric/metabolic surgery. PMID:26584027

  7. Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

    PubMed

    Miras, A D; le Roux, C W

    2014-03-01

    The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals. PMID:24213310

  8. Bariatric Surgery vs. Conventional Dieting in the Morbidly Obese.

    PubMed

    Greenstein; Rabner; Taler

    1994-02-01

    Weight loss and psychosocial events have been compared between low calorie conventional diet (n = 11) or following obesity surgery (n = 17). Interviews were >/= 9 months following initiation of treatment. After surgery significantly less hunger was experienced (surgery 76% [13/17] vs diet 18% [2/11] p < 0.01) and less will-power was required to stop eating (surgery 88% [15/17] vs diet 27% [3/11] p < 0.001). More dieters stopped eating because of 'figure and health' (surgery 12 % [2/17] vs diet 64 % [7/11 ] p < 0.01) whereas postoperative patients stopped due to vomit avoidance (surgery 53% [9/17] vs diet 0% [0/11] p surgery 76% [13/17] vs diet 18% [2/11) p < 0.005). Following surgery there were subjective appearance improvements (surgery 94% [15/16] vs diet 50% [5/10] p < 0.01) and fewer social limitations (surgery 69% [11/16] vs diet 27% [3/11] p surgery 73% [11/15] vs diet 18% [2/11] p < 0.01). Although both groups continue to feel 'fat' at times, more dieters think other people view them as obese (surgery 35% [6/17] vs diet 91% [10/11] p surgery (surgery 100% [16/16] vs diet 33% [3/9] p < 0.005). Enforced behavior modification (vomit avoidance) is the mechanism of action of gastric restrictive surgery. Physical activity increases, and satisfaction with weight loss method is greater, after surgery. Employment is greater (probably self selection) in the post-surgical group. We found that comparing >/= 9 months following surgery or beginning a conventional diet, the morbidly obese have a more positive response to surgery. PMID:10742758

  9. Effect of Intravenous Acetaminophen on Postoperative Opioid Use in Bariatric Surgery Patients

    PubMed Central

    Wang, Shan; Saha, Ronik; Shah, Neal; Hanna, Adel; DeMuro, Jonas; Calixte, Rose; Brathwaite, Collin

    2015-01-01

    Background: The use of opioids to achieve adequate pain relief following surgery is a common clinical practice. Opioids, however, are associated with serious adverse effects, such as respiratory depression, excessive sedation, and prolonged ileus, as well as increased mortality. The administration of intravenous (IV) acetaminophen to control postoperative pain has been effective in reducing opioid consumption in various surgical populations, but no studies have been conducted in bariatric surgery patients. This investigation was performed to determine whether IV acetaminophen reduces opioid requirements after bariatric surgery. Methods: IV acetaminophen was added to the Winthrop-University Hospital formulary in September 2012. We conducted a retrospective chart-review analysis of bariatric surgery patients who received at least four doses of IV acetaminophen (1 g every six hours) plus opioids from October 2012 to March 2013 (after IV acetaminophen was added to the hospital formulary), compared with bariatric surgery patients who received only opioids for postoperative pain control from January 2012 to June 2012 (before IV acetaminophen was added to the hospital formulary). The study’s primary endpoint was the difference between the two groups in opioid consumption, expressed in oral morphine equivalents (OMEs). Secondary endpoints included the reduction in the baseline pain score; the total amount of each opioid used; and the average hospital length of stay (LOS). Results: A total of 96 patients were identified for potential enrollment from January 2012 to March 2013. Eight patients, however, did not qualify for participation because they had received only one dose of IV acetaminophen. The remaining 88 patients comprised two study groups: IV acetaminophen plus opiates (n = 44) and IV opiates alone (n = 44). Paradoxically, the patients in the acetaminophen/opiates group required significantly more opiates (in OMEs) compared with the group that received opiates

  10. A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery

    PubMed Central

    Chow, Alexandra; Switzer, Noah J.; Dang, Jerry; Shi, Xinzhe; de Gara, Christopher; Birch, Daniel W.; Gill, Richdeep S.; Karmali, Shahzeer

    2016-01-01

    Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of 41.16 ± 6.76 years with a mean BMI of 42.50 ± 2.65 kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to 29.55 ± 1.76 kg/m2 (P < 0.00001) and 30.63 ± 2.09 kg/m2 (P < 0.00001), respectively. Preoperative weighted mean total daily insulin requirement was 98 ± 26 IU/d, which decreased significantly to 36 ± 15 IU/d (P < 0.00001) and 42 ± 11 IU/d (P < 0.00001) at 12 months and at study endpoint, respectively. An improvement in HbA1c was also seen from 8.46 ± 0.78% preoperatively to 7.95 ± 0.55% (P = 0.01) and 8.13 ± 0.86% (P = 0.03) at 12 months and at study endpoint, respectively. Conclusion. Bariatric surgery in patients with type 1 diabetes leads to significant reductions in BMI and improvements in glycemic control. PMID:27375900

  11. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine

    PubMed Central

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; Åsberg, A; Christensen, H; Ashcroft, D M; Rostami-Hodjegan, A

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (Foral). In the absence of clinical data, an indication of changes to Foral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicking clinical investigations on cyclosporine and atorvastatin after bariatric surgery. Cyclosporine simulations displayed a reduced fraction absorbed through gut wall (fa) and Foral after surgery, consistent with reported observations. Simulated atorvastatin Foral postsurgery was broadly reflective of observed data with indications of counteracting interplay between reduced fa and an increased fraction escaping gut wall metabolism (FG). Inability to fully recover observed atorvastatin exposure after biliopancreatic diversion with duodenal switch highlights the current gap regarding the knowledge of associated biological changes. PMID:23903405

  12. Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy

    PubMed Central

    Whitty, Jennifer A; Ratcliffe, Julie; Kendall, Elizabeth; Burton, Paul; Wilson, Andrew; Littlejohns, Peter; Harris, Paul; Krinks, Rachael; Scuffham, Paul A

    2015-01-01

    Objectives To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public. Setting Australian public hospital system. Participants Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia. Primary and secondary outcome measures A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis). Results A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI≥50 kg/m2) or (to a lesser extent) severe (BMI≥40 kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level. Conclusions This study extends our understanding of the publics’ preferences for priority setting to the context of bariatric surgery, and derives priority weights

  13. Consequences of bariatric surgery on oesophageal function in health and disease.

    PubMed

    Naik, Rishi D; Choksi, Yash A; Vaezi, Michael F

    2016-02-01

    Obesity is a continuing epidemic with substantial associated morbidity and mortality. Owing to the limitations of lifestyle modifications and pharmacological options, bariatric surgery has come to the forefront as an efficient method of achieving sustained weight loss and decreasing overall mortality in comparison with nonsurgical interventions. The most frequently performed bariatric operations are either purely restrictive, such as laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or restrictive-malabsorptive, such as the Roux-en-Y gastric bypass (RYGB). Each operation results in weight loss, but can also have unintended effects on the health of the oesophagus. Specifically, operations might lead to oesophageal dilation or the development of GERD. LAGB is the best-studied procedure with notable evidence for postoperative worsening of GERD and pseudo-achalasia, which increases lower oesophageal pressure and causes aperistalsis. In some studies, LSG initiates not only a worsening of GERD, but also the formation of de novo GERD in patients without preoperative GERD symptoms. RYGB demonstrates the most profound evidence for improvement of GERD symptoms and preservation of oesophageal motility. Future high-quality studies will be required to better understand the interaction between bariatric surgery and oesophageal disease. PMID:26648126

  14. Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations

    PubMed Central

    Ahmetasevic, Emir; Pasic, Fuad; Beslin, Miroslav Bekavac; Ilic, Miroslav; Ahmetasevic, Dzenita; Mesic, Mirza

    2016-01-01

    Introduction: Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. Material and methods: Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. Results and discussion: So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious. PMID:27147808

  15. Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery.

    PubMed

    Janero, David R

    2014-03-01

    Type 2 diabetes (T2D) - particularly with concurrent obesity ('diabesity') - is an intensifying global public-health problem. Medical needs and market opportunities in the T2D space have propelled discovery efforts aimed at inventing new synthetic T2D drugs differentiable by improved safety and efficacy and/or the ability to modulate emerging T2D targets. Particularly for moderately and severely obese individuals, weight-loss (bariatric) surgery offers an effective means of reducing obesity-driven T2D that is superior in many respects to medical T2D management. Yet, not all overweight or obese individuals with T2D qualify for bariatric surgery, and current healthcare resources are inadequate for applying surgical T2D control to more than a very small segment of qualified patients. Bariatric surgery is no guarantee of 'curative' T2D abrogation, significant rates of T2D non-remission or re-emergence having been observed in diabesity patients following bariatric procedures. Preoperative glucose control by oral hypoglycemic drugs reduces the chance of T2D recurrence post-surgery, and diabesity patients in whom glycemic indices have been improved by bariatric surgery may still require some level of T2D pharmacotherapy. Laboratory and clinical data indicate that synthetic T2D drugs can improve T2D-related outcomes following bariatric procedures, and current T2D drug-discovery efforts are being informed by the metabolic advantages associated with bariatric surgery. These circumstances intensify the need for and extend the impact of T2D drug discovery by demonstrating multiple levels of interplay between medical and surgical approaches to improve the health of individuals with diabesity and, perhaps, approach the overarching goal of decreasing long-term cardiovascular mortality. PMID:24397872

  16. Bariatric surgery and T2DM improvement mechanisms: a mathematical model

    PubMed Central

    2012-01-01

    Background Consensus exists that several bariatric surgery procedures produce a rapid improvement of glucose homeostasis in obese diabetic patients, improvement apparently uncorrelated with the degree of eventual weight loss after surgery. Several hypotheses have been suggested to account for these results: among these, the anti-incretin, the ghrelin and the lower-intestinal dumping hypotheses have been discussed in the literature. Since no clear-cut experimental results are so far available to confirm or disprove any of these hypotheses, in the present work a mathematical model of the glucose-insulin-incretin system has been built, capable of expressing these three postulated mechanisms. The model has been populated with critically evaluated parameter values from the literature, and simulations under the three scenarios have been compared. Results The modeling results seem to indicate that the suppression of ghrelin release is unlikely to determine major changes in short-term glucose control. The possible existence of an anti-incretin hormone would be supported if an experimental increase of GIP concentrations were evident post-surgery. Given that, on the contrary, collected evidence suggests that GIP concentrations decrease post-surgery, the lower-intestinal dumping hypothesis would seem to describe the mechanism most likely to produce the observed normalization of Type 2 Diabetes Mellitus (T2DM) after bariatric surgery. Conclusions The proposed model can help discriminate among competing hypotheses in a context where definitive data are not available and mechanisms are still not clear. PMID:22587410

  17. COMPARISON OF HEPATIC PROFILE IN PRE AND POSTOPERATIVE OF BARIATRIC SURGERY: PRIVATE VS PUBLIC NETWORK

    PubMed Central

    NASCIMENTO, Taianne Machado; ALVES-JÚNIOR, Antônio; NUNES, Marco Antonio Prado; de FREITAS, Tiago Rodrigo Pereira; da SILVA, Marco Antonio Fontes Sarmento; ALVES, Maria Rosa Melo

    2015-01-01

    Background: Obesity is associated to several comorbidities, including nonalcoholic fatty liver disease, which implicates in isolated steatosis to steatohepatitis. The latter may progress to severe manifestations such as liver fibrosis, cirrhosis and hepatocellular carcinoma. Aim: To compare the presence of advanced liver fibrosis before and after bariatric surgery in patients of private and public health system. Methods: Patients from public and privative networks were studied before and after bariatric surgery. The presence or absence of advanced hepatic fibrosis was evaluated by NAFLD Fibrosis Score, a non-invasive method that uses age, BMI, AST/ALT ratio, albumin, platelet count and the presence or absence of hyperglycemia or diabetes. The characteristics of the two groups were compared. The established statistical significance criterion was p<0.05. Results: Were analyzed 40 patients with a mean age of 34.6±9.5 years for private network and 40.6± 10.2 years for public. The study sample, 35% were treated at private health system and 65% in the public ones, 38% male and 62% female. Preoperatively in the private network one (7.1%) patient had advanced liver fibrosis and developed to the absence of liver fibrosis after surgery. In the public eight (30.8%) patients had advanced liver fibrosis preoperatively, and at one year after the proportion fell to six (23%). Conclusion: The non-alcoholic fatty liver disease in its advanced form is more prevalent in obese patients treated in the public network than in the treated at the private network and bariatric surgery may be important therapeutic option in both populations. PMID:26734800

  18. When Mood Worsens after Gastric Bypass Surgery: Characterization of Bariatric Patients with Increases in Depressive Symptoms Following Surgery

    PubMed Central

    Grilo, Carlos M.

    2014-01-01

    Background Depression levels generally decrease substantially following bariatric surgery; however, little is known about bariatric patients who might experience increases in depression following surgery. We examined the frequency of bariatric patients who experienced discernible increases in depression levels following surgery and explored their correlates. Methods Participants were 107 patients with extreme obesity who underwent gastric bypass surgery and were followed up at 6 and 12 months postsurgery. Participants completed self-report questionnaires about depression (BDI), eating disorder psychopathology (EDE-Q), self-esteem (RSES), and social functioning (SF-36) at baseline and again at 6 and 12 months postsurgery. Results Fourteen (13.1 %) participants reported discernible increases (BDI-Increase), 14 (13.1 %) reported discernible decreases (BDI-Decrease), and 79 (73.8 %) did not report discernible changes (no change) in BDI scores from 6 to 12 months postsurgery. Presurgically, there were no differences between the three groups. By 12 months postsurgery, the BDI-Increase group had significantly higher depression scores and significantly lower self-esteem and SF-36 mental component scores than did the other groups. For the BDI-Increase group, BDI Change was significantly associated with body mass index, self-esteem, and SF-36 physical component scores. Conclusions Findings highlight that a subgroup of individuals report discernible increases in depressive scores postsurgery and may differ in potentially clinically meaningful ways from those who do not report discernible increases in depressive symptoms. Future research is needed to better understand the long-term trajectory of patients with discernible worsening mood following gastric bypass surgery. PMID:25190520

  19. Changes of insulin sensitivity and secretion after bariatric/metabolic surgery.

    PubMed

    Mingrone, Geltrude; Cummings, David E

    2016-07-01

    Type 2 diabetes (T2D) is classically characterized by failure of pancreatic β-cell function and insulin secretion to compensate for a prevailing level of insulin resistance, typically associated with visceral obesity. Although this is usually a chronic, progressive disease in which delay of end-organ complications is the primary therapeutic goal for medical and behavioral approaches, several types of bariatric surgery, especially those that include intestinal bypass components, exert powerful antidiabetes effects to yield remission of T2D in most cases. It has become increasingly clear that in addition to the known benefits of acute caloric restriction and chronic weight loss to ameliorate T2D, bariatric/metabolic operations also engage a variety of weight-independent mechanisms to improve glucose homeostasis, enhancing insulin sensitivity and secretion to varying degrees depending on the specific operation. In this paper, we review the effects of Roux-en-Y gastric bypass, biliopancreatic diversion, and vertical sleeve gastrectomy on the primary determinants of glucose homeostasis: insulin sensitivity, insulin secretion, and, to the lesser extent that it is known, insulin-independent glucose disposal. A full understanding of these effects should help optimize surgical and device-based designs to provide maximal antidiabetes impact, and it holds the promise to identify targets for possible novel diabetes pharmacotherapeutics. These insights also contribute to the conceptual rationale for use of bariatric operations as "metabolic surgery," employed primarily to treat T2D, including among patients not obese enough to qualify for surgery based on traditional criteria related to high body mass index. PMID:27568471

  20. All Bariatric Surgeries Are Not Created Equal: Insights from Mechanistic Comparisons

    PubMed Central

    Stefater, Margaret A.; Wilson-Pérez, Hilary E.; Chambers, Adam P.; Sandoval, Darleen A.

    2012-01-01

    Despite considerable scientific progress on the biological systems that regulate energy balance, we have made precious little headway in providing new treatments to curb the obesity epidemic. Diet and exercise are the most popular treatment options for obesity, but rarely are they sufficient to produce long-term weight loss. Bariatric surgery, on the other hand, results in dramatic, sustained weight loss and for this reason has gained increasing popularity as a treatment modality for obesity. At least some surgical approaches also reduce obesity-related comorbidities including type 2 diabetes and hyperlipidemia. This success puts a premium on understanding how these surgeries exert their effects. This review focuses on the growing human and animal model literature addressing the underlying mechanisms. We compare three common procedures: Roux-en-Y Gastric Bypass (RYGB), vertical sleeve gastrectomy (VSG), and adjustable gastric banding (AGB). Although many would group together VSG and AGB as restrictive procedures of the stomach, VSG is more like RYGB than AGB in its effects on a host of endpoints including intake, food choice, glucose regulation, lipids and gut hormone secretion. Our strong belief is that to advance our understanding of these procedures, it is necessary to group bariatric procedures not on the basis of surgical similarity but rather on how they affect key physiological variables. This will allow for greater mechanistic insight into how bariatric surgery works, making it possible to help patients better choose the best possible procedure and to develop new therapeutic strategies that can help a larger portion of the obese population. PMID:22550271

  1. Changes in Whole Blood Gene Expression in Obese Subjects with Type 2 Diabetes Following Bariatric Surgery: a Pilot Study

    PubMed Central

    Berisha, Stela Z.; Serre, David; Schauer, Philip; Kashyap, Sangeeta R.; Smith, Jonathan D.

    2011-01-01

    Background A pilot study was performed in order to investigate the effects of bariatric surgery on whole blood gene expression profiles in obese subjects with type 2 diabetes. Methodology/Principal Findings Whole blood from eleven obese subjects with type 2 diabetes was collected in PAXgene tubes prior to and 6–12 months after bariatric surgery. Total RNA was isolated, amplified, labeled and hybridized to Illumina gene expression microarrays. Clinical and expression data were analyzed using a paired t-test, and correlations between changes in clinical trait and transcript levels were calculated. Pathways were identified using Ingenuity Pathway Analysis and DAVID gene ontology software. Overall, bariatric surgery resulted in significant reduction of body mass index, fasting plasma glucose, fasting plasma insulin, and normalization of glycosylated hemoglobin levels. The expression levels of 204 transcripts, representing 200 unique genes, were significantly altered after bariatric surgery. Among the significantly regulated genes were GGT1, CAMP, DEFA1, LCN2, TP53, PDSS1, OLR1, CNTNAP5, DHCR24, HHAT and SARDH, which have been previously implicated in lipid metabolism, obesity and/or type 2 diabetes. Selected findings were replicated by quantitative real-time-PCR. The changes in expression of seven transcripts, WDR35, FLF45244, DHCR24, TIGD7, TOPBP1, TSHZ1, and FAM8A1 were strongly correlated with the changes in body weight, fasting plasma glucose and glycosylated hemoglobin content. The top pathways associated with gene expression changes after bariatric surgery was lipid metabolism, small molecule biochemistry and gene expression. Two antimicrobial peptides were among the transcripts with the largest changes in gene expression after bariatric surgery. Conclusions/Significance Data from this pilot study suggest that whole blood expression levels of specific transcripts may be useful as biomarkers associated with susceptibility for type 2 diabetes and/or therapeutic

  2. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

    PubMed Central

    Shah, S; Shah, V; Ahmed, A R; Blunt, D M

    2011-01-01

    Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and provide an overview of the most frequently performed procedures, normal post-operative imaging findings and the appearance of common complications. PMID:21045066

  3. Self-determination and motivation for bariatric surgery: a qualitative study.

    PubMed

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery. PMID:26708344

  4. Weight loss by calorie restriction versus bariatric surgery differentially regulates the hypothalamo-pituitary-adrenocortical axis in male rats.

    PubMed

    Grayson, Bernadette E; Hakala-Finch, Andrew P; Kekulawala, Melani; Laub, Holly; Egan, Ann E; Ressler, Ilana B; Woods, Stephen C; Herman, James P; Seeley, Randy J; Benoit, Stephen C; Ulrich-Lai, Yvonne M

    2014-12-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in five groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n = 7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n = 11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n = 11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n = 11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n = 12). Compared with Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentration and increased hypothalamic corticotropin-releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results indicate that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  5. Getting Off on the Right Foot: The Many Roles of the Psychosocial Evaluation in the Bariatric Surgery Practice.

    PubMed

    Sogg, Stephanie; Friedman, Kelli E

    2015-11-01

    A thorough and specialized pre-operative psychosocial assessment is an important part of a comprehensive bariatric treatment protocol. Over time, the presurgical psychosocial evaluation has evolved from a cut-and-dried process of recommending whether a patient should or should not undergo surgery to a more nuanced and multifaceted process that serves multiple functions. In this article, we review the many ways in which the pre-operative psychosocial evaluation can enhance patient outcomes and adjustment and even the functioning of the interdisciplinary bariatric surgery team. PMID:26294256

  6. Metabolic Changes After Roux-N-Y Bariatric Surgery In Hispanics.

    PubMed

    Hernández-Gil de Lamadrid, José; Nieves-Rivera, Juan J; Mora, Laura; Corretjer, Lisa; Altieri, Pablo I; Suárez, Albert; Banchs, Héctor L; Muñiz, Jesús; Soto, Marie Ivelisse; Escobales, Nelson; Crespo, María

    2015-01-01

    The objective was to describe the metabolic outcomes 12 months after bariatric surgery (Roux-N-Y) in morbidly obese Hispanic patients, and evaluate the correlation between weight loss and the observed changes. Medical records from a hundred-and-two Hispanic obese patients who underwent bariatric surgery were identified at the University of Puerto Rico (UPR) Hospital. The following variables were obtained before and 12 months after surgery: Body Mass Index (BMI), body weight, total cholesterol (TC), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS). Ninety-seven percent of patients underwent Roux-N-Y surgery; 79.4% were females and 44% were diabetics. We observed statistically significant reductions (p < 0.05) 12 months after surgery in: BMI -14.3 (± 6.2) kg/m2, weight -86.1 (± 34.4) Ibs, TC -17.9 (± 32.4) mg/dL, triglycerides -28.7(± 40.6) mg/dL, LDL-15.4 (± 30.6) mg/dL, and FBS -11.3 (± 23.5) mg/dL. HDL, instead increased +5.22 (± 12.9) mg/dL (p < 0.0006). Gastric bypass surgery of the Roux-N-Y significantly improves the lipid profile and FBS levels in obese Hispanic patients. The poor correlation factor between weight loss and these variables suggests that other mechanisms, independent from weight loss, are responsible for these changes. PMID:26742199

  7. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

    PubMed Central

    Coen, Paul M.; Tanner, Charles J.; Helbling, Nicole L.; Dubis, Gabriel S.; Hames, Kazanna C.; Xie, Hui; Eid, George M.; Stefanovic-Racic, Maja; Toledo, Frederico G.S.; Jakicic, John M.; Houmard, Joseph A.; Goodpaster, Bret H.

    2014-01-01

    BACKGROUND. Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (SI) in obese patients. Regular exercise can also improve SI in obese individuals; however, it is unknown whether exercise and RYGB surgery–induced weight loss would additively improve SI and other cardiometabolic factors. METHODS. We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1–3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included SI and glucose effectiveness (SG), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week). RESULTS. 119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups (P < 0.001 for time effect). SI improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min–1/μU/ml, P = 0.18 for Δ, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive SI improvement (PP: CON vs. EX; +1.57 vs. +2.69 min–1/μU/ml, P = 0.019) above that of surgery. Exercise also improved SG (ITT: CON vs. EX; +0.0023 vs. +0.0063 min–1, P = 0.009) compared with the CON group. Exercise improved cardiorespiratory fitness (VO2 peak) compared with the CON group. CONCLUSION. Moderate exercise following RYGB surgery provides additional improvements in SI, SG, and cardiorespiratory fitness compared with a sedentary lifestyle during similar weight loss. TRIAL REGISTRATION. clinicaltrials.gov identifier

  8. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery: Techniques and efficacy

    PubMed Central

    Changela, Kinesh; Ofori, Emmanuel; Duddempudi, Sushil; Anand, Sury; Singhal, Shashideep

    2016-01-01

    AIM: To investigate the techniques and efficacy of peroral endoscopic reduction of dilated gastrojejunal anastomosis after bariatric surgery. METHODS: An extensive English language literature search was conducted using PubMed, MEDLINE, Medscape and Google to identify peer-reviewed original and review articles using the keywords “bariatric endoscopic suturing”, “overstitch bariatric surgery”, “endoscopic anastomotic reduction”, “bariatric surgery”, “gastric bypass”, “obesity”, “weight loss”. We identified articles describing technical feasibility, safety, efficacy, and adverse outcomes of overstitch endoscopic suturing system for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass (RYGB). All studies that contained material applicable to the topic were considered. Retrieved peer-reviewed original and review articles were reviewed by the authors and the data extracted using a standardized collection tool. Data were analyzed using statistical analysis as percentages of the event. RESULTS: Four original published articles which met our search criteria were pooled. The total number cases were fifty-nine with a mean age of 46.75 years (34-63 years). Eight of the patients included in those studies were males (13.6%) and fifty-one were females (86.4%). The mean time elapsed since the primary bypass surgery was 5.75 years. The average pre-endoscopic procedure body mass index (BMI) was 38.68 (27.5-48.5). Mean body weight regained post-RYGB surgery was 13.4 kg from their post-RYGB nadir. The average pouch length at the initial upper endoscopy was 5.75 cm (2-14 cm). The pre-intervention anastomotic diameter was averaged at 24.85 mm (8-40 mm). Average procedure time was 74 min (50-164 min). Mean post endoscopic intervention anastomotic diameter was 8 mm (3-15 mm). Weight reduction at 3 to 4 mo post revision noted to be an average of 10.1 kg. Average overall post revision BMI was recorded at 37.7. The combined

  9. Trends in oral drug bioavailability following bariatric surgery: examining the variable extent of impact on exposure of different drug classes

    PubMed Central

    Darwich, Adam S; Henderson, Kathryn; Burgin, Angela; Ward, Nicola; Whittam, Janet; Ammori, Basil J; Ashcroft, Darren M; Rostami-Hodjegan, Amin

    2012-01-01

    AIMS To identify the most commonly prescribed drugs in a bariatric surgery population and to assess existing evidence regarding trends in oral drug bioavailability post bariatric surgery. METHODS A retrospective audit was undertaken to document commonly prescribed drugs amongst patients undergoing bariatric surgery in an NHS hospital in the UK and to assess practice for drug administration following bariatric surgery. The available literature was examined for trends relating to drug permeability and solubility with regards to the Biopharmaceutics Classification System (BCS) and main route of elimination. RESULTS No significant difference in the ‘post/pre surgery oral drug exposure ratio’ (ppR) was apparent between BCS class I to IV drugs, with regards to dose number (Do) or main route of elimination. Drugs classified as ‘solubility limited’ displayed an overall reduction as compared with ‘freely soluble’ compounds, as well as an unaltered and increased ppR. CONCLUSION Clinical studies establishing guidelines for commonly prescribed drugs, and the monitoring of drugs exhibiting a narrow therapeutic window or without a readily assessed clinical endpoint, are warranted. Using mechanistically based pharmacokinetic modelling for simulating the multivariate nature of changes in drug exposure may serve as a useful tool in the further understanding of postoperative trends in oral drug exposure and in developing practical clinical guidance. PMID:22463107

  10. Early-effect of bariatric surgery (Scopinaro method) on intestinal hormones and adipokines in insulin resistant Wistar rat.

    PubMed

    Dib, N; Kiciak, A; Pietrzak, P; Ferenc, K; Jaworski, P; Kapica, M; Tarnowski, W; Zabielski, R

    2013-10-01

    Bariatric surgery consists in duodenal exclusion from the food passage in obese patients with coexistent type 2 diabetes. Nowadays bariatric surgery is considered the most effective method of glycemic index normalization and insulin resistance reduction. Recent results on obese and non-obese rats showed remission of type 2 diabetes symptoms within few days after the surgery. The aim of the present work was to analyze the mechanisms of neuro-hormonal regulation responsible for early normalization of metabolic syndrome after bariatric surgery. In present study the concentration of selected intestinal hormones and adipokines in blood plasma and gastrointestinal tissues were analyzed. Study was conducted on Wistar rats. Animals were divided into three groups (each n=6): control (SH) shame-operated rats; animals in which visceral fat tissue was extracted (LP); and rats in which Scopinaro bariatric surgery was performed (BPD). Immunochemistry analysis of blood plasma showed decrease of insulin concentration in BPD and LP and increase of polypeptide YY (PYY) in BPD group as compared to the control. In duodenal mucosa homogenates the tendency to reduce insulin in LP and BPD group, and increase PYY and visfatin in BPD group was observed. Histometry analysis showed reduction of mucosa thickness in excluded segments of gastrointestinal tract in BPD group as compared to the SH and LP. Concluding, model studies on rats allowed better understanding of mechanisms important for early normalization of glycemic index and insulin resistance reduction in rats. PMID:24304571