Change in self-esteem after weight-loss treatment. Alexithymia as a psychological mechanism.

BackgroundObesity and diabetes as well as their related complications result in both individual and global health burdens. Among patients who present with both obesity and diabetes, bariatric surgery can lead to remission of both these diseases. However, the possible impact of diabetes on the magnitude of weight loss outcomes after bariatric surgery has not been quantified.MethodsTo address this question, we extracted data from Michigan Bariatric Surgery Cohort (MI-BASiC) to see whether diabetes at baseline could be a predictor of weight loss outcomes. Consecutive patients 18 years of age or older undergoing gastric bypass (GB) or sleeve gastrectomy (SG) for obesity at the University of Michigan between January 2008 and November 2013 were included in our retrospective cohort. All patients had either body mass index (BMI) > 40 kg/m2 or BMI 35 – 39.9 kg/m2 with comorbid condition. Firstly, we performed Generalized Linear Mixed Model (GLMM) analysis to compare the probability of achieving BMI under 30kg/m2 or achieving excess body weight loss (EBWL) 50% or more for patients with or without diabetes. We then further tested the effect of presence of diabetes for the BMI outcomes across time using Linear Mixed Model (LMM) analysis. Finally, we conducted a LMM analysis to determine if diabetes is a predictor of the future weight loss, percentage of total weight loss or percentage of excess weight loss over 5 years of follow up.ResultsBased on our criteria, 380 patients were included for GB [female 305 (80.3%), mean age 43.6±0.6 years, mean BMI 47.3±0.4kg/m2, diabetes 149 (39.2%), on insulin 45 (11.8%)] and 334 for SG [female 259 (77.5%), mean age 45.3±0.6 years, mean BMI 49.9±0.5kg/m2, diabetes 108 (32.3%), on insulin 29(8.7%)]. From GLMM analysis, the presence of diabetes at baseline did not impact the probability of achieving BMI under 30kg/m2 (p=0.0848), but substantially impacted the probability of achieving 50% or more EBWL (p=0.0021) with individuals without diabetes having a 1.6 (odds ratio 1.56, 95% CL [1.18-2.08]) times higher chance to achieve this threshold. We also showed that individuals with diabetes at baseline had a significant effect to modify BMI points lost, regardless of the surgery type (p=0.0178). The presence of diabetes at baseline diminished weight loss by 1.2 BMI points (95% CL [0.21- 2.20]) which is roughly 10 to 15% of the total BMI points to be lost. LMM analysis further confirmed that after adjusting the time, surgery type, age, gender and baseline weight, there was still a significant difference of absolute weight loss (p=0.0110), percentage of total weight loss (p=0.0089) and percentage of excess weight loss (p=0.0365) between individuals with diabetes versus individuals without diabetes.ConclusionIn conclusion, our data demonstrate that diabetes diminishes the ultimate weight loss effect of bariatric surgery. Further research is needed to understand why this is the case.

Genetic risk score based on obesity-related genes and progression in weight loss after bariatric surgery: a 60-month follow-up study

Analysis of medium-length biliopancreatic limb on weight loss efficacy in Roux-en-Y gastric bypass: A propensity score-matched retrospective cohort study.

Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy on the resolution of non-alcoholic fatty liver disease. The study included 55 patients with non-alcoholic fatty liver disease who underwent laparoscopic sleeve gastrectomy at a tertiary institution. The analysis consisted of preoperative liver biopsy, abdominal ultrasound, weight loss parameters, Non-Alcoholic Fatty Liver Fibrosis Score and selected laboratory parameters. Before the surgery, 6 patients were diagnosed with grade 1 liver steatosis, 33 patients with grade 2 and 16 patients with grade 3. One year after the surgery, only 21 patients had features of liver steatosis at ultrasound. All weight loss parameters showed statistically significant changes during the observation; the median percentage of total weight loss was 31.0% (IQR: 27.5; 34.5) with p = 0.0003, the median percentage of excess weight loss was 61.8% (IQR: 52.4; 72.3) with p = 0.0013 and the median percentage of excess body mass index loss was 71.0% (IQR: 61.3; 86.9) with p = 0.0036 12 months after laparoscopic sleeve gastrectomy. The median Non-Alcoholic Fatty Liver Fibrosis Score at baseline was 0.2 (IQR: -0.8; 1.0) and decreased to -1.6 (IQR: -2.4; -0.4) (p < 0.0001). Moderate negative correlations between Non-Alcoholic Fatty Liver Fibrosis Score and percentage of total weight loss (r = -0.434, p < 0.0001), percentage of excess weight loss (r = -0.456, p < 0.0001) and percentage of excess body mass index loss (r = -0.512, p < 0.0001) were found. The study supports the thesis that laparoscopic sleeve gastrectomy is an effective method for treatment of non-alcoholic fatty liver disease in patients with morbid obesity.

The main objectives of this study were to verify the relationship among body condition at parturition, decrease of backfat thickness and weight during the lactation and the interval from weaning to oestrus of sows. It was performed with 10 gilts and 10 fifth, sixth and seventh parity Camborough sows. The average breeding age and weight of the gilts were respectively 231 days and 149.5 kg. During lactation all females were fed a wet diet (3.34 Mcal/kg, 17% CP), ad libitum. The average daily food consumption was 5.233 for gilts and 5.721 kg for multiparous sows. Ultrasonic measurements of backfat at the P2 site were recorded on day 6 before and days 2, 7, 14, 21 and 25 after parturition. Body weight was recorded on the same dates, except the day before parturition. Sows were divided into 2 groups according to their backfat thickness 6 days before parturition. Sows with a backfat thickness of 16 mm or less were assigned to the L-group, while those with a backfat thickness more than 16 mm were assigned to the H-group. After weaning, the interval from weaning to oestrus was recorded. The percentage of total weight loss during lactation was slightly higher (not significant) in the H-group (-4.26%) than in the L-group (-2.64%). The percentage of backfat thickness decreased in both groups from 6 days before parturition until day 25 of lactation, but the decrease was highest in the H-group (p < 0.03). The weaning-oestrus interval did not differ significantly between the 2 groups. In conclusion: there was no correlation between percentage of weight loss (total) and weaning to oestrus interval, or percentage of backfat thickness loss (total or by periods) and weaning-oestrus interval, or percentage of weight loss (total or by periods) and percentage of backfat thickness loss (total or by periods). On the other hand, there was a significant positive correlation between weaning-oestrus interval and percentage of weight loss during the third week of lactation.

In the historical development of psychiatric nosology, as in the rest of medicine, more severe disorders tend to be recognized before disorders with milder symptom profiles. Thus, psychiatric classifications recognized schizophrenia and melancholia before schizotypal personality disorder and dysthymia. So, too, with the classification of eating disorders; anorexia nervosa, which may result in death, was recognized many years before bulimia nervosa. The most recent addition to the psychiatric classification of eating disorders is “binge eating disorder.” The diagnosis of binge eating disorder is given to the many obese individuals who are distressed by recurrent binge eating, yet do not regularly engage in the compensatory behavior (e.g., vomiting or use of laxatives) that is seen in individuals with bulimia nervosa. Although binge eating disorder is not an official DSM-IV diagnosis, a variety of studies support its validity (1–4). A description of the disorder and its diagnostic criteria appear in DSM-IV Appendix B, titled “Criteria Sets and Axes Provided for Further Study.” Binge eating disorder is common among study groups drawn from weight-control programs (15%–50%), which show women are approximately 1.5 times more likely to have the disorder than men. In nonpatient community samples, a prevalence rate of 1%–4% has been reported (1, 3). Typically, the disorder begins in late adolescence or in the early 20s, often after weight loss from severe dieting. Common associated features include marked fluctuations in weight over time and a history of depression, anxiety, low self-esteem, somatic concern, and interpersonal sensitivity. Along with the recognition of binge eating disorder and its clinical features, there has been increasing interest in developing effective treatments for the disorder. Several studies have examined the relative efficacy of psychotherapeutic and psychopharmacological approaches (5). This case conference illustrates some of the challenges and rewards involved in the treatment of a patient with binge eating disorder.

Effectiveness of sleeve gastrectomy plus fundoplication versus sleeve gastrectomy alone for treatment of patients with severe obesity: a systematic review and meta-analysis

Several studies have investigated if bariatric surgery candidates with binge eating disorder (BED) are at risk for suboptimal postoperative weight loss. The aim of this systematic review with meta-analysis was to evaluate the association between binge eating diagnosed preoperatively and weight loss after bariatric surgery. MEDLINE, EMBASE, CENTRAL, LILACS, and other specialized databases were searched on August 2020. Clinical trials and observational studies including individuals who had undergone any type of bariatric surgical treatment with preoperative evaluation of BED and at least one postoperative measure of weight were initially selected. Four reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. Nineteen studies, comprising 3223 participants (80.25% women; median age 41years), met the inclusion criteria for meta-analysis. At 6months postoperative, the percentage of total weight loss (%TWL) was not significantly different between BED and non-BED groups [6 studies, 914 participants: - 0.75% (95% CI, - 2.79 to 1.29; I2 = 0%)], even when analyzing only those three studies that included gold standard assessment tools. No significant differences were found at 12, 24, 36, or 60months. Pre-bariatric BED seems to have little or no influence on weight loss after surgery. However, many questions remain unanswered because of the use of different measures across studies. The heterogeneity among studies emphasizes the importance of investigators using the same assessment measures.

In patients with BMI greater than 50, sleeve gastrectomy (SG) may not be adequate to treat obesity. To determine whether one-anastomosis gastric bypass (OAGB) can provide better outcomes compared with SG in patients with BMI greater than 50, a systematic review and meta-analysis was conducted, including a total of nine retrospective studies with a total of 2332 participants. There was a significant difference in the percentage of excess weight loss [weighted mean difference (WMD): 8.52; 95% CI: 5.81–11.22; P<0.001) and percentage of total weight loss (WMD: 6.65; 95% CI: 5.05–8.24; P<0.001). No significant differences were seen in operative time (WMD: 1.91; 95% CI: −11.24 to 15.07; P=0.77) and length of stay in hospital (WMD: −0.41; 95% CI: −1.18 to 0.37; P=0.30) between the two groups. There were no significant differences between OAGB with SG in Clavien–Dindo grades I–III [odds ratio (OR): 1.56; 95% CI: 0.80–3.05], or grade IV complications (OR: 0.72; 95% CI: 0.18–2.94). The meta-analysis on remission of type 2 diabetes indicated a comparable effect between SG and OAGB (OR: 0.77; 95% CI: 0.28–2.16). The OAGB group had a significantly higher rate of remission of hypertension compared with the SG group (OR: 1.63; 95% CI: 1.06–2.50). The findings of this meta-analysis suggest that the OAGB accomplished a higher percentage of total weight loss and percentage of excess weight loss at short-term and mid-term follow-up but, there was no major difference between the OAGB and SG operations in terms of perioperative outcomes, complications, and diabetes remission.

Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery

Whether or not the initial body mass index (BMI) influences weight loss and comorbidities improvement after bariatric surgery continues to be a matter of debate. The main reason for this is a lack of studies including obesity class I. Retrospective study with patients submitted to gastric bypass at a single institution. They were classified based on initial BMI (obesity class I, II, and III), and a comparative analysis of their metabolic profile (glucose, HbA1c%, C-peptide, insulin and diabetes medication), lipid profile (triglycerides, total cholesterol, HDL, LDL), and clinical data (systolic/diastolic blood pressure and cardiovascular risk) was performed at 0 and 12months. Diabetes remission and weight loss were also analyzed. Two-hundred and twenty patients were included (23 in group 1, 113 in group 2, and 84 in group 3). Initial weight, BMI, and number of patients with T2DM were statistically different in group 1; other parameters were homogenous. At 12months, every group had similar improvement of the metabolic profile, excepting serum insulin. Diabetes remission was 57.9, 61.1, and 60% for group 1, 2, and 3. For weight loss, there were differences between groups when using BMI and percentage of excess weight loss, but not with percentage of total weight loss. The non-metabolic and clinical data improved without differences, except for total cholesterol and LDL. The metabolic, lipid, and clinical profiles associated with obesity present similar improvement 1year after laparoscopic gastric bypass, despite different baseline BMI. Diabetes remission and percentage of total weight loss were also similar.

Background: Candidates for bariatric surgery need realistic targets for weight loss after surgery and the surgeons needto ensure that the patients are on the way to successful weight loss. This study aimed to present a weight loss calendarestimating the average loss in BMI per week after the surgery and to introduce a simple formula to help make an easy andreliable prediction of the weight loss outcome after bariatric surgery.Patients and Methods: This is a retrospective study that included patients who were consecutively recruited for bariatricsurgery. During the postoperative follow-up visits, the patients’ weight loss data were recorded and analyzed. The studycohort was randomly split into a training group (to derive the regression models) and a validation group (to validate theobtained model).Results: The mean preoperative BMI was 47.8 ± 8.3 kg/m2. At the 12-month follow-up, the mean BMI was 30.04 ± 5.3 kg/m2, the mean percentage of excess weight loss (EWL %) was 80.9 ± 18.7 and themean percentage of total weight loss % was 36.9 ± 5.8. The regression equation was formulated as follows: 1-yearEWL % = 139.71 + (- 0.291 × age) + (- 0.981 × baseline BMI) + (0.95 × 2-week EWL %) + (- 17.151 × previousbariatric procedure). The regression formula was: 1-year BMI = (- 3.61) + (- 0.079 × age) + (0.539×baseline BMI)+ (4.977 × previous bariatric procedure).Conclusion: The patient’s age, baseline BMI and history of previous bariatric procedures were significant predictors ofthe 1-year BMI. The same variables, combined with the early postoperative EWL %, significantly predicted the 1-yearEWL %.

Revisional bariatric surgery in the elderly: a comprehensive review of the safety and efficacy profile.

BackgroundTelephone-based Cognitive Behavioral Therapy (Tele-CBT) has shown to reduce disordered eating and psychological distress after metabolic and bariatric surgery (MBS). However, it is currently unknown how Tele-CBT impacts outcomes long term, and if differences in weight loss trajectories following Tele-CBT emerge with a long-term follow-up. This study aimed to identify whether Tele-CBT remains effective at 18 months post-intervention for improving psychological distress and maladaptive eating, and mitigating recurrent weight gain.MethodsThis large, multisite randomized control trial was conducted at three hospital-based MBS programs in Ontario, Canada. Participants (n = 306) were randomized 1:1 to receive either Tele-CBT or standard MBS care. The primary outcome was percentage of total weight loss (%TWL). Secondary outcomes included disordered eating (Binge Eating Scale, Emotional Eating Scale) and psychological distress (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). Linear mixed models assessed group-by-time interactions across five time points: baseline (1-year post-MBS), post-intervention, and 3-, 12-, and 18-month follow-ups.ResultsTele-CBT resulted in significant post-intervention improvements in binge eating (MD = − 0.46, p < .001), emotional eating (MD = − 0.14, p = 0.01), anxiety (MD = − 0.40, p < .001), and depressive symptoms (MD = − 0.47, p < .001). These improvements were all sustained at 3 months post-intervention (p < .05) whereas only improvements for emotional eating were sustained at 12 months post-intervention (MD = − 0.15, p = 0.01). There were no significant differences in %TWL trajectories between the Tele-CBT and control groups.ConclusionsTele-CBT provides psychological benefits, particularly in reducing emotional eating. Findings highlight the need for continued psychosocial support to sustain other psychological benefits and mitigate recurrent weight gain post-MBS and further research on optimizing intervention timing and duration.Trial RegistrationClinicalTrials.gov Identifier: NCT03315247.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-025-08163-2.

Weight loss after bariatric surgery is commonly reported as either a percentage of initial body weight (%IBW) or 100% minus %IBW which is a percentage of total weight loss (%TWL). These are basically equivalent expressions. Weight loss is also reported as %EWL or as a percentage of excess body mass index loss (%EBMIL). These last two expressions incorporate the concepts of ideal body weight and BMI = 25 as reference points. More straightforward but less commonly used is absolute weight loss. This study compares these various measures using the Bariatric Outcomes Longitudinal Database (BOLD). BOLD data, 2008-2011, was accessed for outcomes on 239,659 gastric bypass (GB) and sleeve gastrectomy (SG) patients with approval of the Surgical Review Corporation. The outcome data was converted into %TWL, %EWL, and %EBMIL. %EBMIL was varied by changing the reference BMI from 1 to 25 kg/m(2). The post operation data was analyzed for both procedures. Variation coefficients (VC) were compared using different measurements on the same data pool. We assumed that the lesser the variation, the more reliable the measure is, and therefore, we made use of the VC to compare the different reporting methods. There were 164,247 patients who remained after removal of errors and missing data. Demographics are as follows: 78.1% female, 73.1% white, 12.5% black, 8.71% Hispanic, 81.6% GB, 18.4% SG, mean age of 44.8 years, height of 167.0 cm, weight of 132.0 kg, and BMI of 47.1 kg/m(2). GB patients had 26.8%TWL at 6 months (VC = 21.5) and 34.2%TWL at 12 months (VC = 27.0). %EWL was 54.7 at 6 months (VC = 27.3) and 69.4 at 12 months (VC = 30.9). Varying the reference BMI for %EBMIL showed the lowest VC to be 0-2 kg/m(2) for GB up to 12 months post operation. SG patients had 24.0%TWL at 6 months (VC = 25.4) and 29.5 at 12 months (VC = 30.5). %EWL was 50.0% at 6 months (VC = 31.4) and 60.2% at 12 months (VC = 34.5). Varying the reference BMI for %EBMIL showed that the lowest VC occurred when the reference weight was chosen as 0 kg/m(2) for both GB and SG. %TWL or, equivalently, %IBW had the lowest variation coefficient and therefore is the more accurate measure of weight loss following bariatric surgery. For ease and accuracy of comparison, the percentage of initial body weight or percentage of total weight loss should be used for the expression of weight loss after surgery.