Acceptance Of Bariatric Surgery Research Articles

Insulin use and new diabetes after acceptance for bariatric surgery: comparison of outcomes after completion of surgery or withdrawal from the program

IntroductionIn people accepted onto a bariatric surgery program we compared diabetes-related outcomes in those who completed surgery with those who withdrew before having surgery—examining rates of insulin use in people...

Factors Influence the Acceptance of Surgical Treatment in Chinese Bariatric Surgery Candidates

BackgroundThe prevalence of obesity and obesity-related disorders is rapidly increasing among the Chinese populations. Bariatric surgery is becoming more and more popular in China, yet little cases were performed compared with western countries. The acceptance of this new treatment modality in Chinese bariatric surgery candidates was seldom studied.ObjectiveTo investigate the factors affecting the choice of bariatric surgery in Chinese patients with obesity and metabolic disorders, so as to promote the popularization of bariatric surgery in developing countries like ChinaMethodsPatients with obesity and related metabolic disorders meet the indications for bariatric surgery in the Department of Metabolic and Bariatric Surgery in the First Affiliated Hospital of Jinan University between January 2016 and April 2017 were asked to answer a questionnaire about the demographics of the patients, social economic status, present and past history, family history, etc. The data collected and the relationship of the acceptance of bariatric surgery were analyzed.ResultsThere were 157 patients (51 males, 32.5%; 106 females, 67.5%) with mean BMI 38.7 ± 8.1 kg/m2 answered the questionnaire. One hundred twenty-three of them (78%) accepted bariatric surgery. By univariate analysis, it was found that patients’ weight, BMI, family support, medical insurance, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are correlated with the acceptance of bariatric surgery. By multivariate analysis, it was found that patients’ weight (P = 0.024), BMI (P = 0.007), family support (P < 0.001), medical insurance (P < 0.001), past surgical history (P = 0.011), family history of T2DM (P = 0.020), and obesity-related comorbidities and symptoms (P = 0.030) are statistically significant and were positively correlated with the acceptance of bariatric surgery. Age, height, gender, history of smoking and alcohol consumption, family history of obesity, history of hypertension and T2DM, education level, and marital status were not statistically significant (P < 0.05).ConclusionsPatients with heavier weight, higher BMI, family support, medical insurance reimbursement, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are more likely to consider bariatric surgery in Chinese bariatric surgery candidates. It will be important to provide appropriate healthcare education and support to patients focusing on both obesity-related health risks and options of surgical treatment so to improve their acceptance of bariatric surgery.

Effect of Health Literacy on Help-seeking Behavior in Morbidly Obese Patients Agreeing to Bariatric Surgery.

We aimed to evaluate the effect of health literacy on agreement for bariatric surgery among morbidly obese patients. The data of 242 morbidly obese patients (body mass index-BMI ≥40kg/m2) were evaluated in a cross-sectional case-control pattern. The patients were classified into two groups as those who were attending the clinic for the purpose of receiving bariatric surgery (n=138) and those who did not (n=104). The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47), consisting of 47 questions, was used for the health literacy evaluation. It was seen that patients who accepted bariatric surgery were younger and had higher weight and BMI values (p<0.001). HLS-EU-Q47 index results were 33.33 (15.63-50) in the group who agreed to bariatric surgery and 26.04 (8.33:46.88) in the group who did not agree to bariatric surgery, and a statistically significant difference was determined between the two groups (p<0.001). From the HLS-EU-Q47 questionnaire, an insufficient level (0-25) was found for 2.9% of the group who agreed to bariatric surgery and 45.2% of the group who did not (p<0.001). The problematic-limited level was similar in the two groups (>25-33) (respectively, 36.2%, 37.5%, p=0.840). A sufficient level (>33-42) and a perfect level were higher in the group who agreed to bariatric surgery (respectively, 42.8%, 18.1%, p<0.001). There is a relationship between health literacy and acceptance of bariatric surgery in morbidly obese patients. The higher the health literacy level, the more the agreement to bariatric surgery increased.

Socioeconomic deprivation remains a significant barrier in the choice of bariatric surgery even when full medical expense coverage is present

BackgroundThe prevalence of obesity is increasing in the socioeconomically deprived sector of the French population. ObjectivesOur objective was to assess whether the presence of a socioeconomic gradient could affect access to bariatric surgery in a publicly funded healthcare system with full medical expense coverage. SettingThe study was conducted at a general hospital and a health examination center. MethodsWe prospectively included 100 patients who were admitted to the hospital for a preoperative bariatric surgery evaluation. As a reference group, we included 578 patients from the same area with body mass index (BMI) values≥35 kg/m² who visited the health center for regular medical, cardiovascular checkups. The patients were required to complete the Evaluation of Precariousness and Health Inequalities in Health Examination Centers (EPICES) questionnaire to investigate deprivation (deprivation cutoff≥30.17). ResultsA total of 94 patients had complete data, with a mean EPICES score of 37.7±19.1 (P<.001). Patients were younger (mean age 39.2±12.7 years, P<.001), had a stronger female predominance (87%, P = .030), and higher mean BMI (43.3±6.9 kg/m², P<.001) than the reference group and were less socioeconomically deprived (64% versus 82% in the reference group, P<.001). No significant correlations existed among BMI, participant age, and deprivation score. In a subsequent age- and BMI-matched analysis, bariatric surgery candidates exhibited lower levels of deprivation. ConclusionsThe presence not only of material (e.g., coverage for medical expenses) but also social support is an important step toward the acceptance of bariatric surgery by morbidly obese patients.

The influence of an individual's weight perception on the acceptance of bariatric surgery.

This study assessed the proportion of US adults with excess weight and obesity who consider bariatric surgery to be appropriate for themselves and how their own weight perception influences this consideration. A stratified sample of 920 US adults in June 2014 was obtained through an online survey. The respondents were queried about bariatric surgery acceptability and personal weight perception. Average body mass index (BMI) was determined for each demographic variable, and responses were characterized according to BMI and concordance with perceived weight status. Chi-square analyses served to assess perceived weight concordance in relation to bariatric acceptance. Only 32% of respondents with Class III obesity indicated that bariatric surgery would be an acceptable option for them, most often because they considered it to be too risky. Respondents with Class III obesity and concordant perception of weight status were more likely (P < 0.03) than discordant Class III respondents to accept bariatric surgery. Likewise, concordant respondents with excess weight, but not obesity, were more likely (P < 0.001) to correctly consider bariatric surgery to be inappropriate for them. Despite good safety and efficacy, many persons still believe bariatric surgery is too risky. Weight perception concordance or discordance influences one's decision to consider this treatment option.

The effect of socioeconomic and individual factors on acceptance levels of bariatric surgery among Chinese patients

BackgroundThe prevalence of obesity has been increasing over the past years in China. Bariatric surgery is an effective treatment that has been gradually accepted by obese patients. This study explored the effect of different factors on the acceptance levels of bariatric surgery. MethodsA total of 186 obese patients (body mass index [BMI]≥32 kg/m2) answered a questionnaire, including questions about their marital status, income level, education level, health insurance, and obesity-associated co-morbidities; 84 of these patients underwent bariatric surgery. The data was analyzed using the χ2 test. ResultsUnivariate analyses found that age, BMI, gluttonous behavior, income level, health insurance, medications, and weight loss expectations were correlated with the acceptance of bariatric surgery. Multivariate analyses found that BMI (P = .034) and weight loss expectations (P = .001) were positively correlated with the acceptance of bariatric surgery. Patients with gluttonous behavior accepted bariatric surgery (P = .003). However, income levels (P<.001) and health insurance (P = .001) were negatively correlated with the acceptance of bariatric surgery. ConclusionObesity was more prevalent in families of low social status and income levels; this group requires medical assistance, and education is still necessary for obese individuals of high social status and income levels.

Promises and Ethical Pitfalls of Surgical Innovation: the Case of Bariatric Surgery

The last two decades have seen remarkable advances in and acceptance of bariatric surgery. These advances include quality assurance, certification of surgeons and their institutions and the development of national bariatric registries. Yet, in spite of these advances, an urgent need to improve ethical standards in bariatric surgery remains. In particular, surgical innovation must be subjected to adequate scrutiny and sufficient safeguards. New procedures and the processes by which they are assessed should be subject to review and approval by the ethics committees operating under clearly defined guidelines. The public must be able to have confidence that the surgery itself, and the innovative practices that are introduced within it, are not subject to distortions associated with personal, wider professional, industry or institutional interests.

EARLY COMPLICATIONS IN BARIATRIC SURGERY:

Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2. Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

A Predicted Future for Bariatric Surgery: Using the Surgical Model.

Bariatric surgery is the only currently available, effective, long-term method for controlling morbid obesity. 'Long-term' non-surgical, medical, voluntary weight loss data is rare; where it exists, it averages only 5-10% of patients' total body weight - of minimal long-term value for the morbidly obese - and has a consistently high failure rate, with many patients ultimately progressing to disability, End-Stage Obesity Syndrome or premature death. The author predicts that the time will come when most members of the lay and medical communities accept that bariatric surgery is the conservative approach to treatment for the morbidly obese. The mechanism will be by bariatric surgeons gathering and reporting data on their morbidly obese patients from the options presented. Data collection may take the form of controlled, randomized, descriptive, case or group studies of surgical and nonsurgical therapies upon patients' psycho-socioeconomic-physical-behavioral-medical co-morbidities. Stressed is the concept that all bariatric surgeons have the capability and the implied duty to analyze their patients' data and disseminate the results, in part to achieve the predicted improvement in medical and lay acceptance of bariatric surgery as a conservative concept.