Bariatric Surgery Service Research Articles

BS P05 The Return to Bariatric Surgery Following the COVID Pandemic 2020- A Single Center Prospective Study

Abstract Background Elective surgical practice was paused in March 2020 to cope with the Covid pandemic. Bariatric surgery was amongst the first specialities to be stopped as resource allocation prioritised lifesaving service for Covid positive patients over what is considered quality of life improving procedures. It was also one of the last to be restarted due to fears of Covid infection in obese patients undergoing surgery both of which are known risk factors of mortality in Covid cases. This study describes outcomes after bariatric surgery since the weight-loss program restarted and the measures to ensure service provision and maintenance of patient safety. Methods Elective bariatric surgery restarted in June 2021; patients were managed within a ‘green’ elective pathway in a new ring-fenced elective surgical hub. All patients who had surgery from June 2021 to January 2023 in a single centre were identified from a prospectively-maintained database of operations. The outcomes were patient safety measured by Covid infection and complication rates post operatively, impacts on hospital resources measured by length of stay in hospital and HDU/ITU bed occupation, impacts on the Bariatric Surgery service measured by waiting time for surgery and cancellations, and benefits to patients measured by remission of diabetes and hypertension. Results 124 patients were included; 42 (34%) had sleeve gastrectomy and 82 (64%) had gastric bypass. There were no Covid infections/complications in this series. Median length of stay after surgery was two days with no admissions to HDU/ICU. Waiting time for surgery was >52 weeks at the start of the study period which has fallen to 15 weeks after listing and no operations were cancelled due to lack of beds. Post-operative outcomes were favorable and in line with national data; 87% of patients had remission of diabetes and 60% of patients were off anti-hypertensive medications one year after surgery. Conclusions The creation of dedicated ring-fenced elective surgical hub allowed the rapid restart of bariatric surgery despite the effects of the Covid-19 pandemic. This model separated elective and acute patients reducing exposure of high-risk patients. This allowed the resumption of weight-loss surgery safely as evident by the zero Covid-related complications, no additional pressure to hospital resources such as beds and intensive care unit capacity, a high-quality service with short waiting times and favorable long term outcomes. This are all signs of good practice in a resilient service and can very easily be replicated in the future whenever required.

A non-randomised feasibility study of a mHealth follow-up program in bariatric surgery

BackgroundBehavioural support via mobile health (mHealth) is emerging. This study aimed to assess the feasibility, acceptability, cost, and potential effect on weight of a mHealth follow-up program in bariatric surgery.MethodsThis was a non-randomised feasibility study describing intervention development and proof in the concept of a mHealth follow-up program in bariatric surgery. The study compares a prospective cohort with a historical control group and was conducted in a tertiary bariatric surgery service in Australia. The intervention group included individuals who had bariatric surgery (2019–2021) and owned a smart device, and the historical control group received usual postoperative care (2018). The intervention involved usual care plus codesigned biweekly text messages, monthly email newsletters, and online resources/videos over a 6-month period. The primary outcome measures included feasibility (via recruitment and retention rate), acceptability (via mixed methods), marginal costs, and weight 12 months postoperatively. Quantitative analysis was performed, including descriptive statistics and inferential and regression analysis. Multivariate linear regression and mixed-effects models were undertaken to test the potential intervention effect. Qualitative analysis was performed using inductive content analysis.ResultsThe study included 176 participants (n = 129 historical control, n = 47 intervention group; mean age 56 years). Of the 50 eligible patients, 48 consented to participate (96% recruitment rate). One participant opted out of the mHealth program entirely without disclosing their reason (98% retention rate). The survey response rate was low (n = 16/47, 34%). Participants agreed/strongly agreed that text messages supported new behaviours (n = 13/15, 87%); however, few agreed/strongly agreed that the messages motivated goal setting and self-monitoring (n = 8/15, 53%), dietary change (n = 6/15, 40%), or physical activity (n = 5/15, 33%). Interviews generated four main themes (n = 12): ‘motivators and expectations’, ‘preferences and relevance’, ‘reinforced information”, and ‘wanting social support’. The intervention reinforced information, email newsletters were lengthy/challenging to read, and text messages were favoured, yet tailoring was recommended. The intervention cost AUD 11.04 per person. The mean 12-month weight was 86 ± 16 kg and 90 ± 16 kg (intervention and historical control) with no statistically significant difference. Intervention recipients enrolled at 3 months postoperatively demonstrated a statistically significant difference in 12-month weight (p = 0.014).ConclusionAlthough this study observed high rates of recruitment and retention, findings should be considered with caution as mHealth may have been embraced more by the intervention cohort as a result of the 2019 coronavirus pandemic. Of the various digital strategies developed and tested, the text message approach was the most acceptable; however, future intervention iterations could be strengthened through tailoring information when possible. The use of email newsletters and online resources/videos requires further testing of effectiveness to determine their value for continued use in bariatric surgery services.

What is the role of psychology in bariatric surgery? A survey of the differing views of psychologists, the multidisciplinary team, and patients in the UK.

Although psychologists are a key member of the bariatric multidisciplinary team (MDT), there is a lack of clarity about the specific remit of their role. This exploratory study was conducted to identify differences, priorities and clarify how the role of psychology is perceived in the United Kingdom. We conducted surveys of three major stakeholder groups (psychologists, patients, and the bariatric multidisciplinary team) which focused on their perception of psychology in bariatric surgery. The results showed that in UK bariatric services, psychologists are spending the majority of their clinical time providing pre-operative assessments. Differences emerged between psychologists and MDT in how they viewed the purpose of these assessments, with the MDT viewing them as identifying contraindications to surgery whereas psychologists viewed them as identifying readiness for surgery. A total of 51% of patients reported they had not been able to access psychology services when needed and viewed provision of post-operative psychological support to be a key priority. Key themes and tensions emerged around (a) high demand for services yet limited psychology resource, (b) the purpose of the pre-operative assessment and (c) the provision of pre-operative versus post-operative support. These themes combine and interact in a way that currently makes it extremely challenging to provide coherent psychology services. There is clearly a need for education, consensus and adequate resourcing of the psychology role within bariatric surgery services in the United Kingdom.

A mixed-method study to inform the development and implementation of eHealth in a bariatric surgery service in an Australian public hospital.

This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. This mixed-method study (survey and semi-structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two-thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.

Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil.

this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2017 to 2020 at a hospital with specialties besides the basic ones in southern Brazil. the study sample included 26 participants. The first 13 laparotomies, and the first 13 laparoscopies performed at the bariatric surgery service of the institution were evaluated. The values evaluated in such comparison analyzed the costs of operation and hospitalization. It is important to highlight that, in addition to the cost benefit, other costs take significance in the health area, such as: cost-utility, cost-effectiveness and cost-minimization, in addition to the cost-opportunity that is reassessed in the observation of the broad context associating all the values raised here. The software used for data analysis was Excel version® 365. The economic analysis was performed evidencing the profile of the patients and the direct and indirect costs involved in each segmentation. the direct and indirect costs of videolaparoscopy amounted to BRL 10,108.10 and laparoscopy to the amount of BRL 12,568.14. it was concluded that laparoscopy presents more savings in the aspects of all health valuations to the detriment of laparotomy. It was concluded that the videolaparoscopy presents more savings in the aspects of all health valuations than the laparotomy.

"Is it time to throw out the weighing scales?" Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches.

People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches. Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis. 82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness. Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias. Johnson & Johnson funded the BiasProof licence and publication open access charge.

Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil

RESUMO Introdução: o presente estudo tem como objetivo avaliar os principais custos diretos e indiretos das primeiras laparotomias e videolaparoscopias em cirurgias bariátricas em uma análise clínica-econômica, retrospectiva e transversal de 2017 a 2020 em um hospital terciário do sul do Brasil. Métodos: a amostra do estudo incluiu 26 participantes. Foram avaliadas as primeiras 13 laparotomias e as primeiras 13 videolaparoscopias realizadas no serviço de cirurgia bariátrica da instituição. Os valores avaliados em tal comparação analisaram os custos da operação e da internação. É importante ressaltar que além do custo-benefício, outros custos tomam significância na área da saúde. São eles: o custo-utilidade, o custo-efetividade e o custo-minimização, além do custo-oportunidade que é reavaliado na observação do contexto amplo associando todas as valorações aqui levantadas. O software utilizado para a análise dos dados foi o Excel® versão 365. A análise econômica foi realizada evidenciando o perfil dos pacientes e os custos direto e indireto envolvidos em cada segmentação. Resultados: os custos diretos e indiretos da videolaparoscopia somaram o montante de R$ 10.108.10 e da laparoscopia o montante de R$ 12.568,14. Conclusão: concluiu-se que a videolaparoscopia apresenta mais economia nas vertentes de todas as valorizações em saúde em detrimento da laparotomia.

Psychopathology and eating behaviour in people with type 2 diabetes referred for bariatric surgery

PurposePsychopathology and disordered eating behaviours are putative pre-operative risk factors for suboptimal outcomes post-bariatric surgery. Documented psychopathology prevalence rates vary in bariatric candidate samples. Further, less attention has been paid to vulnerable subgroups such as people with diabetes who might be at an elevated risk. For these reasons, this study aimed to investigate the rates of psychopathology and disordered eating in pre-surgical candidates with type 2 diabetes mellitus (T2DM).MethodsParticipants were 401 consecutive patients from a state-wide bariatric surgery service for people with T2DM. Psychopathology was measured using multi-modal assessment including diagnostic interview and battery of validated questionnaires. The mean age of the sample was 51 years with a mean BMI of 46 kg/m2. The majority of the sample was female (60.6%), born in Australia (87%) and 18.2% identified as Aboriginal and/or Torres Strait Islander.ResultsRates of current psychopathology in this sample included: major depressive disorder (MDD; 16.75%), generalised anxiety disorder (GAD; 20.25%), insomnia (17.75%) and binge eating disorder (BED; 10.75%). There were no significant differences on measures between people who endorsed Aboriginal and/or Torres Strait Islander status compared to those who did not endorse. The mean total score on the BES was 21.82 ± 10.40 (range 0–39), with 8.2% of participants meeting criteria for severe binge eating. Presence of an eating disorder was not significantly associated with degree of glycemic compensation. Average emotional eating scores were significantly higher in this study, compared to reference samples. Significantly increased binge eating severity and emotional eating severity was revealed for people with T2DM and comorbid MDD, social anxiety and eating disorders. Binge eating severity was associated with GAD, food addiction, substance use disorders, and history of suicide attempt but not emotional eating severity.ConclusionAmongst people with T2DM seeking bariatric surgery, MDD, GAD and emotional eating were common. Psychopathology in a sample of people with T2DM seeking bariatric surgery was significantly associated with severity of disordered eating. These findings suggest people with T2DM seeking bariatric surgery may be vulnerable to psychopathology and disordered eating with implications for early identification and intervention.Level of evidenceEvidence obtained from cohort or case–control analytic studies.

Handling of the Covid-19 Pandemic and Its Effects on Bariatric Surgical Practice: Analysis of GENEVA Study Database

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.Materials and MethodsThe current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.ResultsA total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001).Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.ConclusionThis study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.Graphical abstract

Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia.

Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0–82.0%) and hypertension (73.7–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.

Covid-19 pandemic impacts on postoperative patients of bariatric surgery / Impactos da pandemia da Covid-19 em pacientes no período de pós-operatório da cirurgia bariátrica

The World Health Organization declared a global pandemic for the new coronavirus on March 11, 2020. The present study aims at describing the impact of coping with the COVID-19 pandemic on bariatric post-surgery patients. This is a cross-sectional study with a qualitative approach in which data were collected through semi-structured interviews. The sample consisted of bariatric post-surgery patients from the bariatric surgery service of a university hospital as well as from a private health service. Four major thematic axes were established from the set of questions to the participants and their answers were analyzed and classified into categories after the transcription of the interviews was done. The results reveal that there are impacts on coping with the pandemic when it comes to emotional and dietary issues and physical exercise. It also shows the emergence of fears for having experienced a post-operative period of bariatric surgery during a pandemic scenario.

Normal transaminases in obese patients with metabolic associated steatohepatitis (MASH): a cohort of Peruvian patients

Introduction: Metabolic associated steatohepatitis (MASH) is one of the most frequent causes of chronic liver disease. Liver transaminases are important biomarkers to measure liver injury, however, a proportion of patients with MASH may present with normal levels of transaminases. The levels of serum transaminases may not correlate with the severity of histopathological changes. Objective: We aimed to identify the frequency of normal transaminases in obese patients with MASH, as well as to describe the clinical, biochemical and histological characteristics in this specific group of patients. Materials and methods: A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) &gt;30Kg/m2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria. Results: 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.03-7.96; p&lt;0.01), diagnosis of type 2 diabetes mellitus OR=4.86 (95% CI: 1.97- 11.95; p&lt;0.01) and levels of GGT &gt;50 IU/L OR=7.50 (95% CI: 3.40-16.56; p&lt;0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p&lt;0.01). Differences in the degree of fibrosis were not associated with transaminases levels. Conclusion: In conclusion we found that the frequency of normal transaminases was 47.2% in obese patients with MASH. Factors associated with elevation in liver enzymes were being male, diagnosis of diabetes mellitus and elevation in GGT levels. The degree of fibrosis was not associated with elevations in liver transaminases. These findings suggest that transaminases levels alone are not accurate markers to assess liver injury, as they do not necessarily correlate with histological liver damage.

O-B06 The Impact of Covid-19 on Bariatric surgery in England during 2020

BackgroundThe Covid-19 pandemic had a significant impact on NHS services across England. Due to the significant rise in demand for beds in both ward and ITU environments, trusts were forced to reduce the number of operations carried out to help reduced the burden on secondary care services. Whilst efforts were made to preserve operations where possible, the Covid-19 burden has had a significant impact on bariatric surgery throughout 2020. The following research looks at the true impact of Covid-19 on bariatric surgery in England and analyses this in relation to the Covid-19 burden.MethodsData relating to operation numbers was taken from The Surgical Workload Outcomes Audit (SWORD) database. The SWORD database was interrogated for the years 2017 – 2020. A mean number of operations was calculated using the 2017-2019 data and compared to data from 2020 for gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion. Operations performed and other demographic data was analysed regionally and compared to Covid-19 deaths throughout England. Covid-19 data was obtained from the national government dashboards.ResultsThe results of the study show that Nationally there was a significant decline in bariatric surgery operations carried out throughout 2020 due to the Covid-19 pandemic. Overall there was a 53.5% reduction in bariatric surgery operations carried out in 2020. Looking at the individual operation types, there was a 50.7% reduction in gastric bypass surgery, a 50% reduction in biliopancreatic diversion and a 51.9% reduction in sleeve gastrectomy. There was a greater reduction in gastric bands, with a 78.1 % reduction in procedures which may also reflect changes in current practice with regards to the use of gastric bands. On reviewing data at a local level, all trusts were significantly impacted by the pandemic with the reduction in services ranging from 50% to 100% reduction in operations performed.ConclusionsOverall, despite national efforts to preserve as many operations as possible, there was a significant reduction in the delivery of bariatric surgery services throughout England during the Covid-19 pandemic. Due to this reduction in service provision, it is likely that there are now much larger waiting lists which will need to be addressed as we recover from the Covid-19 pandemic. Whilst there was a similar reduction in services across most trusts due to the elective nature of the operations, variation should be further analysed to allow for better planning and resource allocation for futor future waves or future pandemics.

P-31 NORMAL TRANSAMINASES IN OBESE PATIENTS WITH METABOLIC ASSOCIATED STEATOHEPATITIS

Metabolic associated fatty liver disease (MAFLD) and metabolic associated steatohepatitis (MASH) are the most frequent causes of chronic liver disease. Measurement of transaminases may not correlate with the severity of histopathological changes. We aimed to identify the frequency of normal and elevated transaminases in obese patients with MASH, as well as their clinical, biochemical and histological characteristics. A retrospective cross-sectional study was conducted in the bariatric surgery service of a private clinic. Obese patients older than 18 years with a body mass index (BMI) >30Kg/m 2 and 2 co-morbidities undergoing a gastric sleeve surgery were included. Measurement of biochemical routine laboratory exams was performed. Insulin resistance was calculated using the homeostasis evaluation model (HOMA-IR). All patients underwent liver biopsies prior to surgery and the diagnosis of MASH was based on the Brunt criteria. 159 obese patients with MASH were included, of which 47.2% had normal transaminases and 52.8% elevated transaminases. Factors associated with alteration in transaminases were: being male OR=4.02 (95% CI: 2.03-7.96; p<0.01), diagnosis of type 2 diabetes mellitus OR=4.86 (95% CI: 1.97-11.95; p<0.01) and levels of GGT >50 IU/L OR=7.50 (95% CI: 3.40-16.56; p<0.01). The values of HOMA-IR and GGT were significantly higher in the group of high transaminases (p<0.01). Differences in the degree of fibrosis were not associated with transaminases levels. In conclusion we found that 47.2% of obese patients with MASH had normal transaminases. The degree of fibrosis was not associated with transaminases levels.

Oral condition of patients submitted to bariatric surgery

INTRODUCTION: Obesity is a chronic disease that impairs health or exacerbates others comorbidities. Among the treatment options, bariatric surgery has shown effective and lasting results. However, patients may experience adverse effects, like gastric reflux, nausea, vomiting, dehydration, vitamin and mineral deficit, and thereby potentiate negative effects of oral manifestation, including dental erosion, caries, periodontal disease, alterations of saliva and oral mucosa. OBJECTIVES: Evaluate oral condition of Unified Health System (SUS) patients at the bariatric surgery service of Hospital Evangélico de Vila Velha (Brazil), analyzing DMFT index, PSR (Periodontal Screening and Recording), salivary pH and the self-perception of oral health. METHODS: An prospective, observational descriptive case series study, conducted in the dental clinic located at Universidade Vila Velha (Brazil), evaluated 24 patients subjected to bariatric surgery. Patients were included in the study after explanation, reading and signing of the Informed Consent Form. The data were collected by means of questionnaires on oral health perception, clinical examination and salivary collection. RESULTS: All evaluated patients had periodontal disease, besides a considerable amount of decayed teeth (7.86%), despite the alkaline pH registered in 83.3% of the sample. Furthermore, 83.3% of the patients stated they did not receive oral hygiene orientation before the gastroplasty. CONCLUSION: The oral health of the participants was unsatisfactory due to the high rates of periodontitis and decayed teeth, even with alkaline salivary pH. Self-perception of oral health does not correspond to the results obtained in the clinical examination. Thus, the inclusion of dentistry in the multidisciplinary team can contribute to health and care of bariatric surgery patients.

Negative impact of the first COVID-19 lockdown upon health-related behaviours and psychological wellbeing in people living with severe and complex obesity in the UK.

BackgroundCoronavirus disease 2019 (COVID-19) has led to unprecedented changes in the way we live, particularly for people at higher risk of severe illness from COVID-19. People with pre-existing health conditions have been markedly impacted and, in some instances, left unsupported due to reduced provision of routine healthcare services. People living with obesity (PLWO) are identified as at higher risk of severe illness from COVID-19 infection. Currently, there is a paucity of evidence about the impact of the first COVID-19 lockdown on PLWO, including those accessing weight management and bariatric surgery services (WMS).Methods543 adults (16–80 years) with obesity (BMI ≥ 30 kg/m2) were recruited between 14th May and 9th July 2020 through social media advertisements, professional and patient obesity organisations and WMS. Participants completed an online survey regarding the impact of the first COVID-19 lockdown upon, mental health, well-being, health-related behaviours, risk mitigating behaviours, access to WMS and weight stigma.FindingsDuring the first COVID-19 lockdown, the majority of PLWO reported deterioration of their mental health and health-related behaviours such as diet, physical activity (PA) and sleep. With 55% reporting an unhealthier diet, 61% reduced PA and 80% worsening of their sleep. Higher depression and lower wellbeing scores were found to associate with the greatest adverse impact upon health-related behaviours. PLWO who were attending WMS prior to the first lockdown reported a greater deterioration of their diet, with nearly 50% reporting worsening of their diet and PA worsening compared to PLWO who were not attending WMS. Most participants took two or more risk mitigating actions (73%). PLWO attending WMS reported reduced access (44%) with insufficient information (49%) from their clinical service providers. The majority of participants reported no change in perceived weight stigma.InterpretationThis study shows the detrimental impact of the first COVID-19 lockdown on PLWO in relation to health-related behaviours, mental health and access to WMS. Our findings show that PLWO with poor mental health and those attending WMS were most adversely impacted and highlights the need for greater mental health support and continued provision of support from WMS for PLWO during future lockdowns.FundingThis research was funded through National Institute for Health Research University College London Hospitals Biomedical Research Centre funding.

Negative Impact of COVID-19 Lockdown Upon Health-Related Behaviours and Psychological Wellbeing in People Living with Severe and Complex Obesity in the UK

Background: Coronavirus disease 2019 (COVID-19) had an unparalleled impact and in particular for people with pre-existing health conditions who in some instances were left unsupported due to reduced provision of routine healthcare services. People living with obesity (PLWO) are identified as at higher risk of severe illness from COVID-19 infection. Currently, there is a paucity of evidence about the COVID-19 lockdown on PLWO, including those accessing weight management and bariatric surgery services.Methods: Using an online survey, 543 UK PLWO were recruited. People were invited through social media advertisements, UK charities, obesity advocacy groups, obesity organisations and weight management services.Findings: PLWO reported that health-related behaviours such as diet, physical activity and sleep were adversely impacted during the first COVID-19 lockdown. Depression, wellbeing and self-reported mental health played a significant role in predicting changes in health-related behaviours. Most PLWO attending weight management services reported reduced access with insufficient communication from their clinical service providers. Perceived stigma remained unchanged during the first COVID-19 lockdown, with the majority of people reporting not experiencing stigma as compared to before COVID-19.Interpretation: This study shows the detrimental impact of COVID-19 on PLWO in relation to health-related behaviours, mental health and access to healthcare services and support. Our findings highlight the need for greater mental health support for PLWO during future lockdowns.Funding: This research was funded through University College London and National Institute for Health Research (NIHR) Biomedical Research funding.Declaration of Interests: AB has received funding for investigator-initiated research through an educational grant and travel grants from Cambridge Weight Plan Ltd, received support to attend an obesity conference from Novo Nordisk and is on the scientific advisory board and share holder of Reset Health Clinics Ltd. RLB consultancy with Boehringer Ingelheim, GSK, Novo Nordisk, and Pfizer. MOK has received honorium and support to attend an obesity conference from Novo Nordisk. SW has received international flights, accommodation and subsistence from Novo Nordisk to attend obesity-related meetings. There are no other declarations of interest. Ethics Approval Statement: The study was granted ethical approval by the UCL Research Ethics Committee (REC number 16191/004).

Weight-gaining medications used by patients followed up at the bariatric and metabolic surgery service of a university hospital

Objective: To verify an association between weight and use of medications that lead to weight gain (MLGP) in a population of obese patients monitored in the Unified Health System. Methods: This is a retrospective descriptive sectional study with data from medical records of all patients. patients treated by the University Hospital Multiprofessional Service for obese patients who are candidates for bariatric surgery. The collection took place from January 2014 to March 2016. A weight-dependent variable, used in the body mass index (BMI) and degree of obesity and as independent variables of sex, age, education, income, number of diseases, number of drugs and number of MLGP. The association was calculated using the Ro Spearman correlation and the chi-square test. Results: 102 patients were studied, mostly women (87%), with a mean BMI of 45.9 kg / m2 (min 32.56 - maximum 70.98 kg / m2 SD = 6.43). The main comorbidities were systemic arterial hypertension (65.7%) and osteoarticular disorders (39.2%). The average number of drugs per patient was 4.3 and the most used class was for the renin-angiotensin system (67.3%). MLGP corresponds to 10.4% of the drugs used and 27.4% of the patients use them. MLGP patients used an average of 5.8 medications and the most prevalent classes were betablocking agents (60.6%), followed by medications used in diabetes (24.2%). Atenolol and a glibenclamide were the most used MLGP. The mean BMI of patients who used more than one MLGP was 51 kg / m2. Conclusion: There was no correlation between weight and the use of MLGP in this population. However, patients who used the MLGP combination had a higher BMI.

A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration.

To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration. We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use. Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time. Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.

Características de pacientes superobesos atendidos em serviço de referência em cirurgia bariátrica

Introduction: Obesity is a worldwide epidemic and people with super obesity (BMI &gt; 50 kg/m²) have the worse prognosis, related to physical complications but also to mental illnesses, physical and verbal abuse, as well as social exclusion. Objective: To determine the profile of super obese patients treated in a referential bariatric surgery service. Methods: Retrospective analysis of 56 medical records of patients treated at the HUUFMA’s Bariatric and Metabolic Surgery Service multidisciplinary ambulatory care in 2017-2019. Incomplete records or with body mass index (BMI) &lt; 50 kg/m² were excluded. Results are presented in mean and standard deviation. Chi-square test was used for association analysis, Shapiro-Wilks test for normality and significance was considered for p&lt;0.05. Results: Prevalence in sample of females (80.3%), brown skin (67.8%), average age of 37.8 ± 9.8 years, and 49.1% graduated high school. The average weight and BMI were that of 136.6 ± 12.4 kg and 59 ± 6.5 kg/m², respectively, with a patient standing out with a BMI of 71 kg/m². Among the comorbidities we found obstructive sleep apnea in 100%, insomnia in 98.2%, joint problems in 53.5%, anxiety in 50%, hepatic steatosis and systemic arterial hypertension with 48.2% each, dyslipidemia in 42.8%, intestinal constipation in 32.1% and type 2 diabetes mellitus in 17.8%. There was a significant relation (p&lt;0.05) between schooling and weight. An impact on mental health was observed, with 37.5% of the patients exhibiting depression, 44.6% binge eating and 17.6% suicidal thoughts and/or self-mutilation. Conclusion: The super obese patients’ profile is that of a young adult woman, with average schooling, various comorbidities and with significant impact on mental health.