Benefits Of Bariatric Surgery Research Articles

Addictive behaviour and bariatric surgery: Case report and literature review

Even though the scientific evidence supports the benefits of bariatric surgery, its indications and contraindications must be continually revised in order to avoid psychiatric complications. Substance use is more common in patients subjected to bariatric surgery than in the general population. There are reports of increased incidence of alcohol abuse in patients after bariatric surgery.ObjectiveTo review the available evidence, after treat the case of a 50-year-old man with addiction history whose addictive behaviour worsened after undergoing bariatric surgery, with decreased tolerance to alcohol effect and increase of the intake, as well as changes in the graduation of alcohol used (including antiseptic). As a result, a dangerous revolving door that led him to repeated admissions, including Intensive Care Unit.ResultsThe case is consistent with the literature that suggests that there is an increased risk of later alcohol-related problems after bariatric surgery. This risk is higher several years post surgery, in patients with previous history of problems related to alcohol, young, men, and Roux-en-Y Gastric Bypass procedure.ConclusionsThe indications for bariatric surgery should thoroughly consider the history of addiction, an adequate assessment of the patient's mental status and psychoeducation about the possible psychiatric side effects, in order to develop preventive strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Bariatric Surgery and the Pregnancy Complicated by Gestational Diabetes.

Gestational diabetes mellitus (GDM) is an increasingly common obstetrical problem. Due to the global escalation in the prevalence of obesity, as many as 15% of pregnant women may soon be classified as having GDM. While often not diagnosed until late gestation, GDM is now recognized as a disorder of glucose and lipid metabolism, systemic inflammation, and insulin resistance that begins early in pregnancy. Recent large randomized trials have clarified the risk of maternal and neonatal complications caused by GDM, as well as the potential to ameliorate these risks. There is significant interest in the potential to reduce the risk for developing GDM in obese women through the performance of bariatric surgery (BS) before pregnancy. BS significantly reduces the risk for GDM, preeclampsia, and large neonates. However, it seems that the risk for small neonates and preterm delivery is increased. No significant differences are observed in regard to cesarean section, postpartum hemorrhage, or perinatal mortality. In this article, we address the effects of GDM on the mother and child, and explore the risks and benefits of BS in the obstetrical population.

Post-Gastric Bypass Hypoglycemia.

Obesity is a major public health problem worldwide. Obesity-related illnesses, such as coronary heart disease, type 2 diabetes, hypertension, dyslipidemia, stroke, sleep apnea, and several forms of cancer (endometrial, breast, and colon), contribute to a significant number of deaths in the USA. Bariatric surgery, including the Roux-en-Y gastric bypass (RYGB) procedure, has demonstrated significant improvements in obesity and obesity-related co-morbidities and is becoming more popular as the number of obese individuals rises. Despite the reported benefits of bariatric surgery, there are potential complications that physicians need to be aware of as the number of patients undergoing these procedures continues to increase. One challenging and potentially life-threatening complication that to date is not well understood is post-RYGB surgery hypoglycemia (PGBH). In this review, we will present the definition, historical perspective, diagnostic approach, currently available treatment options, and anecdotal assessment and treatment algorithm for this disorder.

Changes in one-carbon metabolism after duodenal-jejunal bypass surgery

Bariatric surgery alleviates obesity and ameliorates glucose tolerance. Using metabolomic and proteomic profiles, we evaluated metabolic changes in serum and liver tissue after duodenal-jejunal bypass (DJB) surgery in rats fed a normal chow diet. We found that the levels of vitamin B12 in the sera of DJB rates were decreased. In the liver of DJB rats, betaine-homocysteine S-methyltransferase levels were decreased, whereas serine, cystathionine, cysteine, glutathione, cystathionine β-synthase, glutathione S-transferase, and aldehyde dehydrogenase levels were increased. These results suggested that DJB surgery enhanced trans-sulfuration and its consecutive reactions such as detoxification and the scavenging activities of reactive oxygen species. In addition, DJB rats showed higher levels of purine metabolites such as ATP, ADP, AMP, and inosine monophosphate. Decreased guanine deaminase, as well as lower levels of hypoxanthine, indicated that DJB surgery limited the purine degradation process. In particular, the AMP/ATP ratio and phosphorylation of AMP-activated protein kinase increased after DJB surgery, which led to enhanced energy production and increased catabolic pathway activity, such as fatty acid oxidation and glucose transport. This study shows that bariatric surgery altered trans-sulfuration and purine metabolism in the liver. Characterization of these mechanisms increases our understanding of the benefits of bariatric surgery.

The triad of kidney, obesity, and bariatric surgery.

There is an epidemic of obesity in the USA. Obesity significantly increases the risk of developing chronic kidney disease. Multiple studies have shown overall health and mortalityrelated benefits of medical and surgical weight loss. Renal benefits of bariatric surgery include decrease in proteinuria and hyperfiltration. There have only been a few small studies in patients with abnormally low glomerular filtration rate (GFR) that have shown improvements in GFR postsurgery over a short term. Long-term and larger scale studies are needed to see if renal benefits of weight loss are sustained in post-bariatric surgery patients.

Nonalcoholic Steatohepatitis Is Associated With Increased Mortality in Obese Patients Undergoing Bariatric Surgery.

Bariatric surgery is associated with improved outcomes in subjects with severe obesity. We investigated the prognostic relevance of nonalcoholic steatohepatitis (NASH) and liver gene expression patterns in patients undergoing bariatric surgery. We performed a retrospective analysis of 492 subjects who underwent gastric bypass bariatric surgery at a single center in Switzerland from January 1997 through December 2004; routine perioperative liver biopsies were collected, analyzed histologically, and RNA was isolated. We collected data on overall survival and clinical and biochemical parameters and compared these with data from propensity score-matched subjects participating in the third National Health and Nutrition Examination Survey (NHANES III). We used liver biopsies to identify bariatric surgery patients with NASH; NHANES III participants with NASH were identified based on a hyperechogenic liver at ultrasound and increased alanine transaminase levels. We analyzed a 32-gene signature associated with NAFLD severity in the liver tissues collected from 47 bariatric surgery patients with NASH, and assessed its prognostic features using nearest template prediction and survival analysis. At baseline, the median body mass index of patients who underwent bariatric surgery was 43.6kg/m2; based on histologic findings, 12% had NASH and 16% had fibrosis. During a median follow-up of 10.2 years after the surgery, 4.2% of the subjects died. In multivariable Cox regression, the presence of NASH (hazard ratio [HR], 2.9; P= .02) and arterial hypertension (HR, 3.9; P= .02) were associated with overall mortality. When bariatric surgery patients were matched with NHANES III participants, bariatric surgery reduced the risk of death during the follow-up period (HR, 0.54; P= .04). However, bariatric surgery patients with NASH did not have a reduced risk of death compared with NHANES III participants with NASH (HR, 0.90; P=.85). We identified an expression pattern of 32 genes in liver tissues from patients with NASH that was associated with increased risk of death in multivariable analysis (HR, 7.7; P=.045). Histologically proven NASH is associated with increased risk of death within a median follow-up of 10.2 years after bariatric surgery, compared with patients who undergo bariatric surgery without NASH. The survival benefit of bariatric surgery in subjects with NASH may be reduced. A 32-gene expression pattern identified patients with NASH who underwent bariatric surgery and had shorter survival times.

A107 - Short-Term Outcomes Following Conversion of Adjustable Gastric Banding

Background: Clinical effectiveness of bariatric surgery in treatment of morbid obesity and associated comorbidities has been proven in many studies. Access and coverage remain key barriers to this therapy. Few longitudinal studies have been done on recoupment of the cost of surgery and productivity benefit. Methods: We used the Truven Health Analytics Commercial Claims (MarketScan) database incorporating at least 15 million enrollees annually to identify beneficiaries who underwent laparoscopic Rouxen-Y gastric bypass (RYGB) in 2008. We required individuals to have continuous enrolment 4 years pre-surgery and 4 years postsurgery. Cases with malignancy, colon disease, HIV, ESRD and pregnancy were excluded. A cohort of non-surgical beneficiaries were identified and matched to bariatric cases on age ( 1 year), sex, geographic region, presence of diabetes, hypertension, hyperlipidemia and morbid obesity in the year prior to surgery. Expected post surgery costs were modeled based on the costs of the non-surgical cohort. A comparison of the expected and actual costs was used to determine the cost benefit of surgery. Results: A total of 823 RYGB cases were identified. 786 were matched to the non-surgical cohort. The mean cost of surgery was $25,238. In the first year post surgery, the expected costs were $10,651 whereas the actual costs were $9,529 (12% reduction. Likewise, in the 2, 3 and 4 years, the actual costs were lower than expected by 28%, 37%, and 35%, respectively. Cumulatively, about 38% of the costs of surgery ($7,592) were saved in the 4 years after surgery. In the diabetic subpopulation, the actual costs were 23%, 49%, 61%, 69% lower in the first four years post surgery, respectively. Cumulatively, 78% of the surgery costs ($22,609) were saved. Conclusion: Based on this rigorously matched analysis, about 40% of the surgery costs were saved in the first 4 years after bariatric surgery. In the diabetic subpopulation, the savings was nearly 80%. Further long term follow up research is needed to better quantify the economic benefit of bariatric surgery. Clinical, economic and quality of life outcomes associated with bariatric surgery make it a sustainable and necessary therapy.

Enhancing the Metabolic Benefits of Bariatric Surgery: Tipping the Scales With Exercise.

The Roux-en-Y gastric bypass (RYGB) procedure is regarded as the gold-standard metabolic surgery in the U.S., rivaling sleeve gastrectomy as the most common bariatric surgery procedure. In addition to considerable weight loss, patients undergoing RYGB exhibit remarkable improvements in multiple metabolic abnormalities, including remission of type 2 diabetes and improvements in insulin sensitivity (1–3). These adaptations can be divided into those that prevail acutely in response to severe energy restriction (e.g., improved glycemia, improved hepatic insulin sensitivity) versus those that occur with more latency, associated with weight loss (e.g., improved peripheral insulin sensitivity) (2,4). In many cases, the long-term improvements in peripheral insulin sensitivity align with the degree of weight lost in the months following the RYGB procedure (5,6). Although the point has been made that peripheral insulin sensitivity remains well below what is observed in lean healthy control subjects in spite of substantial weight loss following RYGB, there is hearty evidence that, if anything, the improvements in peripheral insulin sensitivity following RYGB are greater than would be predicted based on weight loss alone (2,7). For example, Camastra et al. (2) followed morbidly obese RYGB patients with or without diabetes up to 1 year following the procedure, evaluating peripheral insulin sensitivity using the euglycemic-hyperinsulinemic clamp procedure. While it is true that insulin-stimulated glucose disposal 1 year following RYGB (38.5 μmol/min/kg fat-free mass [FFM]) remained well below values measured in lean control subjects (64.0 μmol/min/kg FFM), the values were higher …

Is Bariatric Surgery an Effective Treatment for Type II Diabetic Kidney Disease?

Type II diabetic kidney disease is devastating to patients and society alike. This review will evaluate bariatric surgery as a treatment for diabetic kidney disease primarily through its ability to induce and maintain regression of type II diabetes. The review begins by outlining the global challenge of diabetic kidney disease, its link to obesity, and the comparative benefits of bariatric surgery on weight and type II diabetes. It then surveys comprehensively the relevant literature, which reports that although bariatric surgery is associated with reductions in albuminuria, its effect on harder clinical end points like progression of diabetic kidney disease is not known. The review also includes a critical assessment of the risks and costs of bariatric surgery and concludes by acknowledging the major knowledge gaps in the field and providing research strategies to overcome them. Until these knowledge gaps are filled, clinicians will be forced to rely on their own subjective judgment in determining the benefit-risk ratio of bariatric surgery for patients with diabetic kidney disease.

The Pain of Regain: Psychosocial Impacts of Weight Regain Among Long-Term Bariatric Patients

Background: Obesity is a complex disease affecting more than 78 million Americans and increasingly is treated with bariatric surgery. One of the purposes of the present study was to gain an understanding of psychosocial variables and the influence they have on weight regain and post-bariatric follow-up. Materials and methods: The researchers utilized a combined quantitative and qualitative approach to analyze subjective explanations regarding patients' (n=667) long-term bariatric experiences regarding post-surgery weight regain. A multiple linear regression analysis was conducted with weight regain as the outcome variable. Data from the study were jointly interpreted and discussed. Results: The final set of six predictors produced a statistically significant squared multiple correlation (SMC) of 0.276 (F6, 593=37.612, p<0.001), with an adjusted SMC of 0.268. The average amount of weight regain can be expected to decrease by approximately four pounds for each increase of one point on adhering to the recommended postoperative diet. Those who have larger differences from their lowest to highest weights can generally expect to regain slightly more weight. Two qualitative themes on weight regain emerged: (1) weight regain after bariatric surgery is likely (n=129), and (2) bariatric follow-up and support (n=118). Conclusion: Results reveal psychosocial events influence individuals even by a small weight regain, which may overshadow the benefits of bariatric surgery.

Urinary Incontinence Before and After Bariatric Surgery.

Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking. To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery. The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012). Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter. The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up. Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation. Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

Variation in the use of minimally invasive bariatric surgery

BackgroundObesity is a significant public health problem in the United States. Despite the known benefits of bariatric surgery, most patients eligible for bariatric surgery do not receive it. Access to minimally invasive bariatric surgery (MIS), the surgical gold standard, may be a limitation. ObjectivesWe investigated geographic variation in the utilization of laparoscopy for bariatric surgical procedures. MethodsWe utilized a unique 3-state inpatient database. Adult patients receiving initial bariatric surgery were included. Patients were divided into hospital service areas (HSAs). Rates of MIS utilization in each HSA were calculated. HSAs were divided into quintiles of utilization. Patient and hospital characteristics were compared across quintiles. ResultsOver the 5-year study period, 127,008 patients received bariatric surgery. MIS technology was available in all HSAs. MIS was performed in 88.4% of procedures and was performed in 70.6% of patients in the lowest quintile compared with 97.0% in the highest (P<.01). The use of laparoscopy across quintiles varied significantly by rural hospital status: All 7 rural hospitals were located in the lowest quintile of utilization. ConclusionVariation in the performance of MIS bariatric surgical procedures exists. These differences can likely be attributed to physician preference or patient population. Obesity rates are elevated in rural areas. The implementation of MIS bariatric surgery programs in rural areas may improve the treatment of obesity and downstream co-morbidities in these populations.

Balancing risks and benefits of bariatric surgery for type 2 diabetes

Evidence is growing that bariatric surgery can improve glycaemic control in patients with obesity and type 2 diabetes. In The Lancet Diabetes & Endocrinology, Sayeed Ikramuddin and colleagues1 report the extended (2 year) follow-up results from the Diabetes Surgery Study (DSS), a randomised controlled trial that assessed the effects of intensive lifestyle and medical management versus the addition of Roux-en-Y gastric bypass surgery versus in type 2 diabetes. In agreement with the primary endpoint results of the 1 year follow-up,2 the favourable effects of bariatric surgery over lifestyle and medical management alone on the composite triple-endpoint goal of achieving HbA1c, LDL cholesterol, and systolic blood pressure targets according to diabetes treatment guidelines are maintained: 26 [43%] of 60 participants in the gastric bypass group achieved the composite endpoint at 24 months versus just eight [14%] of 59 in the lifestyle management group (odds ratio 5·1 [95% CI 2·0–12·6], p=0·0004).

Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology.

Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of global liver disease that is associated with the rising prevalence of obesity worldwide. There is now increasing clinical and mechanistic evidence reporting on the metabolic and weight loss effects of bariatric surgery on improving NAFLD in obese patients. The aim of this paper was to quantify the effects of bariatric surgery on NAFLD by appraising the modulation between pre- and post-operative liver enzyme levels (as markers of liver injury) and liver histology. A systematic review of studies reporting pre-operative and post-operative liver enzymes or liver histology was done in obese patients with NAFLD undergoing bariatric surgery. Data were meta-analysed using random-effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. Bariatric surgery is associated with a significant reduction in the weighted incidence of a number of histological features of NAFLD including steatosis (50.2 and 95 %CI of 35.5-65.0), fibrosis (11.9 and 95 %CI of 7.4-16.3 %), hepatocyte ballooning (67.7 and 95 %CI 56.9-78.5) and lobular inflammation (50.7 and 95 %CI 26.6-74.8 %). Surgery is also associated with a reduction in liver enzyme levels, with statistically significant reductions in ALT (11.36 u/l, 95 %CI 8.36-14.39), AST (3.91 u/l, 95 %CI 2.23-5.59), ALP (10.55 u/l, 95 %CI 4.40-16.70) and gamma-GT (18.39 u/l, 95 %CI 12.62-24.16). Heterogeneity in results was high. Bariatric surgery is associated with a significant improvement in both histological and biochemical markers of NAFLD. Future studies must focus on higher levels of evidence to better identify the benefits of bariatric surgery on liver disease in order to enhance future treatment strategies in the management of NAFLD.

Weighing the Risks and Benefits of Bariatric Surgery

Bariatric surgery offers patients an explicit choice, a tradeoff between risks and benefits. Making the right choice is a complex balance between the risks of surgery (eg, short-term and long-term complications) and the benefits of weight loss (eg, resolution of comorbid diseases and increased longevity). When compared with other bariatric procedures, biliopancreatic diversion with duodenal switch offers maximal weight loss, yet it continues to be the least common operation performed.1 The Risstad et al2 study reminds us why. We learnedfromRisstadetal2 that 1ormoreadverseevents occurred in nearly 80% of patients during the first 5 years after duodenal switch. This included a 14%hospitalization rate for protein and vitamin malabsorption as well as a reoperation rate of 45% to address problems of the initial procedure. The high rate of adverse events with duodenal switch is consistent with other reports.3 Moreover, the benefits of undergoing duodenal switch hardly seemworth the sacrifice when comparedwith gastric bypass. In this study, duodenal switch resulted in significantlymoreweight loss and lower serumlevels of lipids but therewere no significant differences in blood pressure, type 2 diabetes mellitus, metabolic syndrome, and pulmonary function. Given the high complication rates of duodenal switch in the study by Risstad et al, it is difficult to recommend duodenal switchasa first-lineweight lossprocedure.At thevery least, patients seeking this procedure should receive ample warning regarding the very high risks of adverse nutritional outcomes and the high reoperation rate. Patientswith poor complianceandpoor follow-upshouldnotbeofferedthisprocedure because they could be at risk of fatal complications if postoperative problems are not addressed in a timely fashion. Despite itsnarrowrole inclinicalpractice,duodenal switch may find a resurgence in the future as a second stage procedure for patients who have failed weight loss after sleeve gastrectomy.4 Sleeve gastrectomy, which is part of the duodenal switchoperation, isnowthemost commonbariatricprocedure performed in many regions of the country. Many surgeons advocate revising patientswith inadequateweight loss after sleeve gastrectomy to aduodenal switch.Risstad et al remindus that this strategy should only beusedwith great caution and only in a select group of patients with excellent follow-up and compliance.

Ménage-à-trois of bariatric surgery, bile acids and the gut microbiome.

Bariatric surgeries have emerged as highly effective treatments for obesity associated type-2 diabetes mellitus. Evidently, the desired therapeutic endpoints such as rates of weight loss, lower levels of glycated hemoglobin and remission of diabetes are achieved more rapidly and last longer following bariatric surgery, as opposed to drug therapies alone. In light of these findings, it has been suspected that in addition to causing weight loss dependent glucose intolerance, bariatric surgery induces other physiological changes that contribute to the alleviation of diabetes. However, the putative post-surgical neuro-hormonal pathways that underpin the therapeutic benefits of bariatric surgery remain undefined. In a recent report, Ryan and colleagues shed new light on the potential mechanisms that determine the salutary effects of bariatric surgery in mice. The authors demonstrated that the improved glucose tolerance and weight loss in mice after vertical sleeve gastrectomy (VSG) surgery were likely to be caused by post-surgical changes in circulating bile acids and farnesoid-X receptor (FXR) signaling, both of which were also mechanistically linked to changes in the microbial ecology of the gut. The authors arrived at this conclusion from a comparison of genome-wide, metabolic consequences of VSG surgery in obese wild type (WT) and FXR knockout mice. Gene expression in the distal small intestines of WT and FXR knockout mice revealed that the pathways regulating bile acid composition, nutrient metabolism and anti-oxidant defense were differentially altered by VSG surgery in WT and FXR(-/-) mice. Based on these data Ryan et al, hypothesized that bile acid homeostasis and FXR signaling were mechanistically linked to the gut microbiota that played a role in modulating post-surgical changes in total body mass and glucose tolerance. The authors' data provide a plausible explanation for putative weight loss-independent benefits of bariatric surgery and its relationship with metabolism of bile acids.

WHEN AND WHY OPERATE ELDERLY OBESE.

Introduction: Concurrently with the pandemic obesity is observed global aging phenomenon, with a significant increase of obesity in the elderly population. Aim: To review the indications for bariatric surgery for the elderly, mainly focusing on the morbidity and mortality of procedures. Method: Review of the literature in PubMed/Medline and Scielo focusing on the relationship of risk factors with different techniques of bariatric surgery in the elderly. The following descriptors were crossed in the form of AND/OR: Obesity; Bariatric surgery; Complications; Elderly. Conclusion: In people older than 60 years bariatric procedures represent acceptable and effective treatment option. The elderly should be treated in specialized centers with experience in major surgical procedures and low morbimortality. Going in this way, they experience the benefits of bariatric surgery with acceptable morbidity and mortality. However, age alone should not be considered as an absolute impediment for surgical indication.

BEFORE-AND-AFTER STUDY: DOES BARIATRIC SURGERY REDUCE HEALTHCARE UTILIZATION AND RELATED COSTS AMONG OPERATED PATIENTS?

Healthcare use and costs are about 81% higher for morbidly obese individuals compared to non-obese persons, and 47% higher compared to the non-morbidly obese population. The benefits of bariatric surgery for health are well established, but its mid-term impact on healthcare use and costs remains controversial. This study examines the trends in healthcare use and costs in a Brazilian cohort during a 4-year period before and after surgery. Healthcare use and direct costs related to inpatients and outpatients were retrieved from a healthcare insurance company database from which all cohort members were selected. Between 2004 and 2010, 4,006 individuals underwent bariatric surgery. Most patients were female (80%) with a mean age of 36.2 years and a mean body mass index of 42.8 kg/m2. Elevated blood pressure was present in 38% of cases and diabetes was found in 12.5% of subjects. Hospital admissions increased consistently after surgery, even after excluding hospitalizations for esthetic surgery and pregnancy-related care. The most prevalent conditions in this group were gastrointestinal diseases. Emergency department visits increased after bariatric procedures, in particular for genitourinary and hematologic problems. Adjusted costs were higher after surgery as assessed during a 4-year follow-up period. Results indicate that costs and hospital admissions after bariatric surgery increase following this procedure, even when elective interventions are excluded. Healthcare providers and policy makers need to be aware that a decrease in obesity-related diseases following bariatric surgery does not reduce healthcare use and costs.

Patterns of Weight Loss Response Following Gastric Bypass and Sleeve Gastrectomy.

Despite the health benefits of bariatric surgery (BS) extend beyond WL, better understanding of the WL response may help improve the outcomes of BS. In this context, we aimed to assess patterns within the variability of weight loss (WL) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). WL data from 658 subjects that underwent RYGB (n = 464) or SG (n = 194) as first BS were analyzed. Based on excess WL (EWL), subjects were categorized as good WL responders (EWL ≥ 50 % at nadir weight and throughout follow-up), primarily poor WL responders (1-PWL:EWL < 50 % at nadir weight and thereafter), and secondarily poor WL responders (2-PWL:EWL ≥ 50 % at nadir weight, but <50 % at last follow-up visit). Predictors associated with different WL outcomes were ascertained using regression analysis. Median follow-up was 55.7 months. Nadir EWL ranged 12.4-143.6 %; last follow-up visit EWL ranged -22.1-143.6 % and weight regain (WR) ranged 0-64.1 kg. Good WL was found in 75.7 of the cohort. 1-PWL response (4.7 %) was characterized by lesser WL but similar WR as compared to good WL and was associated with larger BMI and diabetes prior to surgery. 2-PWL response (19.6 %) was characterized by larger WR as compared to the other groups and was more common following SG. Lesser percentage of medical appointments kept was associated with 1-PWL and 2-PWL. Our data show the high inter-individual variability of the WL response at mid-term after RYGB and SG and that poor WL after BS could be illustrated by two different patterns, characterized either by sustained limited WL (1-PWL), or pronounced weight regain (2-PWL).

Perceptions of weight, diabetes and willingness to participate in randomised controlled trials of bariatric surgery for patients with type 2 diabetes mellitus and body mass index 30-39.9 kg/m(2).

Evidence from high-quality randomised controlled trials (RCTs) is needed to establish the long-term benefit of bariatric surgery in people with type 2 diabetes mellitus (T2DM) and body mass index (BMI) 30-39.9 kg/m(2). However, willingness amongst this group to be randomised and undergo surgery is uncertain. This study assessed UK patients' perceptions of their weight and diabetes, and associations with willingness to participate in RCTs involving bariatric surgery, amongst this population. Postal survey of 1820 patients from four regions in England. Eligible patients were as follows: BMI 30-39.9 kg/m(2), 18-74 years, diagnosis of T2DM ≥2 years. A reminder survey was sent after 4 weeks. Independent predictors influencing patients' willingness to consider RCT participation were identified using multiple logistic regression analysis. Thirty-four per cent (614/1820) of patients responded. Weight was considered to be harder to control than diabetes [468/584 (80 %) vs. 107/600 (17 %)]. More people reported a negative impact on life for weight rather than diabetes [379/579 (63 %) vs. 180/574 (31 %)]. Feeling unsatisfied/very unsatisfied with weight loss ability was common 261/578 (45 %). Sixty-four per cent (379/594, CI = 60-68) were willing to consider participating in an RCT. In multivariate analysis, negative impact of weight on life (OR = 2.55, 95 % CI = 1.68-3.89, P < 0.001) and feeling unsatisfied with weight loss ability (OR = 2.47, 95 % CI = 1.55-3.95, P < 0.001) positively influenced patients' willingness to participate in an RCT. Strong patient interest supports the feasibility of such trials for this group. Perceptions of obesity negatively impacting on life and difficulties in achieving weight loss were common and influenced attitudes to potential participation in bariatric surgery RCTs.