Consideration Of Bariatric Surgery Research Articles

Adolescent bariatric surgery-a survey of referring practitioners.

Recent guidelines, supported by large, well-designed studies, suggest that bariatric surgery is a safe and effective treatment for adolescents living with severe obesity to improve health and psychosocial functioning. The aim of this study was to assess the opinions and referral practices of general practitioners (GPs) and paediatricians in Ireland. A cross-sectional survey was circulated online to practising paediatricians and GPs. The survey consisted of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications. There were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%), and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery. Paediatricians were significantly more likely to refer (72% vs. 28%, p = 0.034). A minimum BMI of 40kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%). There is a reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery. Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services.

Comorbidities of obesity and preconception counselling: Consideration of bariatric surgery.

Comorbidities of obesity and preconception counselling: Consideration of bariatric surgery.

Annals for Educators - January 2022.

Annals for Educators - January 2022.

A Review of the Impact of Bariatric Surgery in Women With Polycystic Ovary Syndrome.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in reproductive-age women that causes infertility. Obesity and insulin resistance are closely tied to the pathophysiology of PCOS. Current first-line treatments include lifestyle modifications, hormone modulators, and laparoscopic ovarian drilling, but little attention has been given to bariatric surgery as a viable option. A detailed review of the literature regarding the outcomes of obese women with PCOS after bariatric surgery is necessary. All studies were found in the PubMed database, limited to females and humans, and selected due to relevancy and quantitative data. Bariatric surgery promotes significant weight loss within one year, which is associated with amelioration of insulin resistance, hyperandrogenism, menstrual irregularity, and ovulatory dysfunction. Surgery successfully mediates the regression of PCOS and promotes successful pregnancy. Thus, we recommend the consideration of bariatric surgery as part of the main treatment considerations in obese patients with PCOS. However, more focused and comprehensive research with better study designs are still needed in the future to investigate PCOS and bariatric surgery.

Attitudes and knowledge regarding referrals for bariatric surgery among Danish secondary healthcare providers: A national survey.

Bariatric surgery induces significant and sustained weight loss and subsequently reduces obesity-related comorbidities. However, only a small percentage of patients with severe obesity undergo bariatric surgery in Denmark. There is limited knowledge about the experiences with and possible reservations to bariatric surgery among secondary healthcare providers. The aim of this cross-sectional study was to investigate referral patterns and knowledge regarding the criteria for bariatric surgery among Danish secondary healthcare providers, treating obesity-related diseases. A questionnaire regarding experiences with and reservations to referring patients for consideration for bariatric surgery, along with thoughts to specific patient cases were sent to several specialists: endocrinologists, obstetricians and gynaecologists, orthopaedic surgeons and otorhinolaryngologists. Most questions required responses on a 5-point Likert scale and frequency distributions were calculated. A total of 345 (44%) specialists responded to the questionnaires. Good knowledge of the criteria for referral to bariatric surgery varied among the specialist from 6% to 68%. One of the main issues was a concern about the medical and surgical postoperative complications, which was a barrier to and influenced referral decisions. Furthermore, specialists were more likely to refer patients to bariatric surgery when patients requested this. Except for endocrinologists, the Danish secondary healthcare specialists interviewed have limited knowledge about bariatric surgery, which results in a reluctance in referring patients. Our results indicate that there is a need to improve knowledge among specialists, regarding the indications, criteria and outcomes for bariatric surgery to establish a more pro-active, specialist led approach to referrals.

SAT-101 The Combination of Anti-Obesity Medications and Bariatric Surgery Can Be Effective in Resetting the Cerebral Adipostat in Individuals with Autism Suffering from Severe Obesity

Background Obesity in patients with autism is very prevalent. A third of the children with autism have a BMI above the 85th percentile, placing them at risk for developing obesity as adults. Obesity in the context of autism is likely more difficult to treat. Individuals with autism often demonstrate a preference for routine, which can lead to greater aversion to new tastes; also motor and social impairments may limit activities. People with autism are more likely to receive treatment with psychiatric medications, the majority of which cause weight gain. Under these circumstances, the treatment of obesity can become more challenging. Of importance, many individuals with intellectual/behavioral disabilities are denied bariatric surgery procedures due to their limitations in the ability to provide proper consent. We report here the successful use of anti-obesity medications followed by bariatric surgery in a young woman with autism and class 3 obesity, helping her lose 121 lbs and maintain her weight loss for more than 2 years. Clinical Case A 28-year-old female with autism and intellectual disability (IQ of 50), class 3 obesity (BMI 63.1 kg/m2), and depression presented for consideration of bariatric surgery. She weighed 391 lbs. A psychological assessment, found her to be an inappropriate candidate for surgery due to her intellectual difficulties limiting her ability to consent for surgery. Intense medical management for 18 months allowed the patient to lose 98 lbs with a subsequent weight plateau for another 8 months. At that point the patient’s family requested bariatric surgery to further assist with weight loss. A multidisciplinary evaluation was then performed by a committee involving members from psychology, nutrition, medicine, surgery, and bioethics. A joint decision was reached by all professionals involved to offer bariatric surgery to the patient (laparoscopic sleeve gastrectomy). The decision was based on the following facts: 1) Patient showed an ability to “assent” through a simplified understanding of the surgery and her goal “to become smaller”, 2) Patient was deemed likely to be able to adhere to post-operative protocols, 3) Patient had a strong family support (aptitude for responsible caretaking as all family members were trained as home caregivers). Upon follow-up 4 months post-bariatric surgery, the patient had lost an extra 32 lbs. Overall, her BMI had reduced from an initial 63 to 42 kg/m2, and her weight was down to 270 lbs. Clinical Lessons The combination of anti-obesity medications followed by bariatric surgery may be a useful therapeutic approach for individuals with autism and severe obesity. Bariatric surgery seems to cause a reset of the cerebral set point reached after medical therapy. Special consideration should be given to individuals with cognitive impairments who have been successful losing weight with intense medical management and have strong family support.

Bariatric surgery prior to living donor nephrectomy: a solution to expand the living donor kidney pool - a retrospective study.

Most transplant centers decline morbidly obese people for living kidney donation. Their inclusion in the living donor pool after weight loss and reversal of comorbidities by bariatric surgery could reverse the downward living donation trend. We investigated whether bariatric surgery in the morbidly obese altered their candidacy for donation, complicated their subsequent donor nephrectomy, and impacted their early postoperative outcomes in a series of 22 donors who had bariatric surgery 0.7-22 years prior to laparoscopic living donor nephrectomy. Eighteen would have been excluded from donation prior to bariatric surgery based on a body mass index (BMI) > 40. Seventeen reached a BMI < 35 after bariatric surgery. One had hypertension that resolved after bariatric surgery. Prior bariatric surgery did not influence port placement and laterality of donor nephrectomy. None required open conversion or blood transfusion. In an exploratory comparison with 37 donors with a BMI 35-40, length of stay and warm ischemic time were shorter, blood loss and postoperative complications were similar, and operative time was longer. We therefore advocate the consideration of bariatric surgery in preparation for donation in morbidly obese people since it positively alters their candidacy without major impact on the subsequent living donor nephrectomy and early outcomes.

Coronary Microvascular Dysfunction and Cardiovascular Risk in Obese Patients

BackgroundBesides body mass index (BMI), other discriminators of cardiovascular risk are needed in obese patients, who may or may not undergo consideration for bariatric surgery. Coronary microvascular dysfunction (CMD), defined as impaired coronary flow reserve (CFR) in the absence of flow-limiting coronary artery disease, identifies patients at risk for adverse events independently of traditional risk factors. ObjectivesThe study sought to investigate the relationship among obesity, CMD, and adverse outcomes. MethodsConsecutive patients undergoing evaluation for coronary artery disease with cardiac stress positron emission tomography demonstrating normal perfusion (N = 827) were followed for median 5.6 years for events, including death and hospitalization for myocardial infarction or heart failure. ResultsAn inverted independent J-shaped relationship was observed between BMI and CFR, such that in obese patients CFR decreased linearly with increasing BMI (adjusted p < 0.0001). In adjusted analyses, CFR but not BMI remained independently associated with events (for a 1-U decrease in CFR, adjusted hazard ratio: 1.95; 95% confidence interval: 1.41 to 2.69; p < 0.001; for a 10-U increase in BMI, adjusted hazard ratio: 1.20; 95% confidence interval: 0.95 to 1.50; p = 0.125) and improved model discrimination (C-index 0.71 to 0.74). In obese patients, individuals with impaired CFR demonstrated a higher adjusted rate of events (5.7% vs. 2.6%; p = 0.002), even in those not currently meeting indications for bariatric surgery (6.4% vs. 2.6%; p = 0.04). ConclusionsIn patients referred for testing, CMD was independently associated with elevated BMI and adverse outcomes, and was a better discriminator of risk than BMI and traditional risk factors. CFR may facilitate management of obese patients beyond currently used markers of risk.

Considerations for bariatric surgery in patients with cirrhosis.

With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. Bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis (NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.

Biliopancreatic Diversion Versus Gastric Bypass in the Surgical Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index Below 35

AbstractBackground: Type 2 Diabetes Mellitus (T2DM) is an important health problem worldwide with about 23% of patients with morbid obesity have type 2 DM. Bariatric surgery originally developed solely as a weight-reduction therapy, but has been found to improve T2DM and to reduce rates of chronic vascular disease and death. The International Diabetes Federation have recommended consideration of bariatric surgery for control of T2DM.Methods: A total number of 45 patients were randomized into two groups, the first group with 26 patients (n=26) were submitted for Biliopancreatic Diversion (BPD) and the second group with 19 patients (n=19) were planned for Roux-en-Y Gastric Bypass (RYGBP). The main objective was to compare the efficacy of bariatric surgery in inducing clinical remission of T2DM mellitus in patients with body mass index less than 35 in both groups.Results: The operations were performed laparoscopically in all patients. There were no conversions, operative compli-cations or mortality. Data were collected during a two-year follow-up period and were analyzed at the following periods; pre-operatively and post-operatively at 1 months, 4 months, at 8 months, at 1 year and 2 years. The analyzed parameters included the levels of BMI, FBG, HbA1c, Triglycerides and cholesterol. There were no statistical significant difference between the two groups regarding the BMI, mean glucose levels, and HbA1c levels. However the levels of triglycerides were higher in the BPD group, while the levels of cholesterol were higher in the RYGBP group during most of the follow-up periods.Regarding the diabetes outcome, there was significant reduction of patients who showed diabetes remission at one year and those who remains remittent at 2 year, while the number of patients who showed diabetes failure tripled at 2 years follow-up.Conclusions: Although, BPD is known to have a better effect on type 2 DM in the higher BMI group. There was no difference regarding glycemic control between BPD and RYGBP. And both operations failed to maintain glycemic control at long term follow-up periods.

Peri-operative care considerations for primary total knee arthroplasty in the obese patient

In the United States an increasing obesity epidemic compounded with growth in total knee arthroplasty (TKA) utilization is increasing the incidence of TKA in the obese population. Arthroplasty surgeons are directly affected by the obesity epidemic and need to understand how to safely offer a range of peri-operative care for these patients in order to ensure good clinical outcomes. Preoperative care for the obese patient involves nutritional counseling, weight loss methods, consideration for bariatric surgery, physical therapy, metabolic workup with diagnosis, and management of frequent comorbid conditions. Obese patients must also be counseled on their increased risk of complications following TKA. A successful surgical result is dependent on early risk mitigation techniques including weight loss, co-morbidity management, and nutritional optimization. In the operating room several steps can be taken to improve successful outcomes when performing TKA on obese patients. Peri-operative techniques including adequate surgical exposure, component positioning, and implant selection play an important role in the longevity of the implant in the obese TKA population who are at risk for post-operative tibial loosening and increased re-operation rates. Appropriate weight-adjusted antibiotic dosing, sterile surgical techniques, wound closure and coverage are essential in reducing infection in this susceptible population. Post-operative care of the obese patient following TKA involves several unique considerations. Chronic pain and obesity are frequent comorbid conditions and post-operative pain control regimens need to be tailored to these patients to improve function and surgical outcome. Obese patients can have a higher rate of all complications compared to healthy weight. All infection and deep infection increased in obese patients and patients must be counseled on their risks pre-operatively to encourage an active role in risk mitigation in the peri-operative period.

Evidence based literature review of clinical management of non-alcoholic fatty liver disease in real world settings

The aim of the present review is to understand the gap between real world clinical practices, guidelines recommendations and to propose minimum essentials that can be followed in clinical practice in NAFLD patients in India. A detailed literature search of published medical reports in English language was performed on electronic databases such as PubMed and Cochrane, from 2000 to 2016 using relevant search terms. The search yielded 25 relevant articles whose full texts were retrieved and evaluated. Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of liver disease in India. It is observed that physicians under appreciate the overlap between NAFLD and metabolic risk factors, thus missing a significant proportion of high-risk NAFLD patients. Lifestyle intervention is generally considered the first line therapy for patients with NAFLD without steatohepatitis while pharmacotherapy (in addition to lifestyle intervention) is suggested for patients with non-alcoholic steatohepatitis (NASH). Current therapies are directed towards improving the metabolic parameters which contribute to disease pathogenesis. Pharmacological therapies for NAFLD and NASH include antioxidants such as vitamin E and ursodeoxycholic acid; insulin sensitizers such as metformin and thiazolidinones, weight loss drugs like orlistat and consideration of bariatric surgery for morbidly obese patients. High degree of suspicion is necessary for diagnosing NAFLD in patients with metabolic risk factors. Further studies are required from India as genotype/clinico-pathological profile of Indian NAFLD patients differ from the western population. Further, prospective studies will fill the various missing links associated with management of NAFLD in Indian patients in a more effective manner.

Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates

BackgroundPrevious research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways. MethodsAs part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other. ResultsFindings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females. LimitationsThe majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions. ConclusionsStudy findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.

Is Early Bariatric Surgery the Answer for Diabetes in Obesity?

The article by Aung et al1 in this issue of JAMA Surgery continues the excellent clinical research from the group in Taiwan.Multiple randomized studies havedemonstrated the efficacy of bariatric surgery in treatingtype2diabetes (T2D), and the term metabolic surgery is being increasingly used, although it is not alwayswell defined. In their introduction, Aung and colleagues define this surgery as “the application of bariatric surgical procedures to patients with a body mass index (BMI) (calculated as weight in kilograms divided by height inmeters squared) of less than 35who also have severe comorbidities.”1 We feel defining it as the manipulation of the gastrointestinal tractwith the goal of treatingT2D isnot only more appropriate but also more representative of what the authors have evaluated in their study. In this article, the authors compare the outcomes of bariatric surgery in those with early-onset T2D (age <40 years) and late-onset T2D (age ≥40 years) and conclude that early intervention leads to better ratesofcompletediabetes remission (hemoglobinA1c<6.0% [toconvert toproportionof totalhemoglobin,multiplyby0.01] without antidiabetic medication).1 Previous studies have shown that the duration of diabetes,useof insulin,degreeofpostoperativeweight loss, andtype of surgeryperformed can influence the remission rates of diabetes following bariatric surgery.2 The studybyAung and colleagues shows that age at diabetes onset canbeused as an additionalpredictorof success,whichsuggestseitheradifference in the pathophysiology of early-onset diabetes or preserved pancreatic reserve in young patients, as inferred by higher C-peptide levels. These data are in keepingwith a 2016 study by Inge et al3 showing a 95%diabetes remission rate at 3 years in their adolescent cohort (aged 13-19 years). Taken together, there appears to be an amassing body of data in support of early consideration of bariatric surgery for obese individualswithT2D. This not only has thepotential to reduce their long-termneed for multiple medications but also has the potential to significantly mitigate their risks of health complications compounded over their lifetime. Thestudy’s5-yearoutcomesareamajor strengthof this article. Although the follow-up ratewas around 50%, these data pointsarerareandvaluabletothefield.Theauthorsaretobecongratulatedforcollectingthesedata,whichreveal thatT2Drecurrence,anAchillesheelofbariatricsurgery,occurseveninthemost idealofpatients—onewithearlyonsetandshortdurationofT2D. Thus, identifyingmarkersof long-termT2Dremissionis,andwill continue to be, an area of heavy interest in the field.

Nonalcoholic fatty liver: optimizing pretransplant selection and posttransplant care to maximize survival.

Nonalcoholic steatohepatitis (NASH) is projected to become the most common indication for liver transplantation in the near future. NASH recipients have concurrent obesity, metabolic, and cardiovascular risks, which directly impact patient selection, posttransplant morbidity and potentially long-term outcomes. The purpose of this review is to highlight strategies to optimize pretransplant selection, outcomes, and posttransplant risk modification to optimize patient and graft survival. NASH recipients are at risk for pretransplant cardiovascular disease, diabetes mellitus, and related renovascular complications. Stringent selection criteria identify those patients most likely to benefit from liver transplantation without adverse cardiovascular events yet, the incidence of these events remains high in NASH recipients. High BMI imparts postoperative morbidity because of infections, wound complications, and longer lengths of hospital stay. Aggressive management of modifiable risk factors such as obesity, hyperlipidemia, diabetes mellitus, and hypertension is recommended. Although patient and graft survival in NASH recipients is excellent, long-term reduction in healthcare utilization and outcomes in these patients would benefit from risk factor modification. Periodic reassessment of coronary artery disease and early consideration of bariatric surgery is recommended in this population.

Is Laparoscopic Bariatric Surgery a Safe Option in Extremely High-Risk Morbidly Obese Patients?

Age, superobesity, and cardiopulmonary comorbidities define patients as high risk for bariatric surgery. We evaluated the outcomes following bariatric surgery in extremely high-risk patients. Among 3240 patients who underwent laparoscopic bariatric surgery at a single academic center from January 2006 through June 2012, extremely high-risk patients were identified using the following criteria: age ≥ 65 years, body mass index (BMI) ≥ 50 kg/m(2), and presence of at least two of six cardiopulmonary comorbidities, including hypertension, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, and history of venous thromboembolism. Perioperative and intermediate-term outcomes were assessed. Forty-four extremely high-risk patients underwent laparoscopic Roux-en-Y gastric bypass (n = 23), adjustable gastric banding (n = 11), or sleeve gastrectomy (n = 10). Patients had a mean age of 67.9 ± 2.7 years, a mean BMI of 54.8 ± 5.5 kg/m(2), and a median of two (range, two to five) cardiopulmonary comorbidities. There was no conversion to laparotomy. Thirteen (29.5%) 30-day postoperative complications occurred; only six were major complications. Thirty-day postoperative re-admission, re-operation, and mortality rates were 15.9%, 2.3%, and 0%, respectively. Within a mean follow-up time of 24.0 ± 18.4 months, late morbidity and mortality rates were 18.2% and 2.3%, respectively. The mean percentage total weight and excess weight losses after at least 1 year of follow-up were 26.7 ± 12.0% and 44.1 ± 20.6%, respectively. Laparoscopic bariatric surgery is safe and can be performed with acceptable perioperative outcomes in extremely high-risk patients. Advanced age, BMI, and severe cardiopulmonary comorbidities should not exclude patients from consideration for bariatric surgery.

Further statistical and clinical validity for the Weight Efficacy Lifestyle Questionnaire-Short Form

Identifying barriers to long-term adherence to reduced energy intake and increased physical activity level is critically important for obese patients seeking weight loss treatment. Previous research has identified that one such barrier is low eating self-efficacy or poor confidence in one's ability to control eating behavior in the presence of challenging situations. Accordingly, a valid, brief measure of eating self-efficacy for longitudinal assessment of weight loss and regain is needed. The purpose of this study was to test the internal consistency and clinical validity of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Participants were 1740 consecutive obese patients who presented for a psychological evaluation in consideration for bariatric surgery. Median BMI was 44.9 (range: 35.0–111.9), age 48.7years (range: 18.9–77.3years), and patients were predominantly female (71.1%) and Caucasian (90.8%). The median WEL-SF total score was 56 (range: 0–80) and Cronbach's alpha measuring internal consistency was 0.92 with a one-factor structure. In terms of clinical validation, lower WEL-SF total scores were significantly associated with higher rates of binge eating episodes (P<0.0001), food addiction severity and dependence (P<0.0001), night eating syndrome (P<0.0001), depression (P<0.0001), and anxiety (P<0.0001). In contrast, higher WEL-SF total scores were associated with higher weight management self-efficacy (P<0.0001) and motivation to make positive lifestyle changes (P<0.0001). Taken together, these findings suggest that the WEL-SF is a psychometrically valid clinically meaningful measure of eating self-efficacy.

Development and validation of a new bariatric-specific health-related quality of life instrument ′′bariatric and obesity-specific survey (BOSS)′′

There is a lack of a psychometrically robust bariatric-specific health-related quality of life (HRQOL) tool. A single centre, prospective study to develop and validate a new bariatric-specific 81-item self-report HRQOL instrument called the Bariatric and Obesity-Specific Survey (BOSS). Data were collected from 236 participants. Of these 83 patients were under consideration for bariatric surgery (Group 1) 68 patients had undergone a bariatric procedure (Group 2) and 85 normal healthy participants (Group 3). At baseline, participants were asked to complete the Short Form Health survey (SF-36), Hospital Anxiety and Depression (HADS) scale, Moorehead-Ardelt Quality of life Questionnaire (M-A QoLQ II), and a demographic data sheet. Two weeks following the completion of these five questionnaires, participants were asked to complete BOSS once more along with a feedback sheet. Exploratory factor analysis revealed a multidimensional instrument consisting of 42 items distributed over six domains that addressed various HRQOL aspects and dimensions pertinent to bariatric surgery, and relevant to morbidly obese patients. Further psychometric analysis showed that BOSS has adequate internal consistency reliability (Cronbach α = 0.970), test re-test reliability (ICC = 0.926), construct validity, criterion validity, face validity and acceptability. BOSS thus appears to be a valid and reliable multidimensional instrument that provides a clinically useful and relevant measure to assess HRQOL in patients undergoing bariatric surgery.

S4 Short term use of continuous positive airway pressure (CPAP) by obese patients with obstructive sleep apnoea syndrome (OSAS) diagnosed during assessment for bariatric surgery

Around one in three patients with OSAS is unable to continue with CPAP. The reasons for this are still poorly understood. Patients being assessed for Bariatric Surgery are informed that...

Capsule Commentary on Wee et al., Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity

The number of patients undergoing bariatric surgery is a fraction of those who are eligible, and racial and gender differences exist in rates of bariatric surgery utilization.1 In this study, Wee and colleagues2 examined factors that might contribute to racial and gender differences in the decision to undergo bariatric surgery. They surveyed a diverse sample of over 300 primary care patients with body mass index (BMI) ≥ 35. As anticipated, they found that African Americans and men were less willing to consider bariatric surgery than Caucasians and women, respectively. Interestingly, higher weight-related quality of life among African Americans appeared to account for a substantial portion of this racial difference. Patients who had hypertension, a lower quality of life, received a physician’s recommendation for bariatric surgery, or were younger were more likely to consider bariatric surgery. Compared to Caucasians, African Americans and Hispanics reported a significantly higher willingness to consider bariatric surgery if advised so by a doctor, a particularly interesting finding in light of evidence that African Americans and Hispanics generally report lower trust in their healthcare providers.3,4 A limitation of this study is that the outcome variable—willingness to consider bariatric surgery—is only a proxy for actually undergoing bariatric surgery. Factors that may explain the leap from considering surgery to undergoing bariatric surgery need to be studied. Further research on patients’ reasons for unwillingness to consider surgery could also be enlightening. In the study by Wee et al., patients not willing to consider bariatric surgery most often attributed their unwillingness to believing that surgery was “too risky.” A substantial portion also endorsed the option of “other” when asked for their reason. Further survey-based research could provide information on the accuracy of patients’ risk perceptions, while qualitative research could be valuable in shedding light on the unidentified reasons for unwillingness to consider surgery. Physicians must be mindful of the impact they can have on patients’ decisions to undergo bariatric surgery. Patients deserve accurate, unbiased and thoughtfully delivered information on the risks and benefits of bariatric surgery. Such advising would benefit both patients electing to obtain surgery and those who decline surgery.