Durable Weight Loss Research Articles

Laparoscopic vertical sleeve gastrectomy, long and short-term impact on weight loss and associated co-morbidities.

The laparoscopic vertical sleeve gastrectomy (LVSG) has become the most popular operation for the treatment of morbid obesity in the United States. Being a purely restrictive procedure, the LVSG works to reduce the caloric intake of patients as well as decrease appetite through removal of ghrelin producing cells. Initially developed as the first part of a combined two step restrictive and malabsorptive procedure, the LVSG developed as a standalone procedure when patients lost significant weight with the restrictive portion of the operation alone. Short term outcomes have been promising in terms of weight loss and resolution of comorbid conditions. Long term outcomes are still evolving, but do demonstrate durable weight loss for a significant number of patients. Concerns with the LVSG in the long term revolve around development or worsening of gastroesophageal reflux disease or weight regain. The LVSG has been demonstrated to be a useful tool in the surgical management of morbid obesity.

Endoscopic submucosal dissection with suturing for the treatment of weight regain after gastric bypass: outcomes and comparison with traditional transoral outlet reduction (with video)

Although traditional transoral outlet reduction (TORe) involves argon plasma coagulation (APC) before endoscopic suturing, modified endoscopic submucosal dissection (ESD) has also been used. This study aims to evaluate the safety and efficacy of modified ESD-TORe in comparison with traditional APC-TORe. This was a retrospective study of prospectively collected data from patients who underwent modified ESD-TORe and APC-TORe for weight regain after Roux-en-Y gastric bypass (RYGB). Our outcomes were technical success, adverse events as categorized by the American Society for Gastrointestinal Endoscopy lexicon, and percent total weight loss (TWL) at 6 and 12 months and patients who underwent ESD-TORe were matched 1:3 based on gastrojejunal anastomosis (GJA) and pouch sizes to those who underwent APC-TORe. TWL between groups was compared. A linear regression was performed to control for any confounders. Nineteen RYGB patients underwent ESD-TORe. Technical success rate was 100%, with no severe adverse events. At 6 and 12 months, patients experienced 13.4% ± 6.6% and 12.1% ± 9.3% TWL, respectively (P< .05 for both). Nineteen ESD-TORe patients were also matched with 57 APC-TORe patients based on GJA and pouch sizes. At 12 months, the ESD-TORe group experienced greater weight loss compared with the APC-TORe group (12.1% ± 9.3% vs 7.5% ± 3.3% TWL, respectively; P= .036). On regression analysis, ESD remained a significant predictor of percent of TWL at 12 months after controlling for age, sex, body mass index, weight regain, and years from RYGB (β= 5.99, P= .02). Combining endoscopic tissue dissection with suturing provides greater and more durable weight loss for patients with weight regain after RYGB.

Bioring® gastric banding for obesity in a private South African hospital

Background: Obesity is a significant health problem in South Africa. Surgery is the most effective means of durable weight loss for the morbidly obese. Of the surgical options, laparoscopic adjustable gastric banding is the most controversial. We aimed to assess a single surgeon’s experience with a specific band. Methods: A retrospective observational study of a continuous cohort of laparoscopic adjustable gastric Cousin Bioring® band placements from a single private South African hospital was conducted. Three hundred and fifty bands were placed in 347 patients, 75% were female. Variables analysed were BMI obesity class, comorbidities, weight loss, diabetes resolution, adherence to aftercare, patient satisfaction, complications and death. Results: Outcomes were assessed in 343 patients (4 patients lost to follow-up). The mean follow-up was 39 months (IQR 29–66 months). The mean preoperative BMI was 43.3 kg/m2 (IQR 37.4–47.6 kg/m2). Most weight loss occurred in the first year, and 66% achieved > 40% excess weight loss. Resolution of type 2 diabetes and prediabetes occurred in 56.4% and 89.8% of patients respectively. Increasing age (p = 0.002), class 3 obesity (p < 0.001) and suboptimal aftercare (p < 0.001) were associated with failure. One patient developed band erosion and 40 developed band slippage, 34 of whom underwent secondary surgery (32 removals, 2 revisions). All complications were grade I–III. There was no high grade complication, and no death. Conclusions: Bioring® gastric banding achieved moderately good weight loss and resolution of type 2 diabetes with a low complication rate. BMI > 60 and suboptimal aftercare predicted poor outcome.

Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices.

Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today's children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence.

Cardiometabolic risk reduction after metabolic surgery.

Metabolic surgery provides the largest and most durable weight loss in persons with obesity. There is abundant randomized evidence to show its superiority over medical treatment alone in achieving improved glycemic control. Recent trials have also demonstrated a significant reduction in cardiovascular risk factor burden, whereas data from observational studies suggest an ability to reduce overt cardiovascular events and mortality. In this review, we briefly describe the surgical procedures involved and their indications. We further provide a summary of the effects of metabolic surgery on weight loss, glycemic control, and clinical outcomes.

2409 A Rare Complication of Gastric Bypass in the Setting of Chronic Liver Disease

INTRODUCTION: Porto-mesenteric venous thrombosis (PMVT) is a known and potentially fatal complication of general surgery. However, it has been rarely reported as a complication of worsening liver disease after undergoing bariatric surgery. This is a case of a patient who presented with mesenteric thrombosis following Roux-en-y gastric bypass (RYGB). CASE DESCRIPTION/METHODS: Patient is a 42-year-old African American female with a history of RYGB who presented with episodes of post-operative abdominal pain for 5 years. She was found to have recurrent high-grade small bowel obstruction's (SBO) necessitating a small bowel resection. Her course was further complicated by intra-abdominal abscesses requiring computed tomography (CT)-guided drainage, and wound dehiscence requiring open surgical intervention and debridement. Four months after discharge, she presented with right-sided abdominal pain and acute encephalopathy. Liver enzymes were elevated. Abdominal ultrasound revealed portal vein thrombosis (PVT). Dual-phase CT of the abdomen revealed sub-acute to chronic complete diffuse mesenteric thrombosis with collateralizations involving the portal, splenic, and distal superior mesenteric veins. Given that previous imaging suggested steatosis and hepatomegaly, sub-acute liver injury secondary to thrombosis was established in the setting of chronic liver disease. The patient's underlying non-alcoholic fatty liver disease was likely worsened by severe malnutrition and short gut syndrome following the RYGB. Her hepatic encephalopathy resolved after initiating lactulose and rifaximin. Outpatient hematology evaluation for all causes of thrombophilia remained inconclusive and the patient had no recurrences of thrombosis. DISCUSSION: RYGB remains the gold standard for bariatric surgery as it results in the most durable weight loss. However, complications may occur such as gastrointestinal leak, fistulas, marginal ulcers, SBO, and dumping syndrome. Mechanisms of thrombosis formation in this setting could be related to intra-operative vascular manipulation, increased intra-abdominal pressure, venous stasis, and possibly deteriorating liver function secondary to rapid weight loss and malnutrition. PMVT hasn't been reported consistently as a complication in various bariatric surgery studies, which leads us to conclude that it's either under or mis-diagnosed. It is extremely important to consider PMVT as a complication of RYGB in patients who have evidence of underlying liver disease prior to undergoing RYGB.

2064 Favorable Outcomes Among IBD Patients Undergoing Bariatric Surgery: A Case Series

INTRODUCTION: The prevalence of obesity continues to rise worldwide. It has been demonstrated that conditions such as T2DM and gallbladder disease, among other comorbidities, are related to Class II and III obesity (BMI ≥ 35). To combat this issue, bariatric surgery has been shown to be the most effective and durable weight loss method in individuals with a BMI ≥ 40 or BMI ≥ 35 with an obesity-related comorbidity. The rate of obesity among IBD patients parallels that of the general population and is approaching 30% nationwide. In recent years, there has been an increase in clinical research supporting the use of bariatric surgery within the IBD population as a safe and efficacious treatment option. CASE DESCRIPTION/METHODS: We present a case series of patients with a pre-operative diagnosis of IBD who underwent bariatric surgery at our hospital. Selection process was based on an ICD 9 or 10 diagnosis of IBD prior to Bariatric Surgery referral. Patients with a diagnosis of IBD but not followed by a gastroenterologist were excluded from this review. Patient data was extracted by the Clinical Research Data Service team from the electronic medical record. They identified 144 patients with IBD diagnoses who were seen at bariatric surgery clinic from 2003-2018. 5 IBD patients (3 CD, 2 UC) who underwent bariatric surgery were included in this data set and analyzed for IBD disease activity, operative complications, mortality, post-operative complications and overall excess weight loss (%EWL) at 6-month follow-up. All IBD patients who had bariatric surgery at this facility were included in data analyses. Bariatric surgical procedures included sleeve gastrectomy and Roux-en-Y. Mean age at time of referral was 43 years ± 12. One major perioperative complication was identified in a UC patient, pulmonary embolism complicated by splenic infarct. %EWL at 6-month follow-up was 35.4% ± 12.8. No patients required rehospitalization and mean length of hospital stay for the operation was 2.5 days ± 1.7. DISCUSSION: There were no IBD-related complications (glucocorticoid use or rehospitalization) seen within 30 days of surgery and no major complications (including SBO) were noted within a median follow-up of 54 months. As clinical data continues to emerge regarding bariatric surgery in the obese IBD population, it has become increasingly apparent that the pre-operative diagnosis of IBD should not exclude considerations for utilizing a surgical treatment modality for weight reduction in select patients.

A500 Clinical outcomes and 5-y results after laparoscopic sleeve gastrectomy in young patients (< 25 years) with morbid obesity.

Bariatric surgery proved to be safe and effective in terms of durable weight loss. The aim of our study was to present and discuss our experience with laparoscopic sleeve gastrectomy (LSG) in young patients (< 25-y) treated at our Institution

Bariatric surgery is associated with reduction in non-alcoholic steatohepatitis and hepatocellular carcinoma: A propensity matched analysis

IntroductionObesity is a risk factor for non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC). Bariatric surgery can provide durable weight-loss, but little is known about the later development of NASH and HCC after surgery. MethodsBariatric surgery (n = 3,410) and obese controls (n = 46,873) from an institutional data repository were propensity score matched 1:1 by demographics, comorbidities, BMI, and socioeconomic factors. Comparisons were made through paired univariate analysis and conditional logistic regression. ResultsTotal of 4,112 patients were well matched with no significant baseline differences except initial BMI (49.0 vs 48.2, p = 0.04). Bariatric group demonstrated fewer new-onset NASH (6 0.0% vs 10.3%, p < 0.0001) and HCC (0.05% vs 0.34%, p = 0.03) over a median follow-up of 7.1 years. After risk-adjustment, bariatric surgery was independently associated with reduced development of NASH (OR 0.52, p < 0.0001). ConclusionsBariatric surgery is associated with reduced incidence of NASH and HCC in this large propensity matched cohort. This further supports the use of bariatric surgery for morbidly obese patients to ameliorate NASH cirrhosis and development of HCC.

Weight loss after sleeve gastrectomy in developmentally delayed adolescents and young adults

BackgroundAdolescent obesity is a significant factor in caring for patients with developmental delay (DD). Sleeve gastrectomy provides durable weight loss for teens with obesity but requires behavioral change that may not occur in patients with DD. ObjectivesTo determine whether patients with DD had similar weight loss and adverse outcomes to patients without a diagnosis of DD after sleeve gastrectomy. SettingAcademic children's hospital, United States. MethodsPatients with DD undergoing sleeve gastrectomy were matched to adolescents without DD. Chart review was performed to determine etiology and severity of DD, weight, and body mass index (BMI) change in each group at 3, 6, 9, and 12 months postoperatively. One-year emergency department visits, readmissions, and reoperations were reviewed. ResultsTen patients with DD and 44 patients without DD underwent sleeve gastrectomy between 2008 and 2017. Six patients with DD (60%) had mild cognitive impairment, 3 patients (30%) had moderate cognitive impairment, and 1 patient (10%) had severe cognitive impairment. Patients were 81.5% female, had a mean age of 17.3 years, and had a preoperative BMI of 48.6 kg/m2. Preoperative BMI was similar in the 2 groups, and percent BMI reduction at 1 year was −29% (95% confidence interval: −35 to −23) and −26% (95% confidence interval: −29 to −23) in groups with and without DD respectively (group by time interaction, P = .27). ConclusionAdolescents with DD experience similar 1-year weight loss and adverse events following sleeve gastrectomy to adolescents without DD. Understanding the long-term outcomes for this population is crucial to ensure appropriate implementation of surgical weight loss programs.

Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis.

Obesity and obesity-related comorbidities are associated with increased risk of coronary artery disease (CAD). Bariatric surgery results in durable weight loss and improvement in numerous CAD risk factors, yet limited data exist on CAD-related outcomes. We hypothesized that bariatric surgery would lead to decreased risk of CAD and reduced rates of coronary revascularization procedures. All patients who underwent bariatric surgery at a single medical center from 1985 to 2015 were identified. A control population of morbidly obese patients who did not undergo bariatric surgery was identified using an institutional clinical data repository over the same study period, propensity score matched 1:1 on patient demographics and comorbidities including cardiac history. Univariate analyses were performed to compare outcomes in the surgery and non-surgery groups. A total of 3410 bariatric surgery patients and 45,750 non-surgical patients were identified. After 1:1 propensity-score matching, a total of 3242 patients in each group were found to be well balanced in baseline characteristics and risk factors. With a median follow-up of greater than 6years, the surgery group had significantly lower rates of myocardial infarction (1.8% vs. 10.0%; RR 0.18), coronary catheterization (1.9% vs. 8.8%; RR 0.22), percutaneous coronary intervention (0.4% vs. 7.8%; RR 0.05), and coronary artery bypass grafting (0.6% vs. 2.3%; RR 0.26). Similar benefits were observed for subgroups of patients with and without diabetes. Bariatric surgery was associated with a significant reduction in the incidence of myocardial infarction as well as lower rates of coronary revascularization in a propensity-matched cohort of morbidly obese patients. Though the retrospective nature of this study may have introduced a degree of selection bias, these outcomes support increased utilization of bariatric surgery for the prevention of heart disease.

Laparoscopic Sleeve Gastrectomy: How Do I Do It.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. LSG is a safe and effective primary bariatric procedure with durable weight loss. We believe LSG should not be called "easy" and should be performed only by surgeons trained in bariatric surgery. Method: We describe the technique, step by step, we use to perform a sleeve gastrectomy (SG). Results: The highlights of a safer SG systematization are based on minimum 36Fr bougie calibration, starting 4-5 cm from the pylorus, keeping ∼1 cm distance from esophagus. We routinely use staple line reinforcement by continuous suture. Conclusions: LSG is a safe and effective primary bariatric procedure with durable weight loss. It should be performed only by surgeons trained in bariatric surgery.

Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial

BackgroundThe AspireAssist is the first Food and Drug Administration–approved endoluminal device indicated for treatment of class II and III obesity. ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes. SettingUnited States–based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization). MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis. ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P < .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders. ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior.

Mo2028 – A Structured, Comprehensive Lifestyle Intervention Program Resuls in Durable Weight Loss and Ppi Reduction Among Obese Patients with Gastroesophageal Reflux Disease

Mo2028 – A Structured, Comprehensive Lifestyle Intervention Program Resuls in Durable Weight Loss and Ppi Reduction Among Obese Patients with Gastroesophageal Reflux Disease

The Combination of Left Ventricular Assist Device and Laparoscopic Sleeve Gastrectomy May Promote Myocardial Recovery in Obese Advanced Chronic Heart Failure Patients

Purpose Laparoscopic sleeve gastrectomy (LSG) has been associated with efficient and durable weight loss in obese patients with advanced heart failure (AHF) who undergo LVAD support. However, the effects of this combinatory approach on myocardial recovery remain undefined. Thus, we sought to evaluate the potential association between the combination therapy (LVAD support and LSG) and myocardial recovery in this patient cohort. Methods We retrospectively analyzed patients who underwent simultaneous LVAD implantation and LSG at our center from January 2013-August 2017. Demographic, biochemical, LVAD-related and transplant data were reviewed. Data from patients' outpatient follow-up appointments were gathered for 12 months. Echos were performed at baseline and 12 months. Myocardial recovery was defined as an improvement of LVEF ≥ 10%. Results 20 patients were included in this study. The average patient age was 47±13 years; 11 (56%) of the patients were male and the average BMI was 44±5 kg/m2. Ischemic heart disease was the underlying cause of heart failure in 7 (35%) of the patients. Three (15%) patients received a HeartWare device and 17 (85%) patients received a HeartMate II LVAD. The average pre-implant INTERMACS score was 2.7±0.6. Regarding the cardioprotective therapy, 9 (45%) of patients received ACEI/ARB, 11 (54%) beta blockers and 6 (27%) MRA. The average baseline LVEF was 21±5%; LVEF significantly improved to 32±14% at 12 months (p=0.001). Myocardial recovery was observed in 6 (30%) of the patients; two of these patients' LVEF improved to over 40% and had their LVAD explanted. Interestingly, the average HbA1c also significantly decreased at 12-month follow-up timepoint (6.6±1.5% vs. 5.1±0.5%, p=0.007). There were no deaths during the 12-month follow-up period. Conclusion The combined LVAD and LSG approach may represent a safe and feasible novel treatment strategy to promote myocardial recovery in obese patients with AHF. Although underlying mechanisms remain to be identified, a decrease in insulin resistance, as previously reported, achieved through a combined approach, may represent a significant contributing factor to myocardial recovery in this patient cohort.

Emerging Role of SGLT-2 Inhibitors for the Treatment of Obesity.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are glucose-lowering drugs that reduce plasma glucose levels by inhibiting glucose and sodium reabsorption in the kidneys, thus resulting in glucosuria. Their effects consequently include reductions in HbA1c, blood glucose levels, and blood pressure, but also reductions in body weight and adiposity. The ability to reduce body weight is consistently observed in individuals taking SGLT2 inhibitors, but this weight loss is moderate due to counter-regulatory mechanisms striving to maintain body weight. This has prompted exploration of SGLT2 inhibitors in combination with other agents acting via decreased food intake, e.g., glucagon-like peptide 1 receptor agonists (GLP1-RAs). The bodyweight effects are promising, and together with the signs of prevention of cardiovascular and renal events, such combinations including SGLT2 inhibitors are appealing. The weight loss is clinically important, as most individuals with type 2 diabetes are overweight or obese, but also because there is an unmet need for safe, effective, and durable weight loss interventions in obese individuals without diabetes.

Laparoscopic vagal nerve blocking device explantation: case series and report of operative technique.

Vagal nerve blockade with the vBloc device (ReShape Lifesciences, St. Paul, MN) has been shown to provide durable 2-year weight loss in patients with moderate obesity. These devices may require removal. We present a series of patients and report our technique for laparoscopic removal of this device. From December 2009 to December 2016, the medical records of patients who underwent laparoscopic explantation of a vagal blocking device at our institution were retrospectively reviewed. All patients initially underwent device placement as part of a multi-center, randomized, controlled trial. The device leads were removed with the application of firm traction in order to safely dissect them away from the stomach and esophagus as the body tended to form a fibrotic capsule surrounding the leads. Operative details, length of stay, 30-day post-operative complications, demographics and reasons for device removal were reported. Thirty patients were identified. Median age was 54 (37-65)years. Average operative time was 227.63 (± 100.21)min. Median time from implantation to removal was 41 (11-96)months. Removal reasons included device malfunction (7 patients, 23.3%), pain at the neuroregulator site (5 patients, 16.7%), retrosternal or epigastric pain (11 patients, 36.7%), weight regain or dissatisfaction with weight loss (15 patients, 50%), and severe nausea (2 patients, 6.7%). Two patients (6.7%) had Clavien-Dindo grade II complications following explantation. Thirteen patients (43.3%) had dense adhesions noted at the time of operation. Seroma formation at the neuroregulator site was the most common complication (7 patients, 23.3%). The vagal nerve blocking device can be safely removed laparoscopically with a low 30-day complication rate. Surgeons should be familiar with the details of the device appearance, the typical lead location, and should anticipate dense adhesions surrounding the leads. In addition, experience operating in the region of the gastroesophageal junction is imperative.

Bariatric Surgery and Crohn’s Disease

Obesity is a chronic condition significantly associated with health disorders, including type-II diabetes, cardiovascular diseases and inflammation. Its prevalence has been on the rise for the last few decades, contributing to the World Health Organization’s statement touting obesity as the pandemic of the millennium. In parallel, its incidence in patients with inflammatory bowel disease (IBD) is rising, with the prevalence of obesity among patients with IBD is similar to that of the general population ~20%?30%. The main common pathophysiological pathways which might link obesity to IBD include: disproportional accumulation of visceral fat, impaired release of adipokines, chronic inflammation, and disturbances in the gut microbiome. Large retrospective studies have shown that obesity is associated with an increased risk of Crohn’s Disease (CD), a chronic, progressive, destructive condition whose incidence has been increasing as well (3-20 cases per 100,000). Bariatric surgery is a well-accepted, effective and safe option for significant and durable weight loss in individuals with morbidly obesity. Even though obesity is associated with higher rates of surgical complexities and postoperative complications (possibly further exacerbated in patients with IBD), data from case studies and multiple data analyses have demonstrated that bariatric surgery in patients with both morbid obesity and CD is safe and effective. Bariatric surgery infers marked improvement in weight-associated comorbidities, massive weight loss, as well as better quality of life, in this special patient population.

Strategies for Weight Reduction Prior to Total Joint Arthroplasty.

* The number of total joint arthroplasty (TJA) procedures done in patients with obesity is increasing in the United States.* Compared with patients without obesity who undergo TJA, patients with obesity are at increased risk for numerous complications including periprosthetic joint infection and revision TJA.* Weight reduction prior to TJA in patients with obesity may mitigate these severe complications and the associated costs.* A multidisciplinary approach is most effective in order to achieve durable long-term weight loss.* Numerous therapies including behavioral, pharmaceutical, and surgical options exist but must be tailored to the individual patient.

Multi-sensor ecological momentary assessment of behavioral and psychosocial predictors of weight loss following bariatric surgery: study protocol for\xa0a multicenter prospective longitudinal evaluation

BackgroundBariatric surgery is currently the most effective strategy for producing significant and durable weight loss. Yet, not all patients achieve initial weight loss success and some degree of weight regain is very common, sometimes as early as 1–2 years post-surgery. Suboptimal weight loss not fully explained by surgical, demographic, and medical factors has led to greater emphasis on patient behaviors evidenced by clinical guidelines for appropriate eating and physical activity. However, research to inform such guidelines has often relied on imprecise measures or not been specific to bariatric surgery. There is also little understanding of what psychosocial factors and environmental contexts impact outcomes. To address research gaps and measurement limitations, we designed a protocol that innovatively integrates multiple measurement tools to determine which behaviors, environmental contexts, and psychosocial factors are related to outcomes and explore how psychosocial factors/environmental contexts influence weight. This paper provides a detailed description of our study protocol with a focus on developing and deploying a multi-sensor assessment tool to meet our study aims.MethodsThis NIH-funded prospective cohort study evaluates behavioral, psychosocial, and environmental predictors of weight loss after bariatric surgery using a multi-sensor platform that integrates objective sensors and self-report information collected via smartphone in real-time in patients’ natural environment. A target sample of 100 adult, bariatric surgery patients (ages 21–70) use this multi-sensor platform at preoperative baseline, as well as 3, 6, and 12 months postoperatively, to assess recommended behaviors (e.g., meal frequency, physical activity), psychosocial indicators with prior evidence of an association with surgical outcomes (e.g., mood/depression), and key environmental factors (e.g., type/quality of food environment). Weight also is measured at each assessment point.DiscussionThis project has the potential to build a more sophisticated and valid understanding of behavioral and psychosocial factors contributing to success and risk after bariatric surgery. This new understanding could directly contribute to improved (i.e., specific, consistent, and validated) guidelines for recommended pre- and postoperative behaviors, which could lead to improved surgical outcomes. These data will also inform behavioral, psychosocial, and environmental targets for adjunctive interventions to improve surgical outcomes.Trial registrationRegistered trial NCT02777177 on 5/19/2016.