Excess Body Weight Loss Research Articles

Radiofrequency ablation for the treatment of weight regain after Roux-en-Y gastric bypass surgery

Roux-en-Y gastric bypass (RYGB) surgery is an established modality for the treatment of morbid obesity. However, approximately one-quarter of patients experience weight regain after initially successful weight loss. Endoscopic therapy targeting the gastric remnant pouch represents a novel potential strategy to re-induce weight loss in this population. We performed a pilot trial of radiofrequency ablation (RFA) of the gastric remnant pouch after RYGB to determine feasibility, safety, and efficacy for weight loss. We identified patients who had undergone RYGB, achieved >40% excess body weight loss (EBWL), and then regained >25% of lost weight. RFA was applied to the gastrojejunal anastomosis and the entire surface area of the gastric remnant pouch. Treatment was repeated at 4 and 8 months if patients did not meet specified weight loss targets. Weekly weights were obtained for 12 months. The primary efficacy outcome was percent EBWL at 12 months, compared with baseline. Twenty-five patients were enrolled at 4 centers. Mean (± standard deviation [SD]) age was 45.4 ± 9.1 years, and 84% (21/25) were female. Mean (± SD) baseline body mass index was 40.2 ± 7.8. Twenty-two of 25 patients completed 12 months of follow-up. At 12 months, median (± SD) EBWL was 18.4% (interquartile ratio 10.8, 33.7; P< .0001). Significant weight loss was seen at 3.5 months (P< .0001) and at 7.5 months (P< .0001), with a significant trend for continued weight loss over the 12-month period (P= .013). Two patients had serious adverse events requiring hospitalization. RFA of the gastric remnant pouch in patients with weight regain after RYGB resulted in significant reductions in excess body weight with an acceptable safety profile. Continued weight loss was observed after each RFA treatment. Further clinical trials in well-selected populations are warranted to determine the optimal number and frequency of RFA treatments and to assess durability of weight loss. (Clinical trial registration number: NCT01910688.).

Cannabinoid CB1 /CB2 receptor agonists attenuate hyperactivity and body weight loss in a rat model of activity-based anorexia.

Anorexia nervosa (AN) is a serious psychiatric condition characterized by excessive body weight loss and disturbed perceptions of body shape and size, often associated with excessive physical activity. There is currently no effective drug-related therapy of this disease and this leads to high relapse rate. Clinical data suggest that a promising therapy to treat and reduce reoccurrence of AN may be based on the use of drugs that target the endocannabinoid (EC) system, which appears dysregulated in AN patients. The activity-based anorexia (ABA) rodent model mimics the severe body weight loss and increased physical activity, as well as the neuroendocrine disturbances (i.e. hypoleptinaemia and hypercortisolaemia) in AN. This study investigated whether cannabinoid agonists can effectively modify anorexic-like behaviours and neuroendocrine changes in rats subjected to a repeated ABA regime that mimics the human condition in which patients repeatedly undergo a recovery and illness cycle. Our data show that subchronic treatment with both the natural CB1 /CB2 receptor agonist Δ9 -tetrahydrocannabinol and the synthetic CB1 /CB2 receptor agonist CP-55,940 significantly reduced body weight loss and running wheel activity in ABA rats. These behavioural effects were accompanied by an increase in leptin signalling and a decrease in plasma levels of corticosterone. Taken together, our results further demonstrate the involvement of the EC system in AN pathophysiology and that strategies which modulate EC signalling are useful to treat this disorder, specifically in patients where physical hyperactivity plays a central role in its progression and maintenance.

Quality of Life Assessment After Bariatric Surgery—a Single-Center Experience

Obesity is a current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past 10 years and we can observe an early onset of obesity. We have used a modified BAROS and SF36TM questionnaire to conduct a descriptive study on 34 obese patients undergoing surgery for obesity—laparoscopic sleeve gastrectomy (LSG). The inclusion criteria were the embodiment of surgery for obesity: BMI (body mass index) >40 kg/m2 or BMI > 35 kg/m2 and associated comorbidities. The postoperative BMI was 25.7670 ± 3.74759 kg/m2 (mean ± SD). The average number of lost kilograms was 38.74 ± 12.526 (mean ± SD), and the average percentage of excess body weight loss (% EBWL) was 85.9952 ± 22.69028% (mean ± SD). Patients lost an average of 36.88–38.56 kg at 6–12 months after surgery, and they reach a % EBWL of 94.69 ± 30.02% and a normal BMI of 23.96 kg/m2 at 18 months postoperatively. All patients significantly reduced the amount of food eaten after surgery. More than 2 years after the surgery, patients increased their food intake by about 30%, but maintained their weight loss and a normal BMI. Related to quality of life, 77.78% of patients declared a vast improvement, 11% a good quality of life, and only 3.7% said that the quality of life is worse than before the surgery. Also, a relationship between quality of life and the improvement of sexual life, or with the increased frequency of physical exercise has been observed. Improving quality of life is directly related with the weight loss, with %EBWL, and with the postoperative BMI. Bariatric surgery should be understood in all the positive changes that it generates in everyday life.

ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

ABSTRACTBackground:Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim: To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Method:Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or <25% and adverse effects. Voluntary oral contrasted radiological examinations were scheduled to assess the gastroplasty at different times post-procedure. Results:Mean age was 44.9 (23-69) years. At 24 months after the procedure baseline mean BMI change from 38.3 to 30.8 kg/m2. TBWL, %TBWL and %EWL were of 21.3 kg, 19.5% and 60.4% respectively. 85.7% of patients achieve the goal of >25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up. Conclusion:Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up.

Assessment of gastric sleeve resection efficacy in treatment of patients with obesity

Aim. To study the efficacy of longitudinal resection of the stomach in treatment of patients with obesity according to the results of two-year follow-up after the surgery.Methods. During the period between 2012 and 2015 24 patients with obesity were operated on. In all of them longitudinal resection of the stomach was performed. The age of the patients was 21 to 63 years, mean body weight was 118.8±18.67 kg, mean body mass index (BMI) was 42.3±5.8 kg/m2. Before and after the surgery evaluation of excess weight, presence and characteristics of anemia (red blood cell count, concentration of hemoglobin, serum iron and vitamin B12) and quality of life according to Hamilton scale was performed.Results. Weight loss during the first 2 years after the longitudinal resection of the stomach was 68% and it was less pronounced in patients with increased BMI. In patients with BMI 35 kg/m2 at the admission body weight was close to normal by the end of the first year after the surgery. In 4 patients with iron deficiency anemia after 2 years of follow-up hemoglobin concentration was 15.7% below its average preoperative level. 5 (20.8%) patients developed postoperative pernicious anemia. The average concentration of vitamin B12 in observed patients was 421.4±87.9 pmol/L before the surgery and 316.8±64.3 pmol/L after 2 years (p 0.001). Patients’ quality of life was noted to be improved after the performed surgery.Conclusion. Longitudinal resection of the stomach is a very effective method of obesity treatment; it allows to achieve significant loss of excess body weight and to improve patients’ quality of life.

Patients' Preoperative Estimate of Target Weight and Actual Outcome after Bariatric Surgery.

Evidence about the impact of psychological factors on weight loss after bariatric surgery is scarce. This study explores whether patients' preoperative estimate of target weight influences actual weight loss for different types of bariatric procedures. Patients eligible for bariatric surgery were instructed twice on how to calculate their expected target weight. They were divided into three groups based on their percentage excess weight loss (%EWL) and percentage total body weight loss (%TBWL). Weight loss 12 and 24months after surgery was analyzed for each group and per type of surgery. Six hundred fifty-six patients participated in this study. Types of surgery performed were the Roux-en-Y gastric bypass (RYGB, 75%), sleeve gastrectomy (SG, 8.1%), REDO-RYGB (12.5%), and laparoscopic adjustable gastric banding (LAGB, 4.4%). Data of 622 and 410 patients were available for analysis at 12 and 24months, respectively. Surprisingly, 415 patients (63.3%) overestimated their expected weight loss as opposed to our calculation, based on our own historic data. One hundred thirty-four patients (20.4%) estimated their weight loss correctly and 107 patients (16.3%) underestimated their weight loss. There was a significant higher %EWL 12months after RYGB surgery for patients who overestimated their weight loss compared to those who estimated their weight loss correctly (p=0.001). After 24months and for other types of procedures, no statistically significant differences were found between the three groups. Despite instructions on how to calculate target weight, the majority of patients overestimated their weight loss. Actual %EWL 12months after RYGB surgery might be influenced by setting a low target weight.

How far is sleeve gastrectomy more effective than diet regimen in treating obesity-associated hyperlipidemia

Background The global epidemic of obesity is one of the major health issues in the 21st century that influences many aspects of public health, including psychosocial and socioeconomic aspects. Hyperlipidemia is one of the health hazards associated with morbid obesity. Patients and methods This was a prospective study conducted in Kasr Al-Aini University Hospital (sleeve gastrectomy group) and the National Nutrition Institute (diet group) during the period from June 2015 till December 2015 with a follow-up of 12 months till December 2016 for both groups. One hundred patients were included in the study and were equally divided into two groups: group A (sleeve gastrectomy group) and group B (diet group). Objective The objective of this study was to compare the effects of laparoscopic sleeve gastrectomy (LSG) and a dietary regimen on hyperlipidemia in morbidly obese patients. Results LSG significantly decreased total cholesterol in 70% of cases and triglycerides in 78% of cases; however, diet caused a decrease of total cholesterol in 30% of cases and triglycerides in 54% of case. Low-density lipoprotein was not significantly changed in both groups. Conclusion LSG is more effective than diet programs in treating obesity-associated hyperlipidemia due to more significant and sustained excess body weight loss.

Single anastomosis gastric bypass: A novel bariatric procedure

Since Rutledge developed single anastomosis gastric bypass in 1990, it has been popularized by surgeons in Europe as a procedure of choice in the morbidly obese. It involves creating a gastric pouch of 12 cm and an antecolic loop gastroenterostomy 200 cm distal to the ligament of Trietz. It has comparable excess body weight loss rates to Roux-en-Y gastric bypass, and its safety profi le is better. This review summarizes the technical details and key points in performing a safe procedure while outlining the results of key high volume series in terms of outcome and technical feasibility.

Suboptimal Weight Loss and Weight Regain after Gastric Bypass Surgery\u2014Postoperative Status of Energy Intake, Eating Behavior, Physical Activity, and Psychometrics

BackgroundSuboptimal weight loss (SWL) and weight regain (WR) after gastric bypass surgery (GB) remains poorly understood.ObjectivesThis study aims to compare GB patients experiencing SWL or significant WR (SigWR) with successful controls, regarding postoperative food intake, eating behavior, physical activity (PA), and psychometrics.MethodsForty-nine patients with >1 year post-surgery were classified as either experiencing SWL (excess body weight loss, EWL, <50%, n = 22) or SigWR (total weight regain ≥15%, n = 38), with respective control groups. Energy intake (EI) was measured with a Food Frequency Questionnaire, eating behavior using the Dutch Eating Behavior Questionnaire and the Three-Factor Eating Questionnaire, and PA using both SenseWear Armbands and the International Physical Activity Questionnaire. Eating disorders, depression, and quality of life (QoL) were measured using the Eating Disorder Examination Questionnaire, Beck Depression Inventory II, and Impact of Weight on Quality of Life, respectively.ResultsEI, macronutrient distribution, and meal frequency were similar among groups. However, disinhibited eating behavior score was higher, while most subcategories from IWQOL were significantly lower in both SWL and SigWR groups compared with their respective controls. PA was significantly lower in the SWL and SigWR groups compared with the respective controls. There were no differences between groups regarding depression.ConclusionsLower PA levels, disordered eating behavior and lower QoL are associated with unsuccessful weigh loss outcome after GB surgery. Longitudinal studies are needed to clarify the potential causal relationship between the previously described variables and SWL/SigWR after GB.

Gastric Artery Embolization Trial for the Lessening of Appetite Nonsurgically (GET LEAN): Six-Month Preliminary Data

PurposeTo report 6-month safety and efficacy results of a pilot study of left gastric artery (LGA) embolization for the treatment of morbid obesity (ie, body mass index [BMI] > 40 kg/m2). Materials and MethodsFour white patients (three women; average age, 41 y [range, 30–54 y]; mean weight, 259.3 lbs [range, 199–296 lbs]; mean BMI, 42.4 kg/m2 [range, 40.2–44.9 kg/m2]) underwent an LGA embolization procedure with 300–500–µm Bead Block particles via right common femoral or left radial artery approach. Follow-up included upper endoscopy at 3 days and 30 days if necessary and a gastric emptying study at 3 months. Tracked parameters included adverse events; weight change; ghrelin, leptin, and cholecystokinin levels; and quality of life (QOL; by Short Form 36 version 2 questionnaire). ResultsThree minor complications (superficial gastric ulcerations healed by 30 d) occurred that did not require hospitalization. There were no serious adverse events. Average body weight change at 6 months was −20.3 lbs (n = 4; range, −6 to −38 lbs), or −8.5% (range, −2.2% to −19.1%). Average excess body weight loss at 6 months was −17.2% (range, −4.2% to −38.5%). Patient 4, who had diabetes, showed an improvement in hemoglobin A1c level (7.4% to 6.3%) at 6 months. QOL measures showed a general trend toward improvement, with the average physical component score improving by 9.5 points (range, 3.2–17.2) and mental component score improving by 9.6 points (range, 0.2–19.3) at 6 months. ConclusionsPreliminary data support LGA embolization as a potentially safe procedure that warrants further investigation for weight loss in morbidly obese patients.

Decreased Levels of Circulating Cancer-Associated Protein Biomarkers Following Bariatric Surgery

BackgroundEpidemiological studies have identified obesity as a major risk factor for cancer in humans, and trials have demonstrated a significant reduction in the incidence of cancer after bariatric surgery. The rapidity of weight loss after bariatric surgery provides an opportunity to identify the molecular changes associated with effective obesity treatment. Indirectly, this may provide some insights into the mechanisms that drive the association between obesity and cancer. We sought to measure circulating cancer-associated proteins before and after laparoscopic sleeve gastrectomy (LSG).MethodsWe prospectively enrolled 15 patients undergoing LSG. Thirty-four plasma protein biomarkers thought to be associated with cancer processes were analyzed at baseline and following successful weight loss at 12 weeks using a multiplex bead-based assay.ResultsMean excess body weight loss was 44 % at 12-week follow-up. After LSG, a significant reduction in circulating plasma levels was observed for half (17/34) of the proteins assessed: VEGF-A, VEGF-C, VEGF-D, endoglin, PLGF, sFASL, IGFBP-1, IL-18, prolactin, EGF, TGFα, sCD40L, IL-18, TNFα, IL-6, HB-EGF, and PAI-1. Nonsignificant decreases were found for the remaining proteins.ConclusionsCirculating cancer-related biomarker levels were reduced by surgical weight loss, and this benefit was achieved as early as 3 months after operation. The observed reduction in cancer biomarkers may be related to the reported decrease in cancer incidence following bariatric surgery.

The role of laparoscopic sleeve gastrectomy as a treatment for morbid obesity; review of outcomes.

Global prevalence of obesity has soared. Where lifestyle and medical treatments have failed, laparoscopic sleeve gastrectomy (LSG) is increasingly regarded as a good surgical procedure for morbid obesity. Following the introduction of LSG, we assessed our surgical outcomes. We reviewed a consecutive series of LSGs from January 2009 to January 2015. Our primary focus was to assess the success of this procedure on the percentage excess body weight loss (%EWL), Body Mass Index (BMI), hypertension and diabetes. Additionally, we evaluated the rate of procedure-related complications. There were 183 consecutive patients evaluated. Median age was 45years (24-73). The majority were female (73.2%, n=134). At 1year post-op, median %EWL was 57.6%. There was an associated median reduction in BMI of 16kg/m2 (0-33). At 2 years, median %EWL was sustained at 58.4%. The median reduction in BMI was 16kg/m2 (4-32). At 2-year post-op, 78.9% of diabetic patients had their diabetic medications completely discontinued, while a further 15.8% having their medication reduced. 34.6% of hypertensive patients had their antihypertensives discontinued, with 50% having medications reduced. There was no procedure related mortality. 3.3% (n=6) of patients had a confirmed staple-line leak. This study shows LSG is a safe and successful management strategy for morbid obesity. In addition to the direct effects of sustained weight loss, it highlights indirect effects that LSG has on obesity-related health issues, with substantial reduction in diabetic and anti-hypertensive medications. Our results reaffirm international studies of the beneficial effects of LSG on Type II diabetes and hypertension.

Video Ratings of Surgical Skill and Late Outcomes of Bariatric Surgery.

Measures of surgeons' skills have been associated with variations in short-term outcomes after laparoscopic gastric bypass. However, the effect of surgical skill on long-term outcomes after bariatric surgery is unknown. To study the association between surgical skill and long-term outcomes of bariatric surgery. In this retrospective observational study, 20 surgeons performing bariatric surgery submitted videos; surgeons were ranked on their skill level through blinded peer video review and sorted into quartiles of skill. Outcomes of bariatric surgery were then examined at the patient level across skill levels. The patients (N = 3631) undergoing surgery with these surgeons had 1-year postoperative follow-up data available between 2006 and 2012. The study was conducted using the Michigan Bariatric Surgery Collaborative, a prospective clinical registry of 40 hospitals performing bariatric surgery in the state of Michigan. Surgeon skill level. Excess body weight loss at 1 year; resolution of medical comorbidities (hypertension, sleep apnea, diabetes, and hyperlipidemia), functional status, and patient satisfaction. Surgeons in the top and bottom quartiles had each been practicing for a mean of 11 years. Peer ratings of surgical skill varied from 2.6 to 4.8 on a 5-point scale. There was no difference between the best (top 25%) and worst (bottom 25%) performance quartiles when comparing excess body weight loss (67.2% vs 68.5%; P = .86) at 1 year. There were no differences in resolution of sleep apnea (62.6% vs 62.0%; P = .77), hypertension (47.1% vs 45.4%; P = .73), or hyperlipidemia (52.3% vs 63.4%; P = .45). Surgeons with the lowest skill rating had patients with higher rates of diabetes resolution (78.8%) when compared with the high-skill group (72.8%) (P = .01). In contrast to its effect on early complications, surgical skill did not affect postoperative weight loss or resolution of medical comorbidities at 1 year after laparoscopic gastric bypass. These findings suggest that long-term outcomes after bariatric surgery may be less dependent on a surgeon's operative skill and instead be driven by other factors. Operative technique was not assessed in this analysis and should be considered in future studies.

Risk of post-gastric bypass surgery hypoglycemia in nondiabetic individuals: A single center experience.

The epidemiology of post-gastric bypass surgery hypoglycemia (PGBH) is incompletely understood. This study aimed to evaluate the risk of PGBH among nondiabetic patients and associated factors. A cohort study of nondiabetic patients who underwent Roux-en-Y gastric bypass (RYGB) was conducted. PGBH was defined by any postoperative record of glucose < 60 mg/dL, diagnosis of hypoglycemia, or any medication use for treatment of PGBH. Kaplan-Meier analysis was used to describe PGBH occurrence, log-rank tests, and Cox regression to examine associated factors. Of the 1,206 eligible patients, 86% were female with mean age of 43.7 years, mean preoperative BMI of 48.7 kg/m(2) , and a mean follow-up of 4.8 years. The cumulative incidence of hypoglycemia at 1 and 5 years post-RYGB was 2.7% and 13.3%, respectively. Incidence of PGBH was identified in 158 patients and was associated with lower preoperative BMI (P = 0.048), lower preoperative HbA1c (P = 0.012), and higher 6-month percent of excess body weight loss (%EWL) (P = 0.001). A lower preoperative HbA1c (HR = 1.73, P = 0.0034) and higher 6-month %EWL (HR = 1.96, P = 0.0074) remained independently correlated with increased risk for PGBH in multi-regression analysis. The 5-year incidence of PGBH among nondiabetic individuals was 13.3% and was associated with a lower preoperative HbA1c and greater weight loss at 6 months following surgery.

Formal Nutritional Education Improves Weight Loss in Bariatric Patients Following Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed procedure in the bariatric surgery armamentarium. This study evaluates our experience with LSG at Dwight D. Eisenhower Army Medical Center (DDEAMC) during the time period of 2008-2010. We found that the inclusion of formal nutritional education significantly increased our weight loss results following LSG. This is a retrospective review from our LSG caseload from 2008 to 2010. During that time, we performed 159 LSG. In our review, we performed comparative data of all operative years during 2008-2010 for up to 3years postoperatively. Our main focus was in regard to weight loss as measured by percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess BMI loss (%EBL). We also evaluated the effect of LSG on diabetes mellitus (DM) and hypertension (HTN) postoperatively. We found an improvement in our %EWL, %TWL, and %EBL rates in our LSG cases following the inclusion of formal nutritional education. There was a mean increase in %EWL of 15%, %TWL of 7%, and %EBL of 21%, which were statistically significant, that was present at all postoperative years of follow-up. We determined the only variable that changed in our bariatric program starting in 2010 was the inclusion of formal nutritional education. We also found a statistically significant improvement in resolution of HTN with the inclusion of formal nutritional education. The addition of formal nutritional education can enhance weight loss following bariatric surgery. We have shown a significant improvement in weight loss results following LSG with the implementation of formal nutritional education; this is the only study to our knowledge evaluating formal nutritional education and LSG.

Institutional Improvement in Weight Loss after Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a recent addition to the bariatric surgery armamentarium. It has been demonstrated to be an efficacious stand-alone bariatric procedure in regard to weight loss. This study evaluates the progress of our initial experience with LSG. Retrospective review of prospective data from 2008 to 2010. Compared data between our first operative year of experience with LSG (2008) and our third year of experience (2010). Data compared for up to three years postoperatively. End points were percentage of excess body weight loss (%EWL) and percentage of excess body mass index loss (%EBL). Institutional improvement in %EWL and %EBL rates as our collective experience increased with LSG. Mean increase in %EWL of 14 per cent and mean increase of %EBL of 22 per cent. In our first year performing LSG the institutional weight loss was <50 per cent EWL, which is often cited as a benchmark level for "success" after bariatric surgery. By our third year of experience with LSG we achieved an institutional weight loss >50 per cent EWL. Institutional improvement in weight loss results with LSG as the collective experience increased. Several factors could have contributed to this observation to include a surgical mentorship program and the institution of formal nutritional education. This study demonstrates that institutional experience is a significant factor in weight loss results with LSG.

Successful Management of New-Onset Diabetes Mellitus and Obesity With the Use of Laparoscopic Sleeve Gastrectomy After Kidney Transplantation—A Case Report

In kidney transplantation, obesity is associated with poorer graft survival and patient survival. Bariatric surgery may provide benefit for these patients, not only by inducing weight loss, but also via reduction of diabetes. We report a case of morbid obesity, poorly controlled new-onset diabetes mellitus, and gout after kidney transplantation that was treated with laparoscopic sleeve gastrectomy 3 years after kidney transplantation. After 1 year of follow-up, 76% excessive body weight loss was attained. No complications were noted. The operation also provided total remission of diabetes and gout as well as good graft survival. Based on our experience, laparoscopic sleeve gastrectomy may be a feasible treatment for obese patients after renal transplantation to help resolve obesity and control new-onset diabetes. However, the timing of operation and the long-term potential for graft and patient survivals with this operation require further study.

Virtual reality for improving body image disorders and weight loss after gastric band surgery: a case series.

Laparoscopic Adjustable Gastric Banding (LAGB) is a common surgery method used to help obese patients to lose weight. However, even if LAGB is able to produce a durable and relevant weight loss, it is less effective in improving body image: as demonstrated by a recent study, obese patients with a body image disorder in the pre-operative stage continue to show this even 13 months after the operation. In this presentation we will discuss the possible role of virtual reality (VR) in addressing this problem within an integrated cognitive behavioral approach. To test this approach, a case series of three LAGB patient who experienced body dissatisfaction even after a &gt;30/40% excess body weight loss, is presented and discussed. At the end of the 6-week protocol the patients experienced a 15%-20% further reduction of their weight. This reduction was also matched by a general improvement of the psychological state. Both the weight loss and the level of well-being were further improved after a three-month follow-up.

Perioperative Online Weight Monitoring in Bariatric Surgery with a Digital Internet-Connected Scale

Strict follow-up after bariatric surgery is an important factor in achieving and maintaining weight loss, whereas regaining weight is the most important threat in long-term follow-up. Stagnation in weight loss or weight regain can be signals of early treatment failure. The aim of this study is to assess the possibility of obtaining frequent objective weight measurements using an Internet-connected home weighing scale. Internet-connected home weighing scales were used to perform weekly follow-up in bariatric surgery patients during the first postoperative year. For each patient, weight measurements were registered and excess body weight loss was calculated. This follow-up method was deemed successful if weight measurements were available for 80% of all weeks in the first year. A total of 14 patients started the protocol. Seven patients (50%) performed weekly weight measurements for at least 80% of all weeks in the first year. One-year follow-up was available for 11 patients. Excess weight loss was >50% in nine (82%) of these patients and >40% in the remaining two. Using an Internet-connected weighing scale at home is feasible in postsurgery bariatric patients. It can provide the treating physicians with valuable information about weight loss over time. This could possibly offer opportunities for timely interventions during follow-up in case of insufficient weight loss or weight regain.

Outcome of Laparoscopic Sleeve Gastrectomy for Treatment Morbidly Obese Patients in Srinagarind Hospital

Background: Laparoscopic sleeve gastrectomy (LSG) has been increasingly popular procedure for treatment morbidly obese patients and showing good weight loss and resolution of comorbidity diseases. The objective of this study was to evaluate postoperative outcome in term of operative complication, weight loss and comorbidity improvement after laparoscopic sleeve gastrectomy. Methods: From July 2011 to December 2014 there is 70 patients (45 woman; 64 percent) with an average age of 37.7 years (range; 17-62 years), mean body weight was 126.5 kg (range; 83-250 kg), mean BMI was 45.7 kg/m2 (range; 33-77 kg/m2) who underwent laparoscopic sleeve gastrectomy for treatment morbid obesity. Postoperative time, 1st day postoperative pain, postoperative complication and postoperative follow up data for the body weight change, percent EWL, BMI and improvement of comorbidity at the 6th, 9th,12th, 18th, and 24th months were recorded. Results: The mean operative time was 75 minutes. The mean operative blood loss was 20 ml. The mean 1st day postoperative pain score was 4. No conversion to laparotomy had to be performed. The mean percentages of excessive body weight loss (EWL) were 46.78 percent at 6 months, 59.75 percent at 1 year, 64.53 percent at 18 months, and 62.92 percent at 2 years. The mean BMI were 35.57 kg/m2 at 6 months, 32.69 kg/m2 at 1 year, 29.23 kg/m2 at 18 months, and 29.45 kg/m2 at 2 years. The rate of resolution of OSA was 65.7 percent and improvement of OSA was 31.4 percent. The rate of resolution of hypertension was 68.9 percent and improvement of hypertension was 31.1 percent. The rate of resolution of DM was 70 percent and improvement of DM was 30 percent. The rate of postoperative complication was 4.2 percent. Conclusions: Laparoscopic sleeve gastrectomy is safe and effective procedure for treatment morbidly obese patients. However, weight regained need to evaluated in long term follow up.