Post-bariatric Surgery Research Articles

Bite by byte: can fitness wearables help bariatric patients lose more weight after surgery?

BackgroundMultidisciplinary approaches to weight loss have been shown to improve outcomes in bariatric patients. Few studies have been performed assessing the utility and compliance of fitness tracking devices after bariatric surgery. We aim to determine whether use of an activity tracking device assists bariatric patients in improving postoperative weight loss behaviors.MethodsA fitness wearable was offered to patients undergoing bariatric surgery from 2019 to 2022. A telephone survey was conducted to elucidate the impact of the device on the patient’s postoperative weight loss efforts 6 to 12 months after surgery. Weight loss outcomes of sleeve gastrectomy (SG) patients receiving the fitness wearable (FW) were compared to those of a group of SG patients who did not receive one (non-FW).ResultsThirty-seven patients were given a fitness wearable, 20 of whom responded to our telephone survey. Five patients reported not using the device and were excluded. 88.2% reported that using the device had a positive impact on their overall lifestyle. Patients felt that using the fitness wearable to keeping track of their progress helped them both to achieve short-term fitness goals and sustain them in the long run. From the patients that utilized the device, 44.4% of those that discontinued felt like it helped them build a routine that they maintained even after they were no longer using it. Demographic data between FW and non-FW groups (age, sex, CCI, initial BMI, and surgery BMI) did not differ significantly. The FW group trended towards greater %EWL at 1 year post-operation (65.2% versus 52.4%, p = 0.066) and had significantly greater %TWL at 1 year post-operation (30.3% versus 22.3%, p = 0.02).ConclusionThe use of an activity tracking device enhances a patient’s post-bariatric surgery experience, serving to keep patients informed and motivated, and leading to improved activity that may translate to better weight loss outcomes.

Role of Ursodeoxycholic Acid in Prophylaxis Against Development of Gall Stones Post-Bariatric Surgery

Role of Ursodeoxycholic Acid in Prophylaxis Against Development of Gall Stones Post-Bariatric Surgery

A158 Efficacy of Adjuvant Weight Loss Medications in Post-Bariatric Surgery Patients Regarding Weight, Insulin Resistance, & Hyperlipidemia

A158 Efficacy of Adjuvant Weight Loss Medications in Post-Bariatric Surgery Patients Regarding Weight, Insulin Resistance, & Hyperlipidemia

A316 A qualitative exploration of patients and romantic partners post-bariatric surgery: Understanding the dyadic experience, relationship health, and needs for support

A316 A qualitative exploration of patients and romantic partners post-bariatric surgery: Understanding the dyadic experience, relationship health, and needs for support

A randomised control trial assessing the impact of an investment-based intervention on weight-loss, glycated haemoglobin and psychological outcomes 1 year post bariatric surgery

Background: Whilst bariatric surgery remains the most effective form of weight management, some patients show less than optimal weight loss. This study evaluated the impact of focusing on the investment patients have made in surgery to improve health outcomes. Methods: The study used a randomised control trial design with patients allocated either to the control or investment intervention group. Patients were recruited from University College Hospital, London and half were randomly allocated to the intervention arm and described the investment they had made in their operation just before surgery then 3 and 6 months post-surgery. The primary outcomes were patient’s weight, body mass index (BMI) and HbA1c at 12 months. Secondary psychological outcomes were also assessed at baseline and 12 months. Results: By one year post-operation for 141 patients the mean change in weight was 35.2kg, for BMI it was 12.7 and for HbA1c it was 0.65. At one year follow up there was no significant difference between groups for weight loss (kg and BMI) using both ITT analysis and explanatory analysis. Using explanatory analysis (n=119) a significant difference in HbA1c change was found with those in the control group showing a greater improvement in their blood sugars than those in the intervention group (5.44 vs 5.41; p=0.03). Response rates for psychological outcomes were low (n=73). No differences were found for most psychological outcomes, however, those in the intervention group reported lower levels of imposed control than those in the control group by 12 months. Conclusions: Highlighting the patients’ investment pre and post bariatric surgery had no impact on weight loss as measured by kg or BMI 1 year later. Furthermore, no changes were found for most psychological outcomes. Some detrimental impacts were found however relating to HBA1c and perceptions of control. ClinicalTrials.gov registration: NCT02045628

Diet quality and anthropometric indices of patients undergone bariatric surgery: the prospective Tehran obesity treatment study

BackgroundPatients undergone bariatric surgery (BS) has long-term risks including decrease in diet quality, nutritional deficiencies and weight regain. This study focus on assessing dietary quality and food group components in patients one year after BS, the relationship between dietary quality score and anthropometric indices, and also evaluating the trend of body mass index (BMI) of these patients three years after BS.MethodsA total of 160 obese patients (BMI ≥ 35 kg/m2) were undergone sleeve gastrectomy (SG) (n = 108) or gastric bypass (GB) (n = 52), participated in this study. They were assessed for dietary intakes using three 24-hour dietary recalls one year after surgery. Dietary quality was assessed using food pyramid for post BS patients and healthy eating index (HEI). Anthropometric measurements were taken pre-surgery and 1, 2 and 3 years after operation.ResultsThe mean age of patients was 39.9 ± 11 years (79% female). The mean ± SD percentage of excess weight loss was 76.6 ± 21.0 one year after surgery. Intake patterns are generally (up to 60%) not consistent with the food pyramid. The mean total HEI score was 64 ± 12 out of 100. More than %60 of participants is exceeding the recommendations for saturated fat and sodium. The HEI score did not show significant relationship with anthropometric indices. The mean of BMI in SG group increased over three years of follow up, while in GB group, there were no significant differences in BMI during three years of follow up.ConclusionsThese findings showed that patients had not healthy pattern intake one year after BS. Diet quality did not show significant relationship with anthropometric indices. The trend of BMI three years after surgery was different based on surgery types.

Is there a link between post-bariatric surgery hypoglycemia and the increased risk of external-cause mortality?

Is there a link between post-bariatric surgery hypoglycemia and the increased risk of external-cause mortality?

Self-Nanoemulsifying Drug Delivery System-Containing the Poorly Absorbed Drug - Valsartan in Post-Bariatric Surgery.

Morbid obesity and its related metabolic syndrome are an important health issue. Recently, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have accounted for the most popular bariatric surgeries. Valsartan (VST) is a common hypertension drug, and nano-carriers can increase its solubility and bioavailability. This study aims to explore the nano-VST formula in bariatric surgery subjects. High-fat fed animals were used as obese models. Operations were performed according to a standardized protocol. The drug was administrated by gavage, and blood samples were taken by serial tail vein sampling. Caco-2 cells were used for examining cell viability and drug uptake. A self-nano-emusifying drug delivery system (SNEDDS) formula was composed of sefsol-218, RH-40 and propylene glycol by a specified ratio, while high-performance liquid chromatography (HPLC) was used for determining drug concentrations. Post-operatively, subjects that underwent RYGB lost more body weight compared to the SG group. The SNEDDS did not exhibit cytotoxicity after adequate dilution, and the cytotoxicity was not related to VST dose. A better cellular uptake of SNEDDS was observed in vitro. The SNEDDS formula achieved a diameter of 84 nm in distilled water and 140 nm in simulated gastric fluid. In obese animals, the maximum serum concentration (Cmax) of VST was increased 1.68-folds by SNEDDS. In RYGB with SUS, the Cmax was reduced to less than 50% of the obese group. SNEDDS increased the Cmax to 3.5 folds higher than SUS and resulted in 3.28-folds higher AUC0-24 in the RYGB group. Fluorescence imaging also confirmed a stronger signal of SNEDDS in the gastrointestinal mucosa. SNEDDS accumulated a higher drug concentration than suspension alone in the liver of the obese group. SNEDDS could reverse the VST malabsorption in RYGB. Further studies are mandatory to clarify post-SG change of drug absorption.

Abstract #1404669: Diazoxide in the Treatment of Asymptomatic Refractory Hypoglycemia in End Stage Renal Disease

Diabetic patients with end-stage renal disease (ESRD) treated with insulin or any other diabetic agent show high variations in their glucose metabolism, lower insulin clearance level, and uncertain accuracy of glycemic control measurements. Therefore, these patients are at a greater risk of developing hypoglycemia. Diazoxide use in the treatment of spontaneous and refractory hypoglycemia in this population has not been well documented. We report a case of a young diabetic male that has been successfully treated with diazoxide for his asymptomatic refractory hypoglycemic episodes. A young man with type 2 diabetes mellitus complicated by diabetic nephropathy, on hemodialysis for ESRD, presented with shortness of breath due to COVID pneumonia. After resolution of his infection, he was noted to have recurrent asymptomatic hypoglycemic episodes, although he has been off his diabetes medications for the past few years due to worsening of his kidney function. His oral intake was adequate and there was no concern for malnutrition, or any substance use. From the testing performed, we were able to exclude exogenous insulin or insulin secretagogues use and the presence of insulin antibodies. Insulin and noninsulin (insulin-like growth factor) mediated mechanisms were also ruled out. Since he was having recurrent and refractory asymptomatic hypoglycemic episodes and to minimize the need for supplemental dextrose containing fluids, he was started on diazoxide at 3 mg/kg/day. Knowing the risk of fluid retention with diazoxide, this patient on hemodialysis tolerated it well. Diazoxide helped reduce his episodes of hypoglycemia and he was then safely discharged on it. In ESRD, hypoglycemia can be explained by the impaired contribution of the kidneys to gluconeogenesis and glucose release, as well as the higher insulin levels caused by insulin resistance and decrease in insulin clearance. When his hypoglycemia persisted even after the resolution of his infection, further testing and work-up was done and other causes of hypoglycemia were ruled out. Generally, diazoxide is used as a treatment to manage the symptoms of hypoglycemia in congenital hyperinsulinism, insulinomas and post bariatric surgery cases of hyperinsulinemic hypoglycemia. However, it has not been the optimal treatment when it comes to treating hypoglycemia in ESRD patients because of its side effects; specifically, fluid retention, and electrolyte imbalances. In our case, the patient was treated with diazoxide as a last resort, despite its known side effects and the limited documentation of its use in ESRD patients. Actually, a few other case reports, have also shown promising results with the use of diazoxide for that purpose with no or minimal side effects. However, there are not enough studies that have shown the benefits or risks of long-term treatment of diazoxide in ESRD patients, an area of growing interest.

Vitamin D levels in relation to bariatric surgery: a single center experience

Background: Bariatric surgery has become a major component of the treatment of obesity and obesity related illnesses such as diabetes mellitus, hypertension and dyslipidemia. However, bariatric surgeries have been linked to some disturbances in the overall micronutrient profile in the post-operative period. In obese patients, visceral fat, is most closely related to the development of metabolic syndrome (MS). In this respect, vitamin D is of major importance, since numerous studies have shown that it can impact the prevention of MS, immune diseases and some cancers. Furthermore, given its inverse association with adiposity, high rates of vitamin D deficiency (VDD) have been found in obese patients, including those with morbid obesity who are candidates for bariatric surgery. Methods: A cross sectional study design was carried out after obtaining the required ethical approval. The surgery register was scanned for all bariatric procedures done from January 2018 till December 2018. Data were retrieved about each case through ISEHA labs, progress notes, medications summary, radiological images. Files were retrieved from the filing department for cases who were admitted to the surgical HDU or ICU (as they still use paper documentation). All data were compiled into a detailed excel sheet. Results: The total number of included patients was 232, with a mean age of 41.3. The majority of patients underwent laparoscopic Roux-En-Y bypass (67.2%), while laparoscopic sleeve gastrectomy was done in 32.8% of patients. As expected, mean body mass index (BMI) dropped down from (46.3 to 35.1). The striking result noted was the percentage of patients who had vitamin D deficiency pre bariatric surgery (44 patients, 19%). This percentage has increased up to (73 patients, 31.4%) post bariatric surgery at 12 months follow up. Conclusions: Bariatric surgery is linked to increased incidence of vitamin D deficiency post operatively. Vitamin D level close monitoring in peri-operative management of bariatric patients is recommended to avoid potential complications.

D137. Effect of Elevated Body Mass on Surgical Complications in Patients Undergoing Body Contouring after Massive Weight Loss

PURPOSE: Massive weight loss can result in whole-body deformities that often are addressed with body contouring. However, even after weight loss, many patients have residual obesity. In this study, we aim to determine the effect of BMI on post-bariatric reconstructive surgery complications. METHODS: Patients undergoing body contouring from 2002-2018 after massive weight loss (≥50 pounds) were retrospectively reviewed. Variables of interest include pre and post weight loss BMI, post-operative complications, and procedures per case. RESULTS: In this cohort, 942 massive weight loss patients underwent 1,063 cases involving 1,814 procedures. 884 patients were female while 58 were male. Mean pre-weight loss BMI, or max BMI, was 51.9 ±9.8 while mean post weight loss BMI was 30.5 ±6.0. For all cases, an increased maximum BMI (p=0.006), but not current BMI, was associated with a higher rate of post-operative complications. Increased current BMI significantly amplified the risk of post-operative fat necrosis (p<0.01) while elevated maximum BMI increased the risk of seroma (p<0.01) and wound infection (p<0.05). In patients with multiple procedures (n= 502), increased maximum and current BMI were associated with higher risk of seroma formation (p<0.05), but neither was associated with risk of seroma for single procedures cases (n=561). CONCLUSION: Both pre and post weight loss BMIs play a role in complication rate and type, while only max BMI plays a role in multiple procedure cases. These findings indicate that pre and post weight loss BMI should be assessed, in addition to number of procedures, to optimize outcomes after body contouring.

Childhood Maltreatment in Patients Undergoing Bariatric Surgery: Implications for Weight Loss, Depression and Eating Behavior

We aimed to explore the relationships between childhood maltreatment and changes in weight, depressive symptoms and eating behavior post-bariatric surgery (BS). Participants (n = 111, 85% females) were evaluated pre-surgery, and at 6 months (6 M) and 12 months (12 M) post-BS. History of maltreatment was assessed at baseline (Childhood Trauma Questionnaire), and depressive symptoms (Beck Depression Inventory-II) and eating behavior (Dutch Eating Behavior Questionnaire) were assessed at all time points. Participants’ mean age and median BMI were 45.1 ± 11.7 years and 46.7 (IQR 42.4–51.9) kg/m2, respectively. Histories of emotional (EA), physical (PA) and sexual abuse (SA) and emotional (EN) and physical (PN) neglect were reported by 47.7%, 25.2%, 39.6%, 51.4% and 40.5%, respectively, with 78.4% reporting at least one form of maltreatment. Changes in weight and depressive symptoms were not different between patients with vs. without a history of maltreatment. However, those with vs. without SA demonstrated limited changes in emotional eating (EE) at 12 M, while those without showed improvements. Conversely, patients with vs. without EN showed greater improvements in external eating (ExE) at 6 M, but differences were no longer observed by 12 M. Results indicate that histories of SA and EN are associated with changes in eating behaviors post-BS and have implications for assessment, monitoring and potential intervention development.

Effect of Laparoscopic Sleeve Gastrectomy on Quality of Life.

The clinical benefits of bariatric surgery are well-established, but the impact of bariatric surgery on psychosocial outcomes such as health-related quality of life (HRQL) is less clear. The aim of this study is to assess the Quality of life (QOL) as a whole and in separate domains in post-bariatric surgery patients. A single unit cross-sectional analysis of a prospective study is done on QOL in 51 patients undergoing laparoscopic sleeve gastrectomy at tertiary hospital. QOL was assessed by WHOQOL-BREF (World Health Organisation Quality of Life questionnaire -Brief version) questionnaire and Global Quality of Life Scale in each patient. Scores were calculated on a 0-100 scale and results compared. The median scores given by patients before surgery were 14, 21, 42, 40 and 12.5 for each of the parameters physical, psychological, social, environmental and overall well-being respectively. The median scores for after surgery were 86, 87, 91, 88 and 87.5 respectively. The difference was significant (p value 0.001). Global QOL after surgery, calculated year wise, showed QOL scores of 90, 100, 95 and 80 in patients with 1year, 2years, 3years and 4years of follow-up without any significant difference (p value 0.502). Through this study, we emphasize the need for the selection of a standardised scale by international organisations to compare the different studies. By proving the significant differences in the QOL of patients who underwent LSG [laparoscopic sleeve gastrectomy], we suggest to consider the Quality of Life as one of the criteria to consider a patient for bariatric surgery.

The impact of metabolic endotoxaemia on the browning process in human adipocytes

BackgroundDysfunctional adipose tissue (AT) is known to contribute to the pathophysiology of metabolic disease, including type 2 diabetes mellitus (T2DM). This dysfunction may occur, in part, as a consequence of gut-derived endotoxaemia inducing changes in adipocyte mitochondrial function and reducing the proportion of BRITE (brown-in-white) adipocytes. Therefore, the present study investigated whether endotoxin (lipopolysaccharide; LPS) directly contributes to impaired human adipocyte mitochondrial function and browning in human adipocytes, and the relevant impact of obesity status pre and post bariatric surgery.MethodsHuman differentiated abdominal subcutaneous (AbdSc) adipocytes from participants with obesity and normal-weight participants were treated with endotoxin to assess in vitro changes in mitochondrial function and BRITE phenotype. Ex vivo human AbdSc AT from different groups of participants (normal-weight, obesity, pre- and 6 months post-bariatric surgery) were assessed for similar analyses including circulating endotoxin levels.ResultsEx vivo AT analysis (lean & obese, weight loss post-bariatric surgery) identified that systemic endotoxin negatively correlated with BAT gene expression (p < 0.05). In vitro endotoxin treatment of AbdSc adipocytes (lean & obese) reduced mitochondrial dynamics (74.6% reduction; p < 0.0001), biogenesis (81.2% reduction; p < 0.0001) and the BRITE phenotype (93.8% reduction; p < 0.0001). Lean AbdSc adipocytes were more responsive to adrenergic signalling than obese AbdSc adipocytes; although endotoxin mitigated this response (92.6% reduction; p < 0.0001).ConclusionsTaken together, these data suggest that systemic gut-derived endotoxaemia contributes to both individual adipocyte dysfunction and reduced browning capacity of the adipocyte cell population, exacerbating metabolic consequences. As bariatric surgery reduces endotoxin levels and is associated with improving adipocyte functionality, this may provide further evidence regarding the metabolic benefits of such surgical interventions.

Perceived Barriers, Enablers, Beliefs and Level of Physical Activity and Awareness regarding Role of Physiotherapy in Patients posted for Bariatric Surgery: A Questionnaire Based Study

Background: Obesity is of huge concern worldwide. Bariatric surgery is effective in managing morbid obesity and its associated complications. Physiotherapy plays a crucial role in the pre-operative as well as postoperative phases of bariatric surgery. Lack of physical activity in patients who are obese, patients who are posted for bariatric surgery and those who have undergone bariatric surgery can be accounted to a lot of factors. Identifying their perceived level of physical activity along with the facilitators, barriers and beliefs will help in addressing these issues and thereby increasing adherence to physical activity. Objective: To evaluateperceived level, along with barriers, enablers and beliefs of physical activity in patients posted for bariatric surgery. We also evaluated their awareness about the role of physiotherapy in pre and post-operative phases of bariatric surgery. Method:A questionnaire was designed to gain an insight aboutfactors contributing as barriers and enablers, under the domains of physical, psychological, interpersonal and environmental. It also included perceived level and the existing level of physical activity in the study participants.Questions were also designed to understand their awareness about the role of physiotherapy in the pre and post bariatric surgery phase. It was administered to patients posted for bariatric surgery on an interview basis. Sample size was calculated to be 96. The data was then analysed and represented as descriptive statistics. Results: All study participants failed to meet the recommended level of physical activity. The predominant barriers perceived by the study participants belonged to physical, psychological and interpersonal domains; whereas environmental barriers were found to be of least significance. 72.92% of the study participants lacked the knowledge about the role of physiotherapy in the pre-operative phase of bariatric surgery. Conclusions:Interpersonal, physical and psychological being the predominant barriers faced by the study participants highlight the scope of physiotherapeutic intervention. Also these factors can be modified at an individual level, thereby improving the adherence. There is lack of awareness about the role of physiotherapy in the pre-operative phase of bariatric surgery. Thus there is need to increase awareness about the role of physiotherapy in managing obesity and related complications in pre and post op phases of bariatric surgery. KEY WORDS: Facilitators, Barriers, Beliefs, Awareness, Bariatric Surgery, Physical Activity, Questionnaire based, Physiotherapy, Obesity.

Ramadan Fasting and Diabetes (2022): The Year in Review

Abstract Objectives The literature on the impact of Ramadan fasting (RF) on metabolic control and health in people with diabetes is widely spread in many journals making it not readily accessible to those interested in the subject. We aimed to provide a narrative overview of the global literature production in 1 year (2022) on diabetes and RF. Materials and Methods It is a narrative, non-systematic review of the international literature from a single major medical online database (i.e., PubMed) in one calendar year (2022). Relevant literature was narrated in a concise thematic account. Results Themes emerged from the review of the literature on RF published in 2022, including a couple of studies on the epidemiology of fasting in the real world by adults and children. Three studies involved some pathophysiological observations of metabolic and other biochemical markers. Several studies assessed the use and safety of different pharmacological therapeutic agents. Certain sulfonylureas, such as modified-release gliclazide, were considered safer than other sulfonylureas. Newer basal insulin analogs were studied in different geographical and socioeconomic settings (Gulf vs. South East Asia). The role of diabetes technology in Ramadan was the focus of several studies of insulin pumps and monitoring. Special themes were high-risk groups, pregnancy, acute complications, postbariatric surgery, and COVID-19 in Ramadan. Few studies examined the safety of sodium-glucose co-transporter-2 inhibitors as a class and individually during RF. Professional and patient perspectives released in 2022 included updated guidelines for adults and adolescents. Conclusion In 2022's medical literature, RF and diabetes continue to address epidemiology, the burden of diabetes care on fasting patients, and discussions of concerns of patients and healthcare professionals. Risk stratification and issues of high-risk patients are still in focus for children, adolescents, and adults. Approaches to effective management still gather evidence for newer pharmacological agents and diabetes technology.

The secondary bile acid isoursodeoxycholate correlates with post-prandial lipemia, inflammation, and appetite and changes post-bariatric surgery

Primary and secondary bile acids (BAs) influence metabolism and inflammation, and the gut microbiome modulates levels of BAs. We systematically explore the host genetic, gut microbial, and habitual dietary contribution to a panel of 19 serum and 15 stool BAs in two population-based cohorts (TwinsUK, n= 2,382; ZOE PREDICT-1, n= 327) and assess changes post-bariatric surgery and after nutritional interventions. We report that BAs have a moderately heritable genetic component, and the gut microbiome accurately predicts their levels in serum and stool. The secondary BA isoursodeoxycholate (isoUDCA) can be explained mostly by gut microbes (area under the receiver operating characteristic curve [AUC]= ∼80%) and associates with post-prandial lipemia and inflammation (GlycA). Furthermore, circulating isoUDCA decreases significantly 1 year after bariatric surgery (β= -0.72, p= 1×10-5) and in response to fiber supplementation (β= -0.37, p<0.03) but not omega-3 supplementation. In healthy individuals, isoUDCA fasting levels correlate with pre-meal appetite (p<1×10-4). Our findings indicate an important role for isoUDCA in lipid metabolism, appetite, and, potentially, cardiometabolic risk.

Striatal dopamine D2-like receptors availability in obesity and its modulation by bariatric surgery: a systematic review and meta-analysis

There is significant evidence linking a ‘reward deficiency syndrome’ (RDS), comprising decreased availability of striatal dopamine D2-like receptors (DD2lR) and addiction-like behaviors underlying substance use disorders and obesity. Regarding obesity, a systematic review of the literature with a meta-analysis of such data is lacking. Following a systematic review of the literature, we performed random-effects meta-analyses to determine group differences in case–control studies comparing DD2lR between individuals with obesity and non-obese controls and prospective studies of pre- to post-bariatric surgery DD2lR changes. Cohen's d was used to measure effect size. Additionally, we explored factors potentially associated with group differences in DD2lR availability, such as obesity severity, using univariate meta-regression. In a meta-analysis including positron emission tomography (PET) and single-photon emission computed tomography (SPECT) studies, striatal DD2lR availability did not significantly differ between obesity and controls. However, in studies comprising patients with class III obesity or higher, group differences were significant, favoring lower DD2lR availability in the obesity group. This effect of obesity severity was corroborated by meta-regressions showing inverse associations between the body mass index (BMI) of the obesity group and DD2lR availability. Post-bariatric changes in DD2lR availability were not found, although a limited number of studies were included in this meta-analysis. These results support lower DD2lR in higher classes of obesity which is a more targeted population to explore unanswered questions regarding the RDS.

Improvement of Work Ability After Weight Loss Surgery: Results of a Longitudinal Study of Patients Suffering from Extreme Obesity Before and 4 Years After Bariatric Surgery.

Body mass index (BMI) is directly associated with employment status. Our longitudinal prospective study is aimed at ascertaining whether work ability index (WAI) 4years after surgery remains improved, such as 1year after surgery, or changes and whether socio-demographic or psycho-social factors influence changes in work ability. 197 bariatric surgery candidates were recruited. Data on demographic and psycho-social characteristics were collected prior to surgery (t1) and at 6 (t2), 12 (t3), and 48months (t4). Change effects over time in the WAI and BMI were investigated using a repeated-measures analysis of variance (ANOVA). A hierarchical multiple regression analysis was calculated to predict socio-demographic and psychosocial characteristics at t1 on WAI at t4. Not only a significant increase in WAI was observed between t1 and t2 and between t3 and t4 but also a significant decrease between t2 and t4. BMI reduction was significant between t1 and t2 and t3 and t4, respectively. There was no significant interaction effect of BMI reduction 4years after surgery on decreased work ability from t2 to t4. The hierarchical multiple regression analysis revealed an association of WAI scores at t1 on WAI scores at t4 only. Work ability 4years after surgery remained significantly improved compared to the values at t1-t3 assessment. Since work ability was the only predictor at t1, findings might indicate the use of psycho-social measures post bariatric surgery to increase work ability. There was no association between work ability and other socio-demographic or psycho-social factors.

Psychiatric comorbidity as a prospective predictor of long-term weight and psychosocial outcomes after bariatric surgery

ObjectivesPsychiatric comorbidity is common among the bariatric population although the prognostic significance of psychiatric comorbidity on outcomes is uncertain. This prospective study examined differences in weight and psychosocial functioning outcomes based on lifetime and current (post-surgical) psychiatric comorbidity. MethodsParticipants were 140 adults in a RCT for loss-of-control (LOC)-eating approximately six months post-bariatric surgery. Two structured interviews were administered: the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) to assess LOC-eating and eating-disorder psychopathology, and the Mini International Neuropsychiatric Interview (MINI) to assess lifetime and current (post-surgical) psychiatric disorders. The EDE-BSV and Beck Depression Inventory (BDI-II) were repeated at post-treatment and 24-month follow-ups. ResultsLifetime (75.7%) and current/post-surgical (25%) psychiatric diagnoses were common. Groups with and without psychiatric comorbidity did not differ significantly in weight loss outcomes at any timepoint but psychiatric comorbidity was associated significantly with greater LOC-eating, eating-disorder psychopathology, and depression. ConclusionsAmong participants with LOC-eating post-bariatric surgery, lifetime and post-surgical psychiatric comorbidity was not associated with acute or longer-term weight outcomes but predicted poorer psychosocial functioning. Findings challenge prevailing views that psychiatric comorbidity is related to poorer longer-term weight outcomes following bariatric surgery but highlight its clinical significance as it is associated with broad psychosocial difficulties.