Weight Loss Outcomes In Patients Research Articles

Patients who endorse more binge eating triggers before gastric bypass lose less weight at 6 months

Background Patients presenting for gastric bypass surgery often demonstrate binge eating behaviors. The present study sought to determine whether binge eating triggers are predictive of weight loss outcomes in bariatric surgery patients at 6 months postoperatively in the setting of a university hospital. Methods A total of 48 patients presenting for gastric bypass surgery at an academic medical center in the Southeastern United States and who had returned for the 6-month follow-up visit were included in the present study. The patients were mostly women (85%), white (71%), and middle-aged (mean age 47 years), with an average weight of 100.9 kg. The patients completed the Inventory of Binge Eating Situations at baseline, and weight loss outcomes were assessed at 6 months. Weight loss success was indexed using 2 methods: the percentage of excess weight lost (continuous variable) and whether the patient was on track with their weight loss as defined by a ≥50% excess weight loss (dichotomous variable). Results A significant negative correlation ( r = −.31, P = .03) was found between the preoperative Inventory of Binge Eating Situations scores and the percentage of excess weight loss at 6 months after gastric bypass surgery. Logistic regression analysis showed that “on track” status at 6 months was predicted by the Inventory of Binge Eating Situations score at baseline (Wald chi-square = 3.97, df = 1, P = .046). Conclusion Careful assessment of binge eating situations could serve as a potential predictor of poor weight loss outcomes in patients seeking gastric bypass surgery. These findings support the baseline assessment of binge eating triggers and future research to examine the effectiveness of interventions for coping with binge eating triggers for gastric bypass surgery patients.

Preoperative Binge Eating Status and Gastric Bypass Surgery: A Long-Term Outcome Study

The primary purpose of the study was to evaluate the effect of preoperative binge status on long-term weight loss outcomes. IRB approval was obtained. This prospective study was initiated in 1997 at a large teaching hospital. Adult patients who participated in the study and attended post-surgery clinic visits for at least 12 months were included. Patients completed the gormally binge eating scale (BES), the beck depression inventory (BDI), and the SF-36 at baseline prior to surgery. All data are expressed as mean +/- SD. Data were analyzed using a Student's t test, pairwise correlation and regression analysis as appropriate. A total of 157 patients (135 women) aged 45 +/- 10 years were recruited. Their preoperative BMI was 50.7 +/- 8.0 kg/m(2). Thirty-seven patients were classified as severe binge eaters (BES >or= 27) prior to surgery. There was no significant difference in their weight loss compared to the rest of the group at any time point up to 6 years after surgery. Patients with significant depressive symptoms (BDI >13) had no significant difference in their weight loss outcomes compared to the rest of the group. Pre-surgery SF-36 scores did not predict differences in weight loss outcome. Pre-surgical binge status, incidence of depressive symptoms and health related quality of life were not predictive of poor weight loss outcomes in patients up to 6 years after gastric bypass surgery, who were able to make lifestyle changes in preparation for surgery and who adhered to scheduled post surgery clinic visits.

The Use of a Clinical Practice Guideline to Manage and Verify the Weight Loss Outcomes of Patients Treated With Fen‐Phen in Primary Care Settings

Fenfluramine and phenteramine (“fen‐phen”) enjoyed immense popularity as a weight loss drug combination until September 151, 1997, when fenfluramine was withdrawn from the market because of evidence that it might cause valvular heart disease. In response to the emergence in 1996 of physician disagreement about the appropriate use of diet pills in weight loss treatment plans, MeritCare Health System developed a practice guideline to assist clinicians in the appropriate use of anoretic drugs. The purpose of this report was to answer two questions about MeritCare's experience with fen‐phen. First, how was MeritCare able to use a practice guideline to mediate conflict among physicians and to rapidly implement practice changes as imformation about the deleterious effects of fen‐phen because available? Second, how effective was fenphen as a weight loss agent when prescribed by doctors who practiced in primary care settings? A retrospective review of the charts of 401 patients treated with fen‐phen by primary care physicians practicing in four of MeritCare's Fargo clinics was conducted and MeritCare's experience with fenphen was reviewed. The data show that patients treated with fen‐phen experienced, on average, a rapid decline in body mass index (BMI) over the first 4 months of treatment, after which the rate of decline slowed and then reached a plateau. There appeared to be little, if any, further mean weight loss after 6 months. Patients did not, as a rule, achieve target BMIs (defined as 26 to 27) even when treatment was continued for up to 19 months. In fact, after 6 months of treatment with fen‐phen, expected decreases in BMI began to be supplanted by increases in BMI, even thought patients remained on fen‐phen. The data also reveal wide variations in the weight loss responses of patients treated with fen‐phen. Practice guidelines are useful tools in mediating physician disagreement about “best practice” and in rapidly deploying practice changes as new information about “best practice” becomes available. Beneficial weight loss responses to fen‐phen prescribed by primary care physicians in standard primary care settings were highly variable and fell short of target weights.