Weight Loss Surgery Patients Research Articles

IBC-Ox22 Greater Adherence to Mediterranean Diet leads to longer term weight loss

Abstract We were able to obtain dietary data of 134 weight loss surgery patients with an average follow up of five years with annual scoring of the 9 point Mediterranean Diet. The closer adherence to the MD showed more weight loss than those who had not. Background The Mediterranean Diet has been associated with decreased all cause mortality for those who adhere strongly to it, as well as decreased risk of heart disease, and cancer. The diet is rich in polyphenols with fruits, vegetables, legumes, fish, mono-unsaturated fats, whole grains, while minimizing dairy, meat and poultry, and some moderate alcohol consumption. Methods Pre operatively all bariatric patients patients were counseled about the Mediterranean diet, how to score the diet, and adherence to the diet was reemphasized at their follow ups. Annually they were asked to fill out their scores. We looked at other diet plans that some of the patients reported (low carbohydrate, weight watchers) and the results were not significant. Results Of the 134 patients there were 65 which had scores of 5 points or more and showed an absolute reduction in weight of 54% total weight loss on average, vs those of 1-3 who had 32% total weight loss (total of 60 patients). The remaining 9 patients who escorted 4 points had a wide spread of weight loss that could not be calculated (these patients predominantly followed a self-described low-carbohydrate diet). There was no difference in weight loss regarding the type of surgery that the patient had (Lap-Band (N=74) vs Gastric Sleeve (N=50) vs Gastric bypass (N=10). Nor was there any difference in weight loss when measuring physical activity. Using the 9 point scale of the Mediterranean Diet those who had greater than 5 of the 9 points on the MD had greater weight loss over five years than those who were 0-3. Those who scored 4 points were indeterminate. Conclusions The Mediterranean Diet scale provides a quick and easy guide, providing targets for patients (example, less than 4 ounces per day of poultry or meat is a point, more is 0 points). The emphasis on a post operative diet for health, as opposed to weight loss, inadvertently provided a good model for post operative weight loss.

Health behaviors & weight loss strategies among surgical and non-surgical weight loss seekers

The rate of obesity in the US population continues to rise, with 42.7% of adults having obesity in 2018. Increased pressure to achieve weight loss for cultural and/or health reasons leads many to seek weight loss through various means. The objective of this study was to assess whether differences exist in health behaviors and weight loss strategies between those who underwent weight loss surgery (WLS) and those seeking non-surgical weight loss (NSWL). This cross-sectional study used data from the 2013–2018 National Health and Nutrition Examination Survey. Weighted statistical analyses included descriptives, ANOVAs, and chi-square tests. There was no significant difference between the two groups in dietary quality (p = .12), but those who underwent WLS consumed less calories than those seeking NSWL (p < .001). Those who underwent WLS had 50% lower odds of meeting physical activity recommendations and endorsed higher use of healthy weight loss strategies (OR = 0.02, 95% CI = 0.01–0.05) compared to NSWL participants. As WLS directly impacts patients’ eating, WLS patients may be able to modify eating habits more so than physical activity level. • No differences were found in the dietary quality of WLS and NWLS. • WLS had lower odds of meeting exercise guidelines compared to NWLS. • WLS reported more adaptive weight loss strategies compared to NWLS.

Review of Changes in the Reinforcing Effects of Alcohol in Weight Loss Surgery Patients.

The reinforcing effects of alcohol are well documented, and they have been shown to play a role in the development of alcohol use disorders (AUDs). Also well established is the fact that post-weight loss surgery (WLS) patients are at an increased risk for AUDs. In the current manuscript, we review the notion that the reinforcing effects of alcohol may change from before to after WLS and discuss a number of determinants of alcohol reinforcement change in WLS patients. It has been increasingly well understood that WLS patients are at an increased risk for AUD, but empirical support for the mechanisms that may cause this phenomenon have been lacking. Recently, a model was proposed that offered a number of different potentially causal variables as mechanisms that result in increased risk for AUD in these surgical patients. Change in the extent to which alcohol is reinforcing to WLS patients may be key in determining the likelihood of AUDs in this group. We review a host of biological, psychological, and social variables that ultimately impact how reinforcing alcohol is to WLS patients.

A Preliminary Study on the Influence of Cannabis and Opioid Use on Weight Loss and Mental Health Biomarkers Post-weight Loss Surgery.

A subpopulation of weight loss surgery (WLS) patients endorse cannabis and/or opioid use; however, impact on post-WLS anxiety and depression is unclear. This study examined the influence of the independent and combined use of cannabis and opioids on (1) depression and anxiety, (2) duodenum serotonin and cortisol, and (3) total percent weight loss. A cross-sectional analysis was conducted among patients (N =18) who had biomarkers of serotonin and cortisol collected from the duodenum during WLS. Cannabis and opioid use was determined by self-reported lifetime, past-year, and past 30-day use. The Beck Anxiety Inventory and Depression Inventory-II assessed depression and anxiety symptoms. Total percent weight loss was calculated from pre-WLS and post-WLS weight (kg). Chi-squared analyses and t tests were conducted. Over a quarter (27.8%) were cannabis-only users and 16.7% used a combination of cannabis and opioids. None reported using only opioids in this sample. Combination users presented with greater depressive symptoms (22.7%, p= 0.01) and greater total percent weight loss (34.1%, p= 0.04) than cannabis users (7.8, 23.2%, respectively). Cannabis users had greater serotonin (p= 0.02) and cortisol (p= 0.01) levels than combination users and never users. Cannabis users had greater cortisol levels than never users and combination users. Combination users had greater weight loss and depression symptoms than cannabis users. Future studies should consider a larger sample size, utilization of a cohort design to address causality, and examination of the type, dose, and route of cannabis and opioid administration to further understand the impact of the combined use of cannabis and opioids post-WLS.

Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

ObjectiveTo identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children. DesignCross-sectional survey. SettingTwo US weight management centers. Participants259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2–18 years) Main Outcome Measure(s)Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation. AnalysisBinomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates. ResultsPatients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021). Conclusions and ImplicationsAdditional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.

Effectiveness of Gastric Bypass Versus Gastric Sleeve for Cardiovascular Disease: Protocol and Baseline Results for a Comparative Effectiveness Study.

BackgroundWhen compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission.ObjectiveThe ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety.MethodsThe cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort.ResultsPatients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P<.001), more likely to have had an emergency department visit in the year before surgery (P=.006), less likely to have a mental illness before surgery (P<.001), and more likely to have had a CVD event at any time before surgery (P<.001).ConclusionsThis study had one of the largest populations of gastric sleeve patients (n=13,459). The 5-year follow-up for those patients who had surgery between 2009 and 2013 was excellent for a retrospective cohort study at 85.86% (13,774/16,043). Unlike almost any study in the literature, the majority of the ENGAGE CVD cohort was racial and ethnic minority, providing a rare opportunity to study the effects of bariatric surgery for different racial and ethnic groups, some of whom have the highest rates of severe obesity in the United States. Finally, it also used state-of-the-art statistical and econometric comparative effectiveness methods to mimic the effect of random assignment and control for sources of confounding inherent in large observational studies.International Registered Report Identifier (IRRID)RR1-10.2196/14936

Bariatric Biosociality: Pushed Together, Pulled Apart

This article explores the postoperative experiences of weight loss surgery patients. More specifically, it investigates why bariatric patients seek out and form connection to similarly situated others in online and in-person support forums. Based on a thematic analysis of 30 semi-structured interviews with individuals who have had bariatric surgery, it is argued that the experience of having been medically classified as obese or severely obese, a long history of failed dieting attempts, fears of future morbidity and mortality, and then undergoing bariatric surgery serve as an axis around which some individuals interact, create identity, and form community. The perceived lack of postoperative support from home bariatric clinics, inadequate provider knowledge about the particularities of bariatric bodies, and the fact that patients must “work with” their surgeries to avoid postoperative adverse events are additional drivers for the formation of such bariatric kinship. It is argued that Paul Rabinow’s concept of “biosociality” provides a helpful theoretical frame for understanding these processes. However, just as the aforementioned factors push bariatric patients together, tensions around the type of bariatric procedure undergone, the amount of weight loss, and economic access to reconstructive plastic surgery cause conflict, leading to the formation of subgroups within bariatric communities. It is argued that, ultimately, bariatric biosocialities are spaces in which bariatric patients collectively work to achieve normative health and aesthetic standards. However, these spaces also reflect highly complex, sometimes divergent and conflictual, and often ambivalent frameworks of understanding and experience.

The feasibility of a behavioral group intervention after weight-loss surgery: A randomized pilot trial.

BackgroundFormal psychosocial support programs after weight-loss surgery are limited in scope and availability.ObjectiveThis randomized pilot study evaluated the feasibility of a postoperative behavioral intervention program.Materials and methodsPostoperative weight-loss surgery patients (N = 50) were recruited from February 2017–July 2017 and randomized to a four-month behavioral program or usual care wait-list. Outcomes evaluated in addition to feasibility included health-related quality of life (Short Form -36), psychosocial functioning and adherence. Secondary outcomes included within-group changes for each outcome.ResultsOut of eight possible sessions, intervention participants attended a mean of 4.2 sessions. Intervention group participants experienced greater improvements in the social functioning domain of health-related quality of life compared to usual care. Self-reported dietary adherence in the intervention group remained stable, while usual care group dietary adherence declined. Within the intervention group, participants also reported gains in the physical function, pain and general health aspects of quality life from baseline to post-treatment. No differences in weight, mood or other eating behaviors (e.g., loss of control, emotional eating) were evident between groups.ConclusionThough participation in a postoperative behavioral intervention varied, the program helped participants to maintain aspects of quality of life and self-reported adherence to dietary recommendations.Trial registrationClinicalTrials.gov NCT03092479

'No one is as invested in your continued good health as you should be:' an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics.

This article traces the post-surgical relationship between weight-loss surgery (WLS) patients and their home bariatric clinics. Following surgery, there is substantive drop off in patient attendance at both follow-up appointments and support groups. While barriers to follow-up are often discussed with the bariatric literature, patients themselves are typically defined as the problem. Based upon a thematic analysis of 217 blog posts and comments in two top patient-led online forums, I demonstrate that bariatric patients tell a more complex story about their post-surgical lives. I argue that WLS patients constitute a population with highly specialised medical needs that is caught between the requirements for living with surgically altered digestive systems and a lack of sufficient post-operative follow-up care from their home bariatric clinics. Although online forums provide spaces for patients to examine these post-operative social and clinical experiences in critical terms, seek information and get support, ultimately the conversations serve to underline the value of personal responsibility for post-operative outcomes-a framing that echoes that of the bariatric profession. This framing should be understood within a larger climate of weight-based stigma and discrimination as well as neoliberal healthism.

Associations Between Romantic Relationship Factors and Body Mass Index Among Weight Loss Surgery Patients.

The current study utilized a sample of 183 patients, in romantic relationships, who were either pre- or post-weight loss surgery (WLS), to assess (a) associations between romantic relationship factors and pre- and post-surgery body mass index (BMI), (b) the positive and negative influences of obesity in romantic relationships, and (c) the influence of romantic relationship factors on BMI and the reciprocal. Correlations, confirmatory factor analysis, and multiple linear regression were conducted. Patients endorsed greater negative influence of obesity in their romantic relationships compared to positive influences, and their romantic relationship quality was predicted by several variables, including BMI, in pre- and post-surgery patient groups.

Clinical Characteristics of Roux-en-Y Gastric Bypass Patients with Death from Accidental Overdose or Intentional Self-Harm: a Descriptive Study.

The objective of this descriptive study was to identify clinical characteristics of Roux-en-Y gastric bypass (RYGB) patients who died from intentional self-harm or accidental overdose postoperatively. This retrospective, descriptive study included RYGB patients from a large rural medical center that completed surgery between January 2004 and December 2014 and died from intentional self-harm or accidental overdose through December 2015. Specific causes of death were obtained from the National Death Index and clinical data from electronic health records. Clinical characteristics explored were age, sex, time to surgery, weight loss expectations, postoperative weight loss, medication, diagnoses, psychiatric histories (diagnoses, self-harm, suicidal ideation and behaviors, medications, substance use, preoperative Beck Depression Inventory-II scores), pain, social support, and reported life stressors. Overall, 22 patients of 146 total deceased patients died from intention self-harm (n = 6) or accidental overdose (n = 16) over the study period (77.3% female, mean age at time of surgery = 38.4 ± 9.1years). Younger age (< 40years), history of self-harm or depression, preoperative pain, and use of opioids at the time of surgery emerged as common characteristics in weight loss surgery patients who died from intentional self-harm or accidental overdose. No trends regarding social support, life stressors, or actual or expected weight loss were identified. Certain weight loss surgery patients may be at risk for death from self-harm or overdose and may benefit from greater surveillance postoperatively.

Pre-surgical, surgical and post-surgical experiences of weight loss surgery patients: a closer look at social determinants of health.

Using a novel qualitative approach, Photovoice, researchers assessed social, psychological, physical and economic barriers encountered by patients of weight loss surgery. Applying the Photovoice approach and Williams' theory of narrative reconstruction for qualitative interviewing, the research team set out to investigate the bariatric patient experience from pre-surgery to hospitalization to post-surgery. Fifteen participants were given digital cameras and asked to take photographs that represented their weight loss journeys. Photographs and qualitative interviews were used to theorize the role played by comorbidities, social determinants of health, provider communication experiences and understanding of insurance coverage in patient outcomes. Several themes emerged from the interviews and photographs including themes centred around: (i) racial/ethnic standards of beauty; (ii) gender expectations; (iii) comorbidities, depression/disordered eating and obesity discrimination and (iv) financial hardship impacting adherence. Photographs also illuminated the impact of hospital and state-wide policies on patient lives. Results suggest that Photovoice may be a useful adjunct to standard-of-care to help patients identify barriers, and to identify shortcomings in health services. Additional screening tools for gender- and income-related barriers (and concomitant referrals to support services) provide an opportunity to improve patient care and reduce post-operative readmissions.

A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults.

Mounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern. Additionally, young adults and racial/ethnic minorities are both increasingly undergoing WLS and are at heightened risk for problems related to alcohol use. To date, these groups have been under-represented in study samples. To address these important gaps in the literature, racially/ethnically diverse, young adult WLS patients who indicated a post-WLS increase in alcohol use (n = 12) participated in an individual, semi-structured qualitative interview. Data were analyzed through two coding cycles; an external audit of the emerging themes was also conducted to further ensure the trustworthiness of the data. Interviews revealed four major themes prompting an increase in alcohol use after WLS: (1) increased sensitivity to alcohol intoxication, (2) utilizing alcohol as a replacement self-soothing mechanism for food, (3) increase in socialization, and (4) utilizing alcohol as a coping mechanism. By understanding the drivers of increases in alcohol use after WLS, precision-targeted pre- and post-surgical counseling interventions can be developed to address this emerging concern.

A5054 - Feasibility and Acceptability of an Integrated Behavioral Medicine Service within a Post-Bariatric Surgery Clinic

Weight regain after weight loss surgery (WLS) is a common and significant concern for patients and providers. Many of the concerns facing WLS patients related to weight regain post-surgery have behavioral and psychological components. However, the majority of patients do not attend behavioral medicine (BMED) follow-up appointments, despite its association with weight loss maintenance. Innovative treatment models are needed to reduce barriers to treatment. The current study aims to examine the feasibility and acceptability of an integrated behavioral medicine consult service within a bariatric surgery clinic.

Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients

ABSTRACTBackground: Research suggests that young adults and racial/ethnic minorities are at an increased risk for problematic alcohol use. Recent studies have also documented patterns of problematic alcohol use among a subset of weight loss surgery (WLS) patients. However, to date, there are no published studies investigating the intersection of these demographic and clinical characteristics. Methods: This study used descriptive and inferential analyses to examine alcohol use patterns, prevalence of pre- and post-WLS alcohol use disorders (AUDs), and predictors of increased alcohol use and problematic alcohol use post-WLS among young adult (mean age 26.5 years, SD = 5.5 years) ethnically diverse (57% Hispanic, 28% non-Hispanic black) WLS patients (N = 69). Results: Over 21% of the sample had a history of a lifetime AUD, and 4.2% of the sample developed an AUD post-WLS. In the past 30 days, 14.5% of respondents reported binge drinking, and 42% reported drinking until intoxication. History of a pre-WLS AUD was associated with an increased frequency of alcohol use post-WLS (P = .012). Age, time since WLS, the gastric bypass procedure, and pre-WLS history of an AUD were not significant predictors of binge drinking or drinking to intoxication post-WLS. Conclusions: Ethnically diverse, young adults may have an elevated prevalence of AUD diagnoses pre-WLS. Having a pre-WLS AUD appears to be a risk factor for increased alcohol use post-WLS. Young adult WLS patients might also demonstrate high rates of binge drinking and drinking to intoxication. Binge drinking could be especially problematic considering that WLS could increase sensitivity to alcohol. Further investigation is warranted with this important subpopulation to explore risk factors for problematic alcohol use post-WLS; future assessments of alcohol use should consider potential heightened alcohol sensitivity resulting from WLS.

Alcohol use risk in adolescents 2 years after bariatric surgery

BackgroundProblematic alcohol use and increased sensitivity postoperatively in adult weight loss surgery patients heightens concerns. No data have characterized these behaviors in adolescents—a gap, given adolescent alcohol use and heavy drinking are public health concerns. ObjectiveTo examine alcohol use behavior in adolescents who underwent weight loss surgery across the first two post-operative years in comparison to nonsurgical adolescents. SettingFive academic medical centers. MethodsUtilizing a prospective controlled design, adolescents undergoing weight loss surgery (n = 242) and nonsurgical adolescents with severe obesity (n = 83) completed the Alcohol Use Disorders Test. Analyses included 216 surgical (Mage = 17.1 ± 1.5, MBMI = 52.9 ± 9.3, 91.8% female, 67.6% white) and 79 nonsurgical participants (Mage = 16.2 ± 1.4, MBMI = 46.9 ± 6.1, 82.3% female, 53.2% white), with baseline data and at 12 or 24 months postoperatively. ResultsThe majority reported never consuming alcohol within the year before surgery (surgical, 92%; nonsurgical, 91%) or by 24 months (surgical, 71%; nonsurgical, 74%), when alcohol use disorder approached 9%. Among alcohol users at 24 months (n = 52 surgical, 17 nonsurgical), 35% surgical and 29% nonsurgical consumed 3+drinks on a typical drinking day; 42% surgical and 35% nonsurgical consumed 6+drinks on at least 1 occasion. For the surgical group, alcohol use changed as a function of older age (odds ratio [OR] = 2.47, P = .01) and lower body mass index (OR = .94, P<.001). Greater percent change in weight (0–24 mo) was associated with increased odds of alcohol use at 24 months (OR = 1.01, 95% confidence interval: 1.002–1.02). ConclusionAlcohol use was lower than national base rates. Alcohol use disorder rates and harmful consumption raise concerns given extant adult literature. Alcohol education focused on harm reduction (i.e., lower consumption, managing situations conducive to alcohol-related harm) and monitoring by healthcare providers as patients mature is indicated.

Weight loss surgery and subsequent emergency care use: a population-based cohort study

Study objectiveThis study assessed long-term emergency care utilization after weight loss surgery. MethodsWe conducted a self-matched longitudinal cohort analysis of weight loss surgery patients in Ontario operated between April 1, 2006, and March 31, 2011. Using population-wide registries, we compared emergency visits in the 3-year interval after surgery to the 3years before surgery using incidence rate ratios with 95% confidence intervals. The study excluded patients with repeat surgeries, and the analysis excluded visits in the immediate perioperative interval (ie, 3months before and after surgery). ResultsA total of 8815 patients were identified of whom most were women (81%), living in an urban area (84%), and treated with gastric bypass (99%). Approximately half (53%) were aged 25 to 45years. Approximately half of the patients 4364 (49%) had at least 1 emergency in both preoperative and postoperative intervals, 1417 (16%) in the preoperative interval only and 1661 (19%) in the postoperative interval only. Total emergencies significantly increased from 852 per 1000 patient-years to 1000 per 1000 patient-years, equal to an incidence rate ratio of 1.17 (95% confidence interval, 1.13-1.21; P<.001). Compared to baseline, emergencies from gastrointestinal, genitourinary, substance misuse, trauma, and miscellaneous complaints increased significantly after surgery. Conversely, emergencies due to cardiovascular, ear, respiratory, and dermatology complaints decreased significantly after surgery. Ambulance use, triage urgency, and hospitalizations were significantly higher for emergencies after surgery. ConclusionPersistent and resource-intensive emergency care utilization after weight loss surgery underscores the need of long-term patient support.

Semiphysiologically based pharmacokinetic model for midazolam and CYP3A mediated metabolite 1-OH-midazolam in morbidly obese and weight loss surgery patients.

This study aimed to describe the pharmacokinetics of midazolam and its cytochrome P450 3A (CYP3A) mediated metabolite 1-OH-midazolam in morbidly obese patients receiving oral and i.v. midazolam before (n = 20) and one year after weight loss surgery (n = 18), thereby providing insight into the influence of weight loss surgery on CYP3A activity in the gut wall and liver. In a semiphysiologically based pharmacokinetic (semi-PBPK) model in which different blood flow scenarios were evaluated, intrinsic hepatic clearance of midazolam (CLint,H) was 2 (95% CI 1.40-1.64) times higher compared to morbidly obese patients before surgery (P < 0.01). Midazolam gut wall clearance (CLint,G) was slightly lower in patients after surgery (P > 0.05), with low values for both groups. The results of the semi-PBPK model suggest that, in patients after weight loss surgery, CYP3A hepatic metabolizing capacity seems to recover compared to morbidly obese patients, whereas CYP3A mediated CLint,G was low for both populations and showed large interindividual variability.

A5180 - Acting as a Team to Help Our Patients

ACT is a behavioral therapy designed to guide people to mindfully change their behaviors in the direction of their deepest desires. ACT aims to help people live in mindful, values-congruent ways.Increasing research is being done on the use of ACT in the area of weight loss (with and without weight loss surgery).Results from a 2012 study “show that (weight loss surgery) participants in the ACT condition significantly improve on eating disordered behaviors, body dissatisfaction, quality of life and acceptance for weight related thoughts and feelings, as compared to those in the treatment as usual (TAU) group.” 1Results from a study in 2012 looking at eating attitudes, body anxiety, and preoccupation with eating, weight, and shape using ACT reported that those in the ACT group showed significant reductions in body-related anxiety and significant increases in acceptance when compared to the wait-list control condition. 2A pilot study sponsored by the National Institutes for Health examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants.3When used in nonclinical environments, ACT is sometimes referred to as “acceptance and commitment training.” While a licensed therapist can help weight loss surgery patients work to change how they experience what they perceive to be difficult thoughts, emotions and physiological feelings, a core principle of ACT therapy, all members of the bariatric interdisciplinary team can help patients keep their values and goals in the forefront of their minds and help them focus on choosing behaviors consistent with those values. In this way, the entire interdisciplinary team can effectively use the ACT approach to assist patients to ACT in the treatment of their obesity.

Postoperative marijuana use and disordered eating among bariatric surgery patients

BackgroundCurrent literature is scarce in documenting marijuana use after bariatric weight loss surgery (WLS). ObjectivesThe objective of this study was to explore the association among marijuana use patterns, disordered eating, and food addiction behaviors in patients 2 years after WLS. SettingA university hospital in the United States. MethodsParticipants (N = 50, mean age 28 y, standard deviation = 5.8) were administered a structured assessment that included the Addiction Severity Index, Yale Food Addiction Scale, Eating Disorder Examination Questionnaire, and Disordered Eating Questionnaire. Marijuana use was defined based on the Addiction Severity Index as current use (within 30 d), recent use (use in last year), and increased use (increased use since surgery). Data were analyzed using Fisher’s exact tests and linear regression methods adjusting for age, gender, race/ethnicity, time since surgery, and change in body mass index. ResultsThe majority of the sample was female (76%) and underwent Roux-en-Y gastric bypass (62%). Eighteen percent (18%) of the sample reported current marijuana use; 38% reported recent use; and 21.4% reported increased use post-WLS. A loss of controlled food intake was associated with current (P = .02) and increased post-WLS use (P = .01). Increased use and/or regular marijuana use predicted higher scores on eating disorder subscales compared with respective counterparts (P<.05). Current use did not significantly predict higher scores on the Yale Food Addiction Scale. ConclusionsFindings indicated marijuana use in post-WLS patients despite recommendations against use. A subgroup of WLS patients may be at risk for disordered eating post-WLS, particularly those who used marijuana before surgery, and should be closely monitored for several years post-WLS. (Surg Obes Relat Dis 2015;0:000–000.) © 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.