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Bernat-Villena A, Pérez-Comino FJ, Becerra-Losada M, Algarra-López LS, Caracuel A, Vilar-López R. Intermittent theta burst stimulation (iTBS) and inhibitory control training for excess weight treatment: study protocol for a randomized controlled trial (InhibE). BMC Psychol 2025; 13:225. [PMID: 40065421 PMCID: PMC11895256 DOI: 10.1186/s40359-025-02556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 02/28/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND The prevalence of excess weight has increased globally. Despite interventions include targeted goals on essential aspects such as physical activity and diet, their long-term effectiveness remains limited. Research highlights that eating behaviour is influenced by impulsive processes, especially in the context of a food-rich environment. Inhibitory control has been identified as a key factor in regulating eating behaviour. Neuroscience approaches, including inhibitory control training and non-invasive neuromodulation of brain regions such as the dorsolateral prefrontal cortex, show promise in improving eating behaviour when used in addition to conventional intervention for weight management. This parallel group, randomized, controlled trial aims to study the efficacy of neuromodulation with iTBS as an add-on to the weight loss treatment as usual (TAU: diet and exercise), alone and in combination with inhibitory control training, for excess weight treatment. METHODS AND ANALYSIS 141 people with excess weight will be randomized into three groups: combined intervention (inhibitory control training + iTBS), iTBS and sham iTBS. The three groups will receive individualized diet and physical exercise guidelines (TAU). The interventions will comprehend ten sessions along two weeks. The main outcome measure will be the Body Mass Index change. Secondary outcomes include changes in brain connectivity and activation using fMRI, cognitive measures, eating and physical exercise behaviours, anthropometric and biological measures. Assessments will be carried out before the intervention, after the intervention and 3 months after the intervention. In addition, data on the use of the health system will be collected to analyse the cost-effectiveness and the cost-utility of the intervention. DISCUSSION Findings of this study will expand the available evidence on cognitive interventions to improve eating behaviour in people with excess weight. TRIAL REGISTRATION The trial has been registered at www. CLINICALTRIALS gov under the number NCT06668077 on the 11th of February 2025 named Inhibitory Control Training and iTBS for Excess Weight Behavioral and Brain Changes (InhibE). Any relevant modification to the protocol will be reflected in the clinical trial registry in www. CLINICALTRIALS gov.
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Affiliation(s)
- Andrea Bernat-Villena
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, 18070, Spain.
| | | | - Marta Becerra-Losada
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, 18070, Spain
| | | | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, 18070, Spain
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, 18070, Spain.
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Beavers KM, Cortes TM, Foy CM, Dinkla L, Reyes San Martin F, Ard JD, Serra MC, Beavers DP. GLP1Ra-based therapies and DXA-acquired musculoskeletal health outcomes: a focused meta-analysis of placebo-controlled trials. Obesity (Silver Spring) 2025; 33:225-237. [PMID: 39710882 PMCID: PMC11774015 DOI: 10.1002/oby.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of glucagon-like peptide-1 receptor agonist (GLP1Ra)-based therapies on change in dual-energy x-ray absorptiometry (DXA)-acquired lean mass (LM) or bone mineral density (BMD). METHODS PubMed and Web of Science were searched from database inception through January 29, 2024, for randomized, placebo-controlled trials reporting on change in DXA-acquired LM or BMD measures associated with 12+ weeks of GLP1Ra-based treatment. Of 2618 articles, 9 trials met prespecified search criteria, with 7 reporting on change in total body LM and 2 reporting on change in BMD. For LM outcomes, a hierarchical Bayesian model was used to estimate treatment mean differences. BMD outcomes were described narratively. RESULTS LM was reported in a total of 659 participants (GLP1Ra-based therapies: n = 419; placebo: n = 240), with follow-up times ranging from mean (SD) 12 to 72 (33.5) weeks. At baseline, participants were aged mean (SD) 41.7 (7.6) years, and 75% were female, with BMI values ranging from 30 to 43 kg/m2. Compared with placebo, GLP1Ra-based treatment was associated with significantly reduced total body weight (-6.9 kg; 95% credible interval [CI]: -10.7 to -3.0). GLP1Ra-based treatment was also associated with significantly reduced LM (-1.9 kg; 95% CI: -3.5 to -0.2). CONCLUSIONS Approximately 30% of body weight lost with GLP1Ra-based therapy is LM. More data are needed assessing BMD outcomes.
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Affiliation(s)
- Kristen M. Beavers
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Tiffany M. Cortes
- Division of Endocrinology, Department of MedicineUT Health San AntonioSan AntonioTexasUSA
- Sam and Ann Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTexasUSA
- San Antonio Geriatric Research Education and Clinical Center (GRECC)South Texas Veterans Health Care SystemSan AntonioTexasUSA
| | - Colleen M. Foy
- Zachary Smith Reynolds LibraryWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Lauren Dinkla
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | | | - Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Monica C. Serra
- Sam and Ann Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTexasUSA
- San Antonio Geriatric Research Education and Clinical Center (GRECC)South Texas Veterans Health Care SystemSan AntonioTexasUSA
- Division of Geriatrics, Gerontology & Palliative MedicineUT Health San AntonioSan AntonioTexasUSA
| | - Daniel P. Beavers
- Department of Statistical SciencesWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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Lofton HF, Maranga G, Hold R, Fielding G, Youn H, Gujral A, Heffron S, Fielding C. A randomized, double-blind, placebo-controlled trial of weight loss using liraglutide 3.0 mg for weight recurrence after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2025; 21:135-145. [PMID: 39401933 DOI: 10.1016/j.soard.2024.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/26/2024] [Accepted: 08/31/2024] [Indexed: 01/20/2025]
Abstract
BACKGROUND Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) remains the gold standard for treating obesity. Most people regain weight from postsurgery nadir. OBJECTIVES Liraglutide 3.0 mg is approved for weight management. This study will examine the effects on liraglutide 3.0 mg on weight regain post-RYGB. SETTING University Hospital, United States. METHODS A 56-week, double-blind, placebo-controlled study was conducted in 132 subjects, who achieved ≥25% total body weight loss (TBWL) status-post-RYGB and regained ≥10% TBWL after reaching nadir weight (NW). Subjects 18-120 months post-RYGB were randomized to receive liraglutide 3.0 mg/d (n = 89) or placebo (n = 43) with lifestyle counseling regularly for 56 weeks. The co-primary endpoints were the proportion of subjects losing at least 5%, 10%, and 15% TBWL and achieving weight lower than their NW. RESULTS 53.4% of the placebo group and 65% of the liraglutide group completed the trial due to Severe acute respiratory syndrome coronavirus 2 pandemic. The change in %TBWL from baseline to 56-weeks was -8.8 (8.5, -29.2 to 9.7) and 1.1 (3.5, -7.9 to 5.99) in the liraglutide and placebo groups, respectively. 76% and 17% of subjects achieved ≥5% TBWL at 56 weeks in the liraglutide and placebo groups, respectively; 51% and 26.0% of the liraglutide group achieved ≥10% and ≥15% TBWL, respectively. None of the placebo group lost ≥10% TBWL. Twenty-one percent of subjects receiving liraglutide surpassed postoperative NW. No subjects on placebo met this goal. Nonserious adverse events occurred in 41.6% of subjects on liraglutide. Serious adverse events (SAE) occurred less often on liraglutide. CONCLUSIONS Liraglutide was significantly more effective than placebo in treating weight regain that occurs post-RYGB without increased SAE.
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Affiliation(s)
- Holly F Lofton
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York; Division of Internal Medicine, NYU Grossman School of Medicine, New York, New York.
| | - Gabrielle Maranga
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
| | - Robert Hold
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
| | - George Fielding
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
| | - Heekoung Youn
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
| | - Akash Gujral
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
| | - Sean Heffron
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Christine Fielding
- Division of Bariatric Surgery, NYU Grossman School of Medicine, New York, New York
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Shieh C, Thompson HJ, McLaughlin E, Chiang CW, Hussan H. Advancements in Understanding and Preventing Obesity-Related Colon Cancer. Cancer J 2024; 30:357-369. [PMID: 39312456 DOI: 10.1097/ppo.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
ABSTRACT Obesity and colorectal cancer are global public health issues, with the prevalence of both conditions increasing over the last 4 decades. In the United States alone, the prevalence of obesity is greater than 40%, and this percentage is projected to increase past 50% by 2030. This review focuses on understanding the association between obesity and the risk of colorectal cancer while also highlighting hypotheses about molecular mechanisms underlying the link between these disease processes. We also consider whether those linkages can be disrupted via weight loss therapies, including lifestyle modifications, pharmacotherapy, bariatric surgery, and endobariatrics.
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Affiliation(s)
- Christine Shieh
- From the Department of Gastroenterology, University of California, Davis, Sacramento, CA
| | - Henry J Thompson
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO
| | | | - Chien-Wei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
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Chen S, Chiang J, Ghanem O, Ferzli G. Decision-making Considerations in Revisional Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:400-406. [PMID: 38963277 DOI: 10.1097/sle.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE With drastic variations in bariatric practices, consensus is lacking on an optimal approach for revisional bariatric surgeries. MATERIALS AND METHODS The authors reviewed and consolidated bariatric surgery literature to provide specific revision suggestions based on each index surgery, including adjustable gastric band (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single anastomosis duodenal-ileal bypass with sleeve (SADI-S), one anastomosis gastric bypass (OAGB), and vertical banded gastroplasty (VBG). RESULTS AGB has the highest weight recurrence rate and can be converted to RYGB, SG, and BPD-DS. After index SG, common surgical options include a resleeve or RYGB. The RYGB roux limb can be distalized and pouch resized in context of reflux, and the entire anatomy can be revised into BPD-DS. Data analyzing revisional surgery after a single anastomosis duodenal-ileal bypass with sleeve was limited. In patients with one anastomosis gastric bypass and vertical banded gastroplasty anatomy, most revisions were the conversion to RYGB. CONCLUSIONS As revisional bariatric surgery becomes more common, the best approach depends on the patient's indication for surgery and preexisting anatomy.
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Affiliation(s)
- Sheena Chen
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Omar Ghanem
- Department of General Surgery, Mayo Clinic, Rochester, MN
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
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Dang JT, Hider AM, Barajas-Gamboa JS, Mocanu V, Shin T, Romero-Velez G, Lee Y, Navarrete S, Rodriguez J, Kroh M. Safety of limb lengthening after Roux-en-Y gastric bypass: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2024; 20:564-570. [PMID: 38316579 DOI: 10.1016/j.soard.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. OBJECTIVES This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. METHODS Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. RESULTS A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P < .001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P < .001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P < .001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P = .5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P = .6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P = .03) and deep surgical site infections (1.3 versus .5%, P = .03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus .1% RYGB, P = .5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. CONCLUSIONS When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Shin
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Ghanem OM, Abi Mosleh K, Kerbage A, Lu L, Hage K, Abu Dayyeh BK. Continued Diabetes Remission Despite Weight Recurrence: Gastric Bypass Long-Term Metabolic Benefit. J Am Coll Surg 2024; 238:862-871. [PMID: 38349010 DOI: 10.1097/xcs.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) demonstrates high rates of type 2 diabetes mellitus (T2DM) remission, a phenomenon hypothesized to be mediated mainly by weight loss. Compared with procedures that do not bypass the proximal small intestines, such as sleeve gastrectomy (SG), RYGB exhibits weight loss-independent intestinal mechanisms conducive to T2DM remission. We investigated continued diabetes remission (CDR) rates despite weight recurrence (WR) after RYGB compared with an SG cohort. STUDY DESIGN A retrospective review of patients who underwent successful primary RYGB or SG with a BMI value of 35 kg/m 2 or more and a preoperative diagnosis of T2DM was performed. Patients with less than 5 years of follow-up, absence of WR, or lack of T2DM remission at nadir weight were excluded. After selecting the optimal procedure for glycemic control, rates of CDR were then stratified into WR quartiles and compared. RESULTS A total of 224 RYGB and 46 SG patients were analyzed. The overall rate of CDR was significantly higher in the RYGB group (75%) compared with the SG group (34.8%; p < 0.001). The odds of T2DM recurrence were 5.5 times higher after SG compared with RYGB. Rates of CDR were stratified into WR quartiles (85.5%, <25%; 81.7%, 25% to 44.9%; 63.2%, 45% to 74.9%; and 60%, >75%). Baseline insulin use, higher preoperative glycosylated hemoglobin, and longer preoperative duration of T2DM were associated with T2DM recurrence, whereas WR was not. CONCLUSIONS T2DM remission rates after RYGB are maintained despite WR, arguing for a concurrent weight loss-independent metabolic benefit likely facilitated by bypassing the proximal small intestine.
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Affiliation(s)
- Omar M Ghanem
- From the Department of Surgery (Ghanem, Abi Mosleh, Hage), Mayo Clinic, Rochester, MN
| | - Kamal Abi Mosleh
- From the Department of Surgery (Ghanem, Abi Mosleh, Hage), Mayo Clinic, Rochester, MN
| | - Anthony Kerbage
- Division of Gastroenterology, Department of Medicine (Kerbage, Abu Dayyeh), Mayo Clinic, Rochester, MN
| | - Lauren Lu
- Mayo Clinic Alix School of Medicine (Lu), Mayo Clinic, Rochester, MN
| | - Karl Hage
- From the Department of Surgery (Ghanem, Abi Mosleh, Hage), Mayo Clinic, Rochester, MN
| | - Barham K Abu Dayyeh
- Division of Gastroenterology, Department of Medicine (Kerbage, Abu Dayyeh), Mayo Clinic, Rochester, MN
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Maselli DB, Chittajallu V, Wooley C, Waseem A, Lee D, Secic M, Donnangelo LL, Coan B, McGowan CE. Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice. World J Gastrointest Endosc 2023; 15:602-613. [PMID: 37900116 PMCID: PMC10600692 DOI: 10.4253/wjge.v15.i10.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting. AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB. METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics. RESULTS Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m2) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%). CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.
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Affiliation(s)
- Daniel B Maselli
- Clinical Research, True You Weight Loss, Atlanta, GA 30342, United States
| | - Vibhu Chittajallu
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Chase Wooley
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Areebah Waseem
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
| | - Michelle Secic
- Secic Statistical Consulting, Cleveland, OH 44106, United States
| | | | - Brian Coan
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
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Yıldız E, Karagözoğlu Ş. The Effects of a Web-Based Interactive Nurse Support Program Based on the Health Promotion Model on Healthy Living Behaviors and Self-Efficacy in Patients Who Regained Weight after Bariatric Surgery: A Randomized Controlled Trial. Obes Surg 2023; 33:3212-3222. [PMID: 37620740 DOI: 10.1007/s11695-023-06795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study was conducted in order to determine the effects of web-based interactive nursing support program prepared in line with Health Promotion Model (HPM) on healthy lifestyle behaviors and self-efficacy of patients who regained weight following metabolic and bariatric surgery. MATERIALS AND METHODS A total of 62 patients with a history of weight regain at least two years after metabolic and bariatric surgery were divided into intervention (n = 31) and control (n = 31) groups by stratified randomization. The intervention group was given a web-based interactive nurse support program based on HPM for 10 weeks and followed up by telephone 12 times (every two weeks) in 6 months. No attempt was made to the control group during the study. The data were collected a total of 3 times before the training, in the 12th week and in the 6th month. RESULTS In the last test after the web-based interactive nurse support program and telephone follow-up, the difference was found to be statistically significant in terms of BMI, healthy lifestyle behaviors, eating behaviors, and general self-efficacy mean scores of the patients in the intervention group (p < 0.05). In addition, after the study, it was determined that the physical activity, nutrition, spiritual development, emotional eating and the Dutch Eating Behavior scales total score averages and Self-Efficacy Scale total score averages of the intervention group changed positively compared to the control group, and this change was statistically significant (p < 0.05). There was no difference between the groups in the mean scores of health responsibility, interpersonal relationships, stress, restrictive eating, external eating and Healthy Lifestyle Behaviors-II Scale (p > 0.05). CONCLUSION It can be stated that the web-based interactive nurse support program based on HPM is applicable in patients who regain weight after metabolic and bariatric surgery, and it contributes positively to the healthy lifestyle behaviors, BMI, eating behaviors, and general self-efficacy of these patients. In order to ensure the continuity of post-operative patient follow-up, it is recommended to increase the importance of telephone counseling and to establish follow-up program based on the HPM.
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Affiliation(s)
- Ezgi Yıldız
- Susehri School of Health Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Şerife Karagözoğlu
- Faculty of Health Sciences Fundamentals of Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
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Beckman RM, Costa AJRB, Caetano N, Pinto SL. Food Consumption and Weight Recurrence in Patients Undergoing Bariatric Surgery with a Minimum of 2 Years Post-surgery. Obes Surg 2023; 33:3223-3229. [PMID: 37632585 DOI: 10.1007/s11695-023-06798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Eating habits are one of the factors that directly affect weight recurrence after bariatric surgery, and therefore, this study assessed the association between food consumption and weight recurrence in patients who underwent bariatric surgery a minimum of 2 years. METHODS A cross-sectional observational study was conducted with patients who underwent bariatric surgery a minimum of 2 years through SUS, in the city of Palmas, Tocantins. Food consumption was assessed through two 24-h dietary recalls (R24). The foods were classified into groups by degree of processing following the NOVA classification system. Also, macronutrients and fiber contents were quantified. Anthropometric variables were evaluated and weight recurrence (WR) was defined as 15%. RESULTS Ninety-three (93) patients participated in the study, being 83.9% female, with mean age of 43.5 ± 9.13 years, mean post-surgery time of 4 years, and 58% present WR. A lower total energy consumption was found in patients without WR compared to those with WR (p = 0.05). Among the WR group, calories from processed foods (p = 0.00) and culinary ingredients (p = 0.05) were higher. However, carbohydrate consumption (percentage) was lower in the WR group (p = 0.04). A positive correlation was found between total energy (p = 0.03), processed foods (p = 0.03) and weight recurrence (p = 0.03). CONCLUSION Weight recurrence is associated with total daily energy intake, carbohydrates and food groups classified according to NOVA.
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Affiliation(s)
- Railane M Beckman
- Nutrition Course of the Federal University of Tocantins/TO, Palmas, Brazil
| | - Ana Júlia R B Costa
- Postgraduate Program in Health Science of the Federal University of Tocantins/TO, Palmas, Brazil
| | - Nayara Caetano
- Nutrition Course of the Federal University of Tocantins/TO, Palmas, Brazil
| | - Sônia L Pinto
- Nutrition Course of the Federal University of Tocantins/TO, Palmas, Brazil.
- Postgraduate Program in Health Science of the Federal University of Tocantins/TO, Palmas, Brazil.
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Meyers MH, Swei EC, Tarter W, Schoen J, Rothchild K, Pratap A, Sullivan SA. Factors Associated with Weight Loss After Endoscopic Transoral Outlet Reduction (TORe). J Gastrointest Surg 2023; 27:1587-1593. [PMID: 37237090 PMCID: PMC10215034 DOI: 10.1007/s11605-023-05695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Endoscopic transoral outlet reduction (TORe) has emerged as a safe and effective treatment option for weight regain after Roux-en-Y Gastric Bypass (RYGB). Factors that predict successful weight loss after TORe are incompletely understood. The aims of this study were to evaluate procedural factors and patient factors that may affect percent total body weight loss (%TBWL) after TORe. METHODS A retrospective cohort study was performed on patients after TORe. The primary outcomes were %TBWL at 6 and 12 months based on four procedural factors: purse-string (PS) vs. non-purse-string (NPS) suture pattern, gastric pouch sutures (N), change in the diameter of the gastrojejunal anastomosis, and change in the length of the gastric pouch. Secondary outcomes included patient factors that affected weight loss. RESULTS Fifty-one patients underwent TORe. Weight loss for completers was 11.3 ± 7.6% and 12.2 ± 9.2% at 6 and 12 months. There was a correlation between %TBWL and change in pouch length at 6 and 12 months and number of sutures in the pouch at 6 months. The difference in %TBWL between PS and NPS groups at 6 months (PS, n=21, 12.3 ± 8.5% and NPS, n=8, 8.7 ± 3.7%) and 12 months (PS, n=21, 13.5 ± 9.2% and NPS, n=5, 7.0 ± 7.9%) did not reach statistical significance. For secondary outcomes, depression was associated with %TBWL. CONCLUSION Change in pouch length and number of sutures in the pouch correlated positively while depression correlated negatively with weight loss after TORe. Further studies are needed to understand these effects.
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Affiliation(s)
- Matthew H Meyers
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Eric C Swei
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Wyatt Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Jonathan Schoen
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Kevin Rothchild
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Akshay Pratap
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
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Pereira SE, Rossoni C, Cambi MPC, Faria SL, Mattos FCC, De Campos TBF, Petry TBZ, Da Silva SA, Pereira AZ, Umeda LM, Nogueira C, De Araújo Burgos MGP, Magro DO. Brazilian guide to nutrition in bariatric and metabolic surgery. Langenbecks Arch Surg 2023; 408:143. [PMID: 37039877 DOI: 10.1007/s00423-023-02868-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.
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Affiliation(s)
- Silvia Elaine Pereira
- Postgraduate Program in Nutritional Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Carina Rossoni
- Faculty of Medicine (ISAMB), Instituto of Environmental Health, Universidade de Lisboa, Lisbon, Portugal.
| | | | - Silvia Leite Faria
- Postgraduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | | | | | | | - Silvia Alves Da Silva
- Postgraduate Program in Nutritional in Bariatric Surgery, Federal University of Pernambuco, Recife, Brazil
| | | | - Luciana Mela Umeda
- Medical Residency Program in Endrocrinology and Metabology, Ipiranga Hospital, São Paulo, Brazil
| | - Carla Nogueira
- Postgraduate Program in Human Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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McLennan S, Verhoeff K, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ. Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients. Surg Endosc 2023:10.1007/s00464-023-09951-6. [PMID: 36859722 DOI: 10.1007/s00464-023-09951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/12/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Revisional bariatric surgery in an option for patients who experience weight regain or inadequate weight loss after primary elective bariatric procedures. However, there is conflicting data on safety outcomes of revisional procedures. We aim to characterize patient demographics, procedure type, and safety outcomes for those undergoing revisional compared to initial bariatric interventions to guide management of these patients. METHODS The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing primary elective to revisional bariatric procedures for inadequate weight loss. Bivariate analysis was performed to determine between group differences. Multivariable logistic regression determined factors associated with serious complications or mortality. RESULTS We evaluated 158,424 patients, including 10,589 (6.7%) revisional procedures. Patients undergoing revisional procedures were more like to be female (85.5% revisional vs. 81.0% initial; p < 0.001), had lower body mass index (43.6 ± 7.8 kg/m2 revisional vs. 45.2 ± 7.8 kg/m2 initial; p < 0.001), and less metabolic comorbidities than patients undergoing primary bariatric surgery. The most common revisional procedures were Roux-en-Y gastric bypass (48.4%) and sleeve gastrectomy (32.5%). Revisional procedures had longer operative duration compared to primary procedures. Patients undergoing revisional procedures were more likely to experience readmission to hospital (4.8% revisional vs. 2.9% initial; p < 0.001) and require reoperation (2.4% revisional vs. 1.0% initial; p < 0.001) within 30 days of the procedure. Revisional procedures were independently associated with increased serious complications (OR 1.49, CI 1.36-1.64, p < 0.001) but were not a significant predictor of 30-day mortality (OR 0.74, CI 0.36-1.50, p = 0.409). CONCLUSIONS In comparison to primary bariatric surgery, patients undergoing revisional procedures have less metabolic comorbidities. Revisional procedures have worse perioperative outcomes and are independently associated with serious complications. These data help to contextualize outcomes for patients undergoing revisional bariatric procedures and to inform decision making in these patients.
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Affiliation(s)
- Steffane McLennan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Failed Roux-en-Y Gastric Bypass-Long-Term Results of Distalization with Total Alimentary Limb Length of 250 or 300 cm. Obes Surg 2023; 33:293-302. [PMID: 36459358 PMCID: PMC9834116 DOI: 10.1007/s11695-022-06388-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/02/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Weight loss failure or weight regain may occur after Roux-en-Y gastric bypass (RYGB). Revisional surgery includes distalization. However, few studies have looked at the associations between the total alimentary limb length (TALL) and weight loss outcomes, none with long-term results. OBJECTIVES Peri- and postoperative outcomes were assessed after employing TALL of either 250 cm or 300 cm in the failed RYGB. METHODS This study is a retrospective cohort analysis of 90 patients that underwent laparoscopic distalization between January 2006 and January 2016 due to failed RYBG. The index RYGB was modified to TALL of 250 cm (n = 48) or of 300 cm (n = 42) which entailed elongating the bilio-pancreatic limb (BPL) and transposing the Roux limb (RL) to a common limb (CL) of 100 cm and 150 cm, respectively. Long-term weight loss outcomes along with nutritional and vitamin status were analyzed. RESULTS Preoperative BMI at distalization was 38.6 kg/m2. After 8 years, excess weight loss (EWL) was 61.8%. No differences between the two groups were seen in weight loss outcomes or early surgical complication rates (6.7%). However, more vitamin and nutritional deficiencies were present in the TALL 250-cm group (50.0% and 35.4%, respectively) versus the TALL 300-cm group (33.3% and 14.3% respectively), which led to laparoscopic revision in 27 patients by lengthening the TALL with 100 cm. Patients with weight regain after index RYGB had in average 59.9% higher EWL than patients with EWL failure. CONCLUSION Distalization of the failed RYGBP is safe and effective, but TALL should not be shorter than 300 cm (and CL 150 cm) due to high rates of malnutrition. Adequate supplementation and long-term follow-up are mandatory to prevent serious malnutrition.
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Mahmoud AM, da Silva ALG, André LD, Hwang CL, Severin R, Sanchez-Johnsen L, Borghi-Silva A, Elokda A, Arena R, Phillips SA. Effects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery: A Narrative Review. Am J Phys Med Rehabil 2022; 101:1056-1065. [PMID: 35034058 PMCID: PMC9279514 DOI: 10.1097/phm.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.
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Affiliation(s)
- Abeer M. Mahmoud
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Andréa Lúcia Gonçalves da Silva
- Department of Physical Education and Health, Physiotherapy‘ Course at University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Larissa Delgado André
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Chueh-Lung Hwang
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard Severin
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Lisa Sanchez-Johnsen
- Departments of Surgery, Psychiatry, and Psychology, College of Medicine, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Department of Family Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL
| | - Ross Arena
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Shane A. Phillips
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
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16
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Resizing of the Gastric Pouch for Weight Regain after Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: Is It a Valid Option? J Clin Med 2022; 11:jcm11216238. [PMID: 36362466 PMCID: PMC9659038 DOI: 10.3390/jcm11216238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The laparoscopic resizing of the gastric pouch (LPR) has recently been proposed as a revisional technique in the case of weight regain (WR) after gastric bypass procedures. The aim of this study was to report our experience with LPR for WR. Materials and Methods: All patients with WR ≥ 25% after gastric bypass and with a dilated gastric pouch and/or gastrojejunal anastomosis who underwent LPR between January 2017 and January 2022 were retrospectively reviewed. From a radiological point of view, a gastric pouch was considered dilated when its volume was calculated at >80 cm3 for LRYGB and >200 cm3 for OAGB upon a 3D-CT scan. The endoscopic criterion considered both the diameter of the gastrojejunal anastomosis and the gastric pouch volume. All anastomoses > 20 mm for LRYGB and >40 mm for OAGB were considered dilated, while a gastric pouch was considered endoscopically dilated when the retrovision maneuver with the gastroscope was easily performed. These selection criteria were arbitrarily established on the basis of both our personal experience and literature data. Results: Twenty-three patients had LPR after a Roux-en-Y gastric bypass or one-anastomosis gastric bypass. The mean BMI at LPR was 36.3 ± 4.7 kg/m2. All patients underwent LPR, while the resizing of the GJA was also performed in 3/23 (13%) cases, and hiatoplasty was associated with the resizing of the pouch in 6/23 cases (26.1%). The mean BMI at the last follow-up was 29.3 ± 5.8 kg/m2. The difference between the BMI before resizing and the BMI at the last follow-up visit was statistically significant (p = 0.00005). The mean %TWL at 24.2 ± 16.1 months was 19.6 ± 9%. Comorbidities had an overall resolution and/or improvement rate of 47%. The mean operative time was 71.7 ± 21.9 min. The conversion rate was nil. Postoperative complications occurred in two cases (8.7%). Conclusions: In our series, LPR for WR showed good results in weight loss and in improvement/resolution of comorbidities, with an acceptable complication rate and operative time. Only further studies with a greater cohort of patients and a longer postoperative follow-up will be able to highlight the long-term benefits of this technique.
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Solier-López L, González-González R, Caracuel A, Kakoschke N, Lawrence N, Vilar-López R. A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148447. [PMID: 35886296 PMCID: PMC9324504 DOI: 10.3390/ijerph19148447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023]
Abstract
Background: The available treatments for people with excess weight have shown small effects. Cognitive training has shown promising results, but most of the research focused on normal-weight university students and reported immediate results after a single training session. This parallel group, randomized, controlled trial aims to study the efficacy of a program for the comprehensive cognitive treatment of excess weight. Methods and Analysis: Participants will be 150 people with excess weight recruited through social media, who will be randomized into three groups: cognitive intervention, sham cognitive intervention, and treatment as usual. All assessment and intervention sessions will be online in groups of 5–6 participants. The three groups will attend a motivational interviewing session, and they will receive individualized diet and physical exercise guidelines throughout the program. The cognitive training will consist of four weekly sessions of approximately 60–90 min, each based on approach–avoidance bias training, inhibitory control training, implementation of intentions, and episodic future thinking, respectively. The main outcome measure will be a change in Body Mass Index (kg/m2). Secondary outcomes include changes in cognitive measures, eating and physical exercise behaviors, and anthropometric measures. Assessments will be conducted up to 6 months after the end of the program. In addition, data on the use of the health system will be collected to analyze the cost-effectiveness and the cost-utility of training. Linear mixed models will be used for statistical analysis. Findings of this study will expand the available evidence on cognitive interventions to reduce excess weight.
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Affiliation(s)
- Lucía Solier-López
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
| | - Raquel González-González
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
| | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
- Correspondence:
| | - Naomi Kakoschke
- Nutrition and Health Program (Health & Biosecurity) at CSIRO, Adelaide, SA 5000, Australia;
| | - Natalia Lawrence
- Department of Psychology, University of Exeter, Exeter EX4 4PY, UK;
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
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Berino TN, Reis AL, Carvalhal MMDL, Kikuchi JLD, Teixeira RCR, Gomes DL. Relationship between Eating Behavior, Quality of Life and Weight Regain in Women after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137648. [PMID: 35805307 PMCID: PMC9265978 DOI: 10.3390/ijerph19137648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
Individuals undergoing bariatric Surgery (BS) may have long-term weight regain. There is a need to investigate factors that may be related to this and if they can interfere with Quality of Life (QOL). This study aims to evaluate the relationship between eating behavior, perception of QOL, and weight regain in women after 24 months of bariatric surgery. This was a transversal study with 50 adult women residents in the city of Belém, Brazil. Sociodemographic, anthropometric, eating behavior (Three-Factor Eating Questionnaire—TFEQ-21) and perception of QOL (Item Short Form Healthy Survey—SF-36) data were collected. In 60% (n = 30) there was weight regain (≥15%), with a mean weight regain of 23.3% (±18.4). Emotional eating was the most frequent pattern (p = 0.047). Regarding QOL, the functional capacity and limitation due to physical aspects domains had a better perception (p < 0.0001). Women without weight regain showed a better perception of the functional capacity aspects (p = 0.007), limitation due to physical aspects (p = 0.044), social aspects (p = 0.048), and general physical components (p = 0.016) and also had an inverse association with the perception of QOL in physical components (p = 0.008). Patterns of eating behavior and weight regain can damage the perception of QOL, especially physical capacity. Long-term follow-up is essential to evaluate the behavior of people who have undergone BS in order to prevent weight regain and QOL damage.
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Affiliation(s)
- Talita Nogueira Berino
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075110, Pará, Brazil; (A.L.R.); (J.L.D.K.); (R.C.R.T.); (D.L.G.)
- Correspondence:
| | - Aline Leão Reis
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075110, Pará, Brazil; (A.L.R.); (J.L.D.K.); (R.C.R.T.); (D.L.G.)
| | - Manuela Maria de Lima Carvalhal
- Nucleus of Tropical Medicine, Federal University of Pará, Belém 66075110, Pará, Brazil;
- Nutrition Faculty, Federal University of Pará, Belém 66075110, Pará, Brazil
| | - Jeane Lorena Dias Kikuchi
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075110, Pará, Brazil; (A.L.R.); (J.L.D.K.); (R.C.R.T.); (D.L.G.)
| | - Rachel Coêlho Ripardo Teixeira
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075110, Pará, Brazil; (A.L.R.); (J.L.D.K.); (R.C.R.T.); (D.L.G.)
| | - Daniela Lopes Gomes
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075110, Pará, Brazil; (A.L.R.); (J.L.D.K.); (R.C.R.T.); (D.L.G.)
- Nutrition Faculty, Federal University of Pará, Belém 66075110, Pará, Brazil
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Nonino CB, Barato M, Ferreira FC, Delfino HBP, Noronha NY, Nicoletti CF, Junior WS, Welendorf CR, Souza DRS, Ferreira-Julio MA, Watanabe LM, de Souza Pinhel MA. DRD2 and BDNF polymorphisms are associated with binge eating disorder in patients with weight regain after bariatric surgery. Eat Weight Disord 2022; 27:1505-1512. [PMID: 34478125 DOI: 10.1007/s40519-021-01290-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022] Open
Abstract
AIM The aim of this study was to analyze the association and susceptibility of Single Nucleotide Polymorphisms (SNPs) in the DRD2 and BDNF genes with BED in patients with weight regain in the postoperative period of bariatric surgery. METHODS One hundred and seventy-seven individuals who underwent bariatric surgery with weight regain were evaluated and divided into two groups according to the BED diagnostic. The individuals were submitted to an anthropometric evaluation, analysis of the presence of BED using a validated questionnaire, and blood collection for genotyping of the polymorphisms rs6265 (BDNF) and rs1800497 (DRD2) by real-time polymerase chain reaction (RT-PCR). RESULTS The presence of wild-type alleles for rs1800497 (CC) and rs6265 (GG) was more frequent in patients without BED. Nevertheless, the presence of one or two variant alleles for rs1800497 (CT + TT) and rs6265 (GA + AA) was more frequent in patients with BED. The combination of the two studied SNPs prevailed in patients with BED. CONCLUSIONS The presence of allele frequency of rs1800497 SNP in the DRD2 gene and rs6265 SNP in the BDNF gene, isolated and/or combined, indicated an additional risk for the development of BED in patients with obesity, especially in the context of weight regain. LEVEL OF EVIDENCE III (evidence obtained from the case-control analytic study).
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Affiliation(s)
- Carla Barbosa Nonino
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Mariana Barato
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
| | - Flávia Campos Ferreira
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Heitor Bernardes Pereira Delfino
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Natalia Yumi Noronha
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Carolina Ferreira Nicoletti
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Wilson Salgado Junior
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Caroline Rossi Welendorf
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Doroteia Rossi Silva Souza
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
| | | | - Ligia Moriguchi Watanabe
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Marcela Augusta de Souza Pinhel
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
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Storman D, Świerz MJ, Storman M, Jasińska KW, Jemioło P, Bała MM. Psychological Interventions and Bariatric Surgery among People with Clinically Severe Obesity-A Systematic Review with Bayesian Meta-Analysis. Nutrients 2022; 14:1592. [PMID: 35458154 PMCID: PMC9024573 DOI: 10.3390/nu14081592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the effectiveness of perioperative psychological interventions provided to patients with clinically severe obesity undergoing bariatric surgery regarding weight loss, BMI, quality of life, and psychosocial health using the Bayesian approach. METHODS We considered randomised trials that assessed the beneficial and harmful effects of perioperative psychological interventions in people with clinically severe obesity undergoing bariatric surgery. We searched four data sources from inception to 3 October 2021. The authors independently selected studies for inclusion, extracted data, and assessed the risk of bias. We conducted a meta-analysis using a Bayesian approach. PROSPERO CRD42017077724. RESULTS Of 13,355 identified records, we included nine studies (published in 27 papers with 1060 participants (365 males; 693 females, 2 people with missing data)). Perioperative psychological interventions may provide little or no benefit for BMI (the last reported follow-up: MD [95% credible intervals] = -0.58 [-1.32, 0.15]; BF01 = 0.65; 7 studies; very low certainty of evidence) and weight loss (the last reported follow-up: MD = -0.50 [-2.21, 0.77]; BF01 = 1.24, 9 studies, very low certainty of evidence). Regarding psychosocial outcomes, the direction of the effect was mainly inconsistent, and the certainty of the evidence was low to very low. CONCLUSIONS Evidence is anecdotal according to Bayesian factors and uncertain whether perioperative psychological interventions may affect weight-related and psychosocial outcomes in people with clinically severe obesity undergoing bariatric surgery. As the results are ambiguous, we suggest conducting more high-quality studies in the field to estimate the true effect, its direction, and improve confidence in the body of evidence.
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Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (M.J.Ś.)
- Systematic Reviews Unit, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Mateusz Jan Świerz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (M.J.Ś.)
- Systematic Reviews Unit, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, 31-034 Krakow, Poland;
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, 02-091 Warszawa, Poland
| | - Katarzyna Weronika Jasińska
- Students’ Scientific Research Group, Systematic Reviews Unit, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Paweł Jemioło
- Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, AGH University of Science and Technology, al. Mickiewicza 30, 30-059 Krakow, Poland;
| | - Małgorzata Maria Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (M.J.Ś.)
- Systematic Reviews Unit, Jagiellonian University Medical College, 31-034 Krakow, Poland;
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21
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Sohail AH, Howell RS, Brathwaite BM, Silverstein J, Amodu L, Cherasard P, Petrone P, Goparaju A, Levine J, Kella V, Brathwaite CEM. Gastric Banding with Previous Roux-en-Y Gastric Bypass (Band over Pouch): Not Worth the Weight. JSLS 2022; 26:JSLS.2022.00010. [PMID: 35815327 PMCID: PMC9205461 DOI: 10.4293/jsls.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Revisional bariatric surgery continues to increase. Laparoscopic adjustable gastric banding (LAGB) after previous Roux-en-Y gastric bypass (RYGB), known colloquially as “band-overpouch” has become an option despite a dearth of critically analyzed long-term data. Methods: Our prospectively maintained database was retrospectively reviewed for patients who underwent band-overpouch at our Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Center of Excellence in a 18-year period ending October 31, 2021. We evaluated: demographics, comorbidities, operative procedures, and outcomes (30-day and > 30-day). Results: During the study period, of 4,614 bariatric procedures performed, 42 were band-overpouch with 39 (93%) being women. Overall, mean age was 49.8 years (range 26–75), a mean weight 251 pounds (range 141–447), and mean body mass index 42.4 (range 26–62). Comorbidities included: hypertension (n = 31; 74%), diabetes (n = 27; 64%), obstructive sleep apnea (n = 26; 62%), gastroesophageal reflux disease (n = 26; 62%), and osteoarthritis (n = 25; 60%). All procedures were performed laparoscopically with no conversions to open. Mean length of stay was 1.2 days (range 1–3). Mean follow-up time was 4.2 years (range 0.5–11). Mean excess weight loss was 14.9%, 24.3%, and 28.2% at 6 months, 1 year and ≥ 3 years, respectively. There was one 30-day trocar-site hematoma requiring transfusion. Long-term events included: 1-year (1 endoscopy for retained food; 1 internal hernia), 3-year (1 LAGB erosion; 1 LAGB explant), 4-year (1 anastomotic ulcer), 6-year (1 LAGB explant and Roux-en-Y revision), and 8-year (1 LAGB erosion). One 5-year mortality occurred (2.4%), in association with hospitalization for chronic illness and malnutrition. Band erosions were successfully treated surgically without replacement. Conclusion: Band-overpouch is associated with moderate excess weight loss and has good short-term safety outcomes.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Raelina S Howell
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Barbara M Brathwaite
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Jeffrey Silverstein
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Leo Amodu
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Patricia Cherasard
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Patrizio Petrone
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Anirudha Goparaju
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Jun Levine
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Venkata Kella
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
| | - Collin E M Brathwaite
- Department of Surgery, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine; Mineola, NY
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22
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Novais PFS, Crisp AH, Leandro-Merhi VA, Verlengia R, Rasera I, Oliveira MRMD. Lack of Association Between 11 Gene Polymorphisms on Weight Loss One Year After Roux-en-Y Gastric Bypass Surgery in Women. J Hum Nutr Diet 2022; 35:731-738. [PMID: 35239993 DOI: 10.1111/jhn.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although effective, the impact of bariatric surgery on weight loss is variable, and little is known about the influence of single nucleotide polymorphisms (SNPs). This study investigated the association of eleven SNPs related to obesity with weight loss one year after Roux-Y gastric bypass (RYGB) surgery in female patients. METHODS This prospective study included 351 women with obesity. The genotypes for eleven SNPs (GHRL - rs26802; GHSR - rs572169; LEP - rs7799039; LEPR - rs1137101; 5HT2C - rs3813929; UCP2 - rs659366; UCP3 - rs1800849; SH2B1 - rs7498665; TAS1R2 - rs35874116; TAS1R2 - rs9701796; FTO - rs9939609) were determined using real-time polymerase chain reaction (PCR) and TaqMan assays. Anthropometric measurements were performed before and one year after RYGB surgery. To evaluate the factors that influenced the proportion of weight loss 1 year after surgery, beta regression analysis was used. The models were estimated using the SAS software GLIMMIX procedure. The level of significance adopted for the statistical tests was 5%. RESULTS The average percentage of total body weight loss in one year was 64.4 ± 5.8% and the median was 65.0%. In assessing the proportion of weight loss in one year after surgery, using univariate analysis (beta regression), no single nucleotide polymorphisms (SNPs) influenced weight loss. And in the multiple analysis, with stepwise process of variable selection, no variable was significant to compose the multiple model. CONCLUSION The 11 SNPs investigated did not influence weight loss one year after RYGB surgery in female patients. This result indicates that individual behaviors and other factors might better contribute to the magnitude of loss weight loss in a short period after bariatric surgery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Alex Harley Crisp
- Human Performance Laboratory, Universidade Metodista de Piracicaba, Piracicaba-SP, Brazil
| | | | - Rozangela Verlengia
- Faculty of Health Sciences, Universidade Metodista de Piracicaba, Piracicaba-SP, Brazil
| | - Irineu Rasera
- Clínica Bariátrica de Piracicaba, Piracicaba-SP, Brazil
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23
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A Multidisciplinary Approach for Nonresponders Following Bariatric Surgery: What Is the Value? Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Beaumont JD, Smith NC, Starr D, Davis D, Dalton M, Nowicky A, Russell M, Barwood MJ. Modulating eating behavior with transcranial direct current stimulation (tDCS): A systematic literature review on the impact of eating behavior traits. Obes Rev 2022; 23:e13364. [PMID: 34786811 DOI: 10.1111/obr.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) is becoming an increasingly popular technique for altering eating behaviors. Recent research suggests a possible eating behavior trait-dependent effect of tDCS. However, studies recruit participant populations with heterogeneous trait characteristics, including "healthy" individuals who do not present with eating behavior traits suggesting susceptibility to overconsumption. The present review considers the effects of tDCS across eating-related measures and explores whether a trait-dependent effect is evident across the literature. A literature search identified 28 articles using sham-controlled tDCS to modify eating-related measures. Random effects meta-analyses were performed, with subgroup analyses to identify differences between "healthy" and trait groups. Trivial overall effects (g = -0.12 to 0.09) of active versus sham tDCS were found. Subgroup analyses showed a more consistent effect for trait groups, with small and moderate effect size (g = -1.03 to 0.60), suggesting tDCS is dependent on participants' eating behavior traits. Larger effect sizes were found for those displaying traits associated with study outcomes (e.g., heightened food cravings). "Healthy" individuals appear to be unresponsive to stimulation. Based on this meta data, future work should recruit those with eating behavior trait susceptibilities to overconsumption, focusing on those who present with traits associated with the outcome of interest.
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Affiliation(s)
- Jordan D Beaumont
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Natalie C Smith
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - David Starr
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Danielle Davis
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Michelle Dalton
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Alexander Nowicky
- Centre for Cognitive Neuroscience, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mark Russell
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Martin J Barwood
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
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25
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Loh HH, Shahar MA, Loh HS, Yee A. Female sexual dysfunction after bariatric surgery in women with obesity: A systematic review and meta-analysis. Scand J Surg 2022; 111:14574969211072395. [PMID: 35253540 DOI: 10.1177/14574969211072395] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Obesity is prevalent and has a negative impact on women's health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery. METHODS We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes. RESULTS The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (β = 0.395, p = 0.1, 95% CI = 0.884, 0.095). CONCLUSIONS Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.
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Affiliation(s)
- Huai H Loh
- Faculty of Medicine and Health Sciences Universiti Malaysia Sarawak Jalan Datuk Muhammad Musa 94300 Kota Samarahan Sarawak Malaysia
| | | | - Huai S Loh
- Newcastle University Medicine Malaysia, Iskandar Puteri, Johor, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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26
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Lazaridis II, Kraljević M, Süsstrunk J, Köstler T, Zingg U, Delko T. Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass-Is It Worth It? J Gastrointest Surg 2021; 25:3056-3063. [PMID: 34100249 PMCID: PMC8654708 DOI: 10.1007/s11605-021-05045-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. METHODS Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. RESULTS Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9-38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5-76.5) months, the median BMI was 28.7 (IQR 26.1-32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23-44.4), leading to a median total EWL of 79.5% (IQR 54.4-94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8-26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. CONCLUSION LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.
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Affiliation(s)
- Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Julian Süsstrunk
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Urs Zingg
- Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland.
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27
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Demerdash HM. Weight regain after bariatric surgery: Promoters and potential predictors. World J Meta-Anal 2021; 9:438-454. [DOI: 10.13105/wjma.v9.i5.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
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28
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Farha J, Gebran S, Itani MI, Simsek C, Abbarh S, Lopez A, Haq Z, Koller K, Dunlap M, Adam A, Khashab MA, Oberbach A, Schweitzer M, Badurdeen D, Kumbhari V. Transoral outlet reduction: could additional sutures cause more harm? Endoscopy 2021; 53:1059-1064. [PMID: 33254242 DOI: 10.1055/a-1325-4324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The double purse-string pattern (DPSP) of transoral outlet reduction (TORe) should conceivably result in a more robust scaffolding for the gastrojejunal anastomosis (GJA). However, there is a paucity of literature pertaining to post-TORe stenosis as an adverse event. Our aim was to determine the rate of stenosis, its potential predictors, and other complications of DPSP TORe. METHODS We performed a retrospective analysis of a prospectively maintained database of 129 consecutive patients who underwent DPSP TORe between December 2015 and August 2019. RESULTS The adverse event rate of TORe was 17.1 % (n = 22), with a 13.3 % (n = 17) rate of stenosis. Stenosis was not significantly associated with any baseline characteristics. GJA diameter pre- and post-TORe, the difference between these values, and procedure duration were not predictive of stenosis. Of patients who developed stenosis, 10 (58.8 %) responded to endoscopic balloon dilation and 7 (41.2 %) required stent placement. CONCLUSION As the DPSP technique is a challenging procedure, with high complication rate and limited benefit, it should not be used for TORe.
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Affiliation(s)
- Jad Farha
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Selim Gebran
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Mohamad I Itani
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Cem Simsek
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Shahem Abbarh
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ariana Lopez
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Zadid Haq
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Kristen Koller
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Atif Adam
- Department of Mental Health at The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States.,Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Michael Schweitzer
- Department of Surgery, The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, United States
| | - Dilhana Badurdeen
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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29
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Rostami Rayeni N, Abdollahzad H, Alibakhshi P, Morvaridzadeh M, Heydari H, Dehnad A, Khorshidi M, Izadi A, Shidfar F, Dulce Estêvão M, Omidi A, Heshmati J. Effects of body weight regain on leptin levels: A systematic review and meta-analysis. Cytokine 2021; 148:155647. [PMID: 34344588 DOI: 10.1016/j.cyto.2021.155647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are different changes observed before and after diet therapy, and also after weight regain. However, there is not sufficient information regarding weight regain and hormonal changes. PURPOSE The purpose of this study was to review the connection between weight regain and leptin concentration levels. METHODS MEDLINE, SCOPUS, Web of Science, and the Cochrane Library were searched for interventional articles published from January 1, 1980, to June 30, 2020. Randomized clinical trials with parallel or cross over design assessing leptin concentrations at the baseline and at the end of study were reviewed. Two independent reviewers extracted data related to study design, year of publication, country, age, gender, body mass index (BMI), duration of the following up period and mean ± SD of other intended variables. RESULTS Four articles were included, published between 2004 and 2016. Three of them were conducted in the US and one of them in Netherland. Sample size of the studies ranged between 25 and 148 participants. The range of following up period was from13 to 48 weeks. The age range of participants was from 34 to 44 years. Our analysis shows that weight regain could reduce leptin levels, but this change is not statistically significant. CONCLUSION This review suggests that weight regain may induce a non-significant reduction in leptin level. However, the limited number and great heterogeneity between the included studies may affect the presented results and there are still need to well-designed, large population studies to determine the relationship between weight regain and leptin levels.
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Affiliation(s)
- Najme Rostami Rayeni
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Abdollahzad
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pooya Alibakhshi
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Morvaridzadeh
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hafez Heydari
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Afsaneh Dehnad
- Department of English Language, School of Health Management and Information Sciences, Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Iran.
| | - Masoud Khorshidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azimeh Izadi
- Iran Football Medical Assessment and Rehabilitation Center (IFMARC), Tehran, Iran; Department of Biochemistry and Diet Therapy, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - M Dulce Estêvão
- Universidade do Algarve, Escola Superior de Saúde, Campus de Gambelas, Faro, Portugal.
| | - Amirhosein Omidi
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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30
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Romeijn MM, van Hoef S, Janssen L, van de Pas KGH, van Dielen FMH, Luijten AAPM, Göttgens KWA, Greve JWM, Leclercq WKG. Comparison of Linear versus Circular-Stapled Gastroenterostomy in Roux-en-Y Gastric Bypass: A Nationwide Population-Based Cohort Study. Obes Surg 2021; 31:3579-3587. [PMID: 33905068 PMCID: PMC8270800 DOI: 10.1007/s11695-021-05436-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 01/13/2023]
Abstract
Background When performing a Roux-en-Y gastric bypass (RYGB), the gastroenterostomy can be constructed with a circular stapled or linear stapled technique. The size of the gastroenterostomy depends on the stapling method and this may affect weight loss outcomes. The aim of this study was to examine the impact of the stapling technique on weight loss outcomes after RYGB. Methods This is a nationwide population-based cohort study of patients that received a RYGB. Data were derived from the Dutch Audit of Treatment of Obesity. Primary outcome was the impact of stapling technique on the rate of non-response defined as significant weight regain (≥20% of a patients’ lost weight) 2–4 years post-surgery, after initial successful weight loss (≥20% total weight loss, TWL). Secondary outcomes were the rate of response, defined as successful weight loss (≥20% TWL) within 1.5 years post-surgery, the incidence of complications and the progression of comorbidities. Results In a cohort of 12,468 patients, non-response was equally distributed between both groups (circular 18.0% vs. linear 17.6%). No differences in response rate (circular 97.0% vs. linear 96.5%) or %TWL were observed up to 4 years post-surgery. Patients in the circular stapled group experienced more complications, specifically major bleedings (2.4% vs. 1.2%; p=0.002) within 30 days postoperatively. No differences were found in deteriorated comorbidities, neither in de novo developed comorbidities. Conclusion When comparing stapling technique in RYGB, weight loss outcomes did not differ during a 4-year follow-up period. The linear stapled gastroenterostomy could pose an advantage due to its lower complication rate. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05436-4.
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Affiliation(s)
- Marleen M Romeijn
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. .,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stijn van Hoef
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Kelly G H van de Pas
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Kevin W A Göttgens
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem M Greve
- Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
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Luker J, Tajran J, Marquette L, Tepper D, Carlin A, Darian V, Siddiqui A. Long-Term Weight Loss with Body Contour Surgery After Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:3159-3164. [PMID: 33851305 DOI: 10.1007/s11695-021-05405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery is accepted as an evidence-based treatment for morbid obesity. Many patients seek out body contour surgery afterwards to correct acquired deformities. This study seeks to better define the impact of body contour surgery on long-term weight loss. METHODS This study is a single-center retrospective review of 78 patients who underwent body contouring surgery post-Roux-en-Y gastric bypass compared with 221 matched control patients who underwent Roux-en-Y gastric bypass only. Data was collected for patients at least 7 years post-Roux-en-Y gastric bypass. RESULTS Patients who underwent both bariatric surgery and body contour surgery maintained mean long-term weight loss of 58 kg. The matched control group mean weight loss over the same time interval was 42 kg. The difference was statistically and clinically significant (p = 0.005). Change in body mass index, percent total weight loss, and percent excess body mass index loss were all statistically significant between the 2 groups. CONCLUSION Patients who underwent body contour surgery better maintained long-term weight reduction in comparison to those who only had gastric bypass. Further understanding of the etiology of this association is important for patients contemplating body contouring surgery.
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Affiliation(s)
- Jenna Luker
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Jahan Tajran
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Lauren Marquette
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Donna Tepper
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Arthur Carlin
- Division of Bariatric Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Vigen Darian
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Aamir Siddiqui
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA.
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Kraljević M, Köstler T, Süsstrunk J, Lazaridis II, Taheri A, Zingg U, Delko T. Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters. Obes Surg 2021; 30:804-811. [PMID: 31863410 DOI: 10.1007/s11695-019-04348-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Weight regain after laparoscopic Roux-en-Y gastric bypass (RYGB) occurs in up to 35% of patients. Revisional surgery may be applied. Conversion from RYGB to a long biliopancreatic limb (BPL) RYGB is a potential option for revisional surgery and short-term results are promising. METHODS All patients who underwent conversion to long BPL RYGB due to weight loss failure, defined as excess weight loss (EWL) < 50% or body mass index (BMI) > 35 kg/m2, were assessed. Proximal RYGB or very very long limb RYGB (VVLL RYGB) was modified by shortening of the total alimentary limb length (TALL) to create a long BPL. RESULTS A total of 28 patients received revisional surgery from either PRYGB (n = 22) or VVLL RYGB (n = 6). Mean age at operation was 45.3 ± 10.4 years, with 78% females. Mean prerevisional BMI was 41.7 ± 4.4 kg/m2. Mean time to revision was 76.5 ± 38.5 months. Limb lengths were 150 cm (95% CI 133-156 cm) for RL and 100 cm (95% CI 97-113 cm) for CC, thus providing a total median alimentary limb length of 250 (95% CI 238-260 cm). Additional %EWL and TWL improved significantly in long-term. Five years postoperatively, all patients (n = 9) had an EWL% > 50%. Six patients (21.4%) required reoperation due to severe malnutrition during the postoperative course. CONCLUSION Conversion from RYGB to BPL RYGB leads to significant additional weight loss in the long term. However, the morbidity is relevant, especially severe protein malnutrition and the frequency of revisional surgery. Therefore, this type of surgery should not be done routinely.
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Affiliation(s)
- Marko Kraljević
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Julian Süsstrunk
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Ioannis I Lazaridis
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland
| | - Amy Taheri
- Institute of Clinical Chemistry, University Hospital Zurich, 8952, Zurich-Schlieren, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Tarik Delko
- Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.
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Boerboom A, Aarts E, Lange V, Plamper A, Rheinwalt K, Linke K, Peterli R, Berends F, Hazebroek E. Banding the Pouch with a Non-adjustable Ring as Revisional Procedure in Patients with Insufficient Results After Roux-en-Y Gastric Bypass: Short-term Outcomes of a Multicenter Cohort Study. Obes Surg 2021; 30:797-803. [PMID: 31898043 DOI: 10.1007/s11695-019-04361-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND After laparoscopic Roux-en-Y gastric bypass (RYGB), approximately 10-35% of patients with morbid obesity regain weight after an initial good result or fail to achieve a sufficient amount of weight loss. Patients in which conservative measures are not successful may potentially benefit from revisional surgery. OBJECTIVE To evaluate the effect of a non-adjustable ring placed around the gastric pouch in patients with insufficient weight loss or weight regain after RYGB. SETTING Four specialized bariatric hospitals in The Netherlands, Germany, and Switzerland. METHODS From 2011 to 2017, 79 patients underwent revisional surgery using a non-adjustable silicone ring because of insufficient results after RYGB. Data on weight loss and complications up to 2 years after revisional surgery was collected and analyzed retrospectively. RESULTS A follow-up percentage of 86% after 1 year and 61% after 2 years was achieved. In 75% of patients, further weight regain was prevented. Percentage total body weight loss improved by 7 to 26% 1 year after revisional surgery and remained stable during 2 years of follow-up. The additional weight loss effect of placing a non-adjustable ring was more pronounced in patients with an initial good result after primary RYGB. Eighteen (23%) rings were removed, most often due to dysphagia. CONCLUSION Especially for patients who experience weight regain after initial good weight loss, placing a non-adjustable silicone ring around the gastric pouch results in modest improvements in weight loss. To prevent the risk of ring removal due to dysphagia, surgeons should take notice not to place the ring too tight around the gastric pouch during revisional surgery.
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Affiliation(s)
- Abel Boerboom
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
| | - Edo Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Volker Lange
- Department of Obesity and Metabolic surgery, Helios Klinikum, Berlin, Germany
| | - Andreas Plamper
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Karl Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Katja Linke
- Department of Surgery, Clarunis Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Ralph Peterli
- Department of Surgery, Clarunis Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Frits Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Eric Hazebroek
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Angrisani L, Ferraro L, Santonicola A, Palma R, Formisano G, Iovino P. Long-term results of laparoscopic Roux-en-Y gastric bypass for morbid obesity: 105 patients with minimum follow-up of 15 years. Surg Obes Relat Dis 2021; 17:727-736. [PMID: 33390352 DOI: 10.1016/j.soard.2020.11.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/07/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the second most frequently performed bariatric procedure worldwide; however, long-term results are not frequently reported. OBJECTIVES To evaluate the outcomes of LRYGB on weight loss and co-morbidities in a single center 15 years after the operation. SETTING Tertiary-care referral hospital. METHODS From February 2000 to December 2003, 105 patients (86 women; mean age 39.9 ± 17.4; mean body mass index [BMI] 47.2 ± 6.4 kg/m2; 78 with BMI < 50 kg/m2 and 27 with BMI ≥ 50 kg/m2) underwent LRYGB. Retrospective analyses of a prospectively maintained database were carried out to evaluate weight loss; resolution of co-morbidities, including type 2 diabetes mellitus (T2D), hypertension (HTN), and dyslipidemia; complications; and nutritional status. RESULTS The follow-up rate at 15 years was 87.6%. Mean excess weight loss was 58.6 ± 27%, with 74.1% of patients achieving a total weight loss ≥ 20%. According to the Biron et al. criteria, an inadequate outcome was found in 11/21 (52.4%) of patients with an initial BMI ≥ 50 kg/m2 versus 21/64 (32.8%) of patients with a preoperative BMI < 50 kg/m2 (P = .001). Both groups experienced gradual weight regain (WR); specifically, 34.1% of patients regained more than 15% of their lowest postoperative weight. The rates of reoperations due to early and late surgical complications were 3.8% and 9.5%, respectively. T2D was resolved in 50% of patients, HTN in 61.1%, and dyslipidemia in 58.3%. Iron deficiency anemia (53%) was the most common postoperative nutritional finding. CONCLUSION LRYGB provides satisfactory weight loss and resolution of co-morbidities up to 15 years. WR was a common finding. A significant proportion of patients with a preoperative BMI ≥ 50 kg/m2 did not achieve a favorable weight loss outcome. Indications to perform LRYGB in this group of patients should be definitively reconsidered.
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Affiliation(s)
- Luigi Angrisani
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Luca Ferraro
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana," University of Salerno, Salerno, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Giampaolo Formisano
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana," University of Salerno, Salerno, Italy
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Du Z, Li J, Huang J, Ma J, Xu X, Zou R, Xu X. Executive Functions in Predicting Weight Loss and Obesity Indicators: A Meta-Analysis. Front Psychol 2021; 11:604113. [PMID: 33584440 PMCID: PMC7876286 DOI: 10.3389/fpsyg.2020.604113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022] Open
Abstract
While previous studies have suggested that there exists a relationship between obesity and executive function (EF), the mechanisms and causal relationship between them remain unclear. There are important clinical implications of determining whether EF can predict and treat obesity. We conducted a multilevel meta-analysis of randomized controlled trials (RCTs) and longitudinal studies. Specifically, we investigate (a) whether EF interventions have an effect on weight loss, (b) whether baseline EF can be a predictor of future weight loss through obesity intervention, and (c) whether early-life EF can predict future weight loss. Eight RCTs and 17 longitudinal studies with a total of 11,393 participants were identified. We found that (a) EF interventions may not have an effect on weight loss, (b) baseline inhibition (β = 0.259, p = 0.03) and delay discounting (β = −0.17, p = 0.04) significantly predict future weight loss through obesity intervention, (c) age (F = 13.666, p = 0.005) moderates the relationship between working memory and weight loss through intervention, but not weight status, type of intervention, and percentage of female, and (d) early life inhibition (β = 0.185, p = 0.07) is a marginally significant predictor of future weight loss. Our results seem to support the assumption that the relationship between EF and obesity is not direct, and a higher-order factor, such as genes, may link obesity and EF. Building on the preliminary findings, further studies focusing on EF and obesity are needed in the future.
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Affiliation(s)
- Zhongquan Du
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Jingjing Li
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Jiaai Huang
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Jing Ma
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Xiaoyu Xu
- Graduate School, Wuhan Sports University, Wuhan, China
| | - Rong Zou
- College of Health Science, Wuhan Sport University, Wuhan, China
| | - Xia Xu
- College of Health Science, Wuhan Sport University, Wuhan, China.,Hubei Key Laboratory of Sport Training and Monitoring, Wuhan Sports University, Wuhan, China
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Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures. J Clin Med 2021; 10:jcm10040674. [PMID: 33578635 PMCID: PMC7916324 DOI: 10.3390/jcm10040674] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.
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37
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Gorgov E, Rayman S, Carmeli I, Keidar A. Laparoscopic Single Anastomosis Gastric Bypass for Morbid Obesity Following Renal Transplantation: a Case. Obes Surg 2021; 31:1848-1851. [PMID: 33420978 DOI: 10.1007/s11695-020-05108-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Eliyahu Gorgov
- Department of General Surgery, Assuta Medical Centers, Ashdod Campus, 7 Ha'Refua St., 7747629, Ashdod, Israel. .,Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel. .,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel.
| | - Shlomi Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Idan Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
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38
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Ismail M, Nagaraj D, Rajagopal M, Ansari H, Iyyankutty K, Nair M, Hegde A, Rekha PD. Is weight regaining significant post laparoscopic Roux-en-Y gastric bypass surgery? - A 5-year follow-up study on Indian patients. J Minim Access Surg 2021; 17:159-164. [PMID: 33723179 PMCID: PMC8083740 DOI: 10.4103/jmas.jmas_108_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to induce significant weight loss and remission of related co-morbidities in patients with morbid obesity. The long-term follow-up data show weight regain or failure to achieve complete remission of type 2 diabetes mellitus (T2DM) in some patients. In this study, we report weight loss patterns and remission of T2DM in patients with morbid obesity during a 5-year follow-up after RYGB. Objective The objective was to evaluate outcomes during the follow-up on excess weight loss (EWL) and remission of T2DM after laparoscopic RYGB among Indian patients. Setting The study was conducted in a tertiary care hospital, Kerala, India. Materials and Methods This is a retrospective study in patients who underwent surgery between 2007 and 2010. The patient demographics, pre- and post-operative body mass index (BMI), co-morbidities and EWL were recorded from the medical records. These data were compared between pre-operative and follow-up intervals till 5 years using statistical approaches. Results The study included 157 patients (91 males and 66 females) having a mean pre-operative BMI of 47.91 ± 7.01 kg/m2. A significant reduction in the BMI was observed at each follow-up point (P < 0.01) till 5 years after the surgery. The mean percentage of EWL increased from 34.57% ± 12.62% to 71.50% ± 15.41% from 3 months to 5 years after the surgery. Twelve per cent (n = 19) of patients achieved normal BMI (<25 mg/kg2) by 3rd year after the surgery. However, the remission of T2DM was achieved in >50% of patients within a year of surgery. During the 5th year, weight regain (1-22 kg) was observed in 36.70% (n = 58) patients, and recurrence of T2DM was observed in two patients. Conclusions The long-term durability of RYGB in the study population was satisfactory with significant weight loss and remission of T2DM.
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Affiliation(s)
- Mohamed Ismail
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Dileep Nagaraj
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Mahesh Rajagopal
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Hafiz Ansari
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Kingsly Iyyankutty
- Department of General, Laparoscopic and Bariatric Surgery, Moulana Hospital, Perinthalmanna, Kerala, India
| | - Megha Nair
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
| | - Aparna Hegde
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
| | - P D Rekha
- Yenepoya Research Centre, Yenepoya University, Mangalore, Karnataka, India
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Swierz MJ, Storman D, Jasinska KW, Storman M, Staskiewicz W, Gorecka M, Skuza A, Tobola P, Bala MM. Systematic review and meta-analysis of perioperative behavioral lifestyle and nutritional interventions in bariatric surgery: a call for better research and reporting. Surg Obes Relat Dis 2020; 16:2088-2104. [PMID: 33036943 DOI: 10.1016/j.soard.2020.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
Bariatric surgery is considered the most effective treatment for people with morbid obesity, and certain interventions could enhance its long-term results. We searched MEDLINE, Embase, Web of Science, CENTRAL, and trial registers up to January 1, 2020. Randomized controlled trials, where behavioral lifestyle or nutritional interventions were provided perioperatively were included. Primary outcome was weight change. Two reviewers independently performed each stage of the review. Altogether 6652 references were screened. 31 studies were included for qualitative synthesis and 22 studies for quantitative synthesis. Interventions varied greatly, thus limiting possibility of synthesizing all results. Six groups of interventions were discerned, and we used standardized mean differences for synthesis. Low to very-low certainty evidence suggests that physical activity, nonvitamin nutritional interventions, vitamins, psychotherapy, and counseling but not combined interventions might bring some benefit regarding short-term postsurgery follow-ups (up to 12 mo), but the estimates varied and results were not statistically significant, except for 12 months follow-ups regarding counseling. Psychotherapy and counseling, but not vitamins and combined interventions, may provide some benefit at longer follow-ups (over 12 mo), but the certainty of evidence was low to very-low and statistically significant results were observed in comparisons including data from single studies with small sample sizes only. Included studies expressed an outcome "weight change" using 20 different measures. Misreporting of data and huge variety of outcomes do not benefit systematic analyses and may possibly lead to confusion of both researchers and readers. We suggest that authors follow a predefined set of outcomes when reporting the results of their studies. The initiative to produce "core outcome set" for clinical trials in bariatric surgery trials is currently underway.
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Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Tobola
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.
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Jaruvongvanich V, Vantanasiri K, Laoveeravat P, Matar RH, Vargas EJ, Maselli DB, Alkhatry M, Fayad L, Kumbhari V, Fittipaldi-Fernandez RJ, Hollenbach M, Watson RR, Gustavo de Quadros L, Galvao Neto M, Aepli P, Staudenmann D, Brunaldi VO, Storm AC, Martin JA, Gomez V, Abu Dayyeh BK. Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis. Gastrointest Endosc 2020; 92:1164-1175.e6. [PMID: 32692991 DOI: 10.1016/j.gie.2020.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe). METHODS A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss. RESULTS Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe. CONCLUSIONS This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.
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Affiliation(s)
| | - Kornpong Vantanasiri
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Reem H Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Maryam Alkhatry
- Division of Gastroenterology, IBHO hospital, Ras Al Khaimah, United Arab Emirates
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | | | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology - University of Leipzig Medical Center, Leipzig, Germany
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Patrick Aepli
- Gastroenterology and Hepatology Unit, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Perceived and Preferred Social Support in Patients Experiencing Weight Regain After Bariatric Surgery-a Qualitative Study. Obes Surg 2020; 31:1256-1264. [PMID: 33205368 PMCID: PMC7921025 DOI: 10.1007/s11695-020-05128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
Purpose While bariatric surgery generally shows successful weight loss outcomes in patients with obesity, weight regain exists. The aim of this qualitative study was to improve understanding of how patients with substantial weight regain after bariatric surgery experienced the support from family, friends, and healthcare providers, and what kind of support they had preferred. Materials and Methods Qualitative data were collected from semi-structured interviews with 16 participants. Mean weight regain from surgery to interview was 36%. The transcribed interviews were analyzed with thematic analysis. Results Two main themes and seven sub-themes were formulated. The theme, A lonely struggle, illustrates patients’ feelings of abandonment and struggle during weight regain due to lack of support or unfavorable treatment. Participants commonly blamed themselves for re-gaining weight, and shame made them reluctant to engage in social activities or seek medical care. The theme, Others as sources of compassion and control, covers what support they desired, as well as had perceived to be helpful. Exercising or eating healthy with others was appreciated and felt supportive. Pro-active healthcare support and access to dietitians, physiotherapists, and psychological support were desired. Conclusion To optimize the effect of bariatric surgery, support may need to be individualized and lifelong. Since shame and self-blame in patients with weight regain may hinder seeking professional help, care providers may need to initiate follow-up visits. Empathetic and non-judgmental support, access to multidisciplinary healthcare team, as well as peer-support groups may be beneficial to counteract weight regain post-bariatric surgery.
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Harrod CS, Elman MR, Vesco KK, Wolfe BM, Mitchell JE, Pories WJ, Pomp A, Boone-Heinonen J, Purnell JQ. Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study. Obesity (Silver Spring) 2020; 28:2209-2215. [PMID: 32918404 PMCID: PMC7650043 DOI: 10.1002/oby.22944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. RESULTS Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). CONCLUSIONS Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.
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Affiliation(s)
| | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Alfons Pomp
- Weill Cornell University Medical Center, New York, New York, USA
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43
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Hussan H, Patel A, Akinyeye S, Porter K, Ahnen D, Lieberman D. Bariatric Surgery Is Associated with a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults Below 50 Years of Age. Obes Surg 2020; 30:4867-4876. [PMID: 32789550 DOI: 10.1007/s11695-020-04902-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Colorectal cancer incidence is rising in adults < 50 years old, possibly due to obesity. Having bariatric surgery (BRS) should hypothetically reduce this trend, but data are limited. This study compared trends of colorectal cancer (CRC) versus other obesity-related gastrointestinal cancers (OGCs) between morbidly obese and post-BRS subjects. MATERIAL AND METHODS This retrospective cohort study investigated OGC resection trends using the 2006-2013 National Inpatient Sample. Patients with prior BRS and non-BRS controls with body mass index ≥ 40 kg/m2 were included (n = 30,279 total). We divided OGCs into CRC and non-CRC OGCs (esophageal, stomach, liver, gallbladder, and pancreas). We calculated OGC resection trends in patients < 50 and ≥ 50 years old using the average annual percent change (AAPC). RESULTS BRS patients with OGCs were younger (59.3 vs 62.3 years old), with more female gender (77.4% vs 57.1%) and White race (72.6% vs 67%) compared with controls (p < 0.05). The number of CRC resections increased across all ages in 2006-2013, especially rectal cancer for BRS patients (AAPC + 19.8%, p = 0.04). The steepest rise in early-onset CRC resections was after BRS versus a lesser increase in morbid obesity controls (AAPC + 18.7% and + 13.7%, respectively, p < 0.001). In contrast, non-CRC OGCs increased in our controls but not post-BRS. In a sensitivity analysis, estimated CRC incidence trends also increased post-BRS despite adjusting for increasing BRS prevalence. CONCLUSION Our findings suggest that bariatric surgery is associated with a persistent increase in early-onset CRC trends. Studies are warranted to validate our results and test the impact of bariatric surgery on early-onset CRC biological mechanisms.
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Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University, 395 W 12th Ave, Suite 250, Columbus, OH, 43210, USA. .,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Arsheya Patel
- Department of Internal Medicine, Ohio State University, Columbus, OH, USA
| | - Samuel Akinyeye
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University, 395 W 12th Ave, Suite 250, Columbus, OH, 43210, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dennis Ahnen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oregon Health and Science University, Portland, OR, USA
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Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2020; 30:542-553. [PMID: 32658120 DOI: 10.1097/sle.0000000000000834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the 5-year outcomes of comparing LVSG and LRYGB. We undertook a systematic review and meta-analysis to compare 5-year weight loss outcomes of randomized controlled trials comparing LVSG to LRYGB. MATERIALS AND METHODS Searches of electronic databases (PubMed, Embase, CINAHL, Cochrane) were undertaken for randomized controlled trials describing weight loss outcomes in adults at 5 years postoperatively. Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman estimation method for random effects model was utilized. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Five studies met the inclusion criteria totaling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies. Statistically significant body mass index loss ranged from -11.37 kg/m (range: -6.3 to -15.7 kg/m) in the LVSG group and -12.6 kg/m (range: -9.5 to -15.4 kg/m) for LRYGB at 5 years (P<0.001). Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess body mass index loss than LVSG: this was not corroborated in the meta-analysis. CONCLUSIONS Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at 5 years postoperatively, however, differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol analysis of the 2 largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.
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Amor IB, Petrucciani N, Kassir R, Malyshev E, Mazoyer C, Korkmaz C, Debs T, Gugenheim J. Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:2723-2728. [PMID: 32356094 DOI: 10.1007/s11695-020-04560-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Resizing of the gastric pouch, with eventually resizing of the gastrojejunal anastomosis, has been proposed as revisional procedure to treat weight regain after Roux-en-Y gastric bypass (RYGB), in patients with large gastric pouch and/or large gastrojejunal (GJ) anastomosis. The aim of this study is to determine the midterm results and the safety of laparoscopic resizing of the gastric pouch after RYGB in cases where gastric pouch is > 200 ml and/or GJ anastomosis > 20 mm. MATERIALS AND METHODS All patients who underwent gastric pouch resizing between January 2009 and December 2016 were retrospectively reviewed from a prospective database. The gastric pouch was resized to a volume of 30-40 ml. RESULTS A total of 48 patients had gastric pouch resizing after RYGB. The mean initial BMI was 42.9 ± 4.8 kg/m2. Perioperative morbidity was 8.3% in this series. Mean follow-up was 5.4 years. The mean BMI was 30.0 ± 7.3 kg/m2 at 1 year, 30.0 ± 6.0 kg/m2 at 3 years, and 30.9 ± 5.7 kg/m2 at 5 years. Mean %EBMIL at 1-, 3-, and 5-year follow-up was 51.9%, 55.1%, and 39%, respectively, in 48% follow-up rate. The obesity-related comorbidities disappeared in 67.3% of cases at maximum follow-up. CONCLUSIONS In carefully selected patients with gastric pouch size > 200 ml and/or GJ anastomosis > 20 mm, and after extensive preoperative evaluation, gastric pouch resizing is a potentially effective option to treat weight regain due to anatomical factors after RYGB, with complication rate of 8%.
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Affiliation(s)
- Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Niccolo Petrucciani
- Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, via di Grottarossa 1035-9, 00139, Rome, Italy.
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France
| | - Eugene Malyshev
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Clementine Mazoyer
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Carine Korkmaz
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Archet 2 Hospital, University Hospital of Nice, Nice, France
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Romeijn MM, Leclercq WKG, Luijten AAPM, Janssen L, van Dielen FMH. Banded Roux-en-Y gastric bypass in patients with super morbid obesity (BRandY-study): protocol of a cohort study with 10 year follow-up. BMC Surg 2020; 20:122. [PMID: 32503510 PMCID: PMC7275500 DOI: 10.1186/s12893-020-00784-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background Weight loss outcomes after bariatric surgery are less favorable in super morbidly obese patients (BMI ≥50 kg/m2). Non-response, either defined as insufficient weight loss or weight regain after initial successful weight loss, is a matter of serious concern in these patients. The primary banded Roux-en-Y gastric bypass has shown promising results regarding weight loss in the bariatric population. However, up to now, long-term comparative data about the banded and non-banded bypass in superobese patients is lacking. The aim of this study is to assess the added value of the banded Roux-en-Y gastric bypass in superobese patients on long-term weight loss outcomes. Methods This single center study will evaluate superobese patients who receive a non-banded Roux-en-Y gastric bypass (NB-RYGB) and a banded Roux-en-Y gastric bypass (B-RYGB). Data from the NB-RYGB group will be collected in retrospect, while data from the B-RYGB group will be collected prospectively. When performing a B-RYGB, a 7.0–8.0 cm silastic ring (MiniMizer®) will be placed proximal to the gastrojejunostomy. The main outcomes of this study are weight loss and non-response during a 10 year follow-up period. Secondary outcomes are reduction of obesity related comorbidities and medication, (ring-related) morbidity and mortality, complications, re-operations, patient satisfaction and health-related quality of life. A total of 142 patients will be included in this study. Discussion This study will help establish the clinical utility of the B-RYGB in superobese patients. Trial register NL8093. Registered 15 October 2019 - Retrospectively registered on the Dutch Registry of Clinical trials, www.trialregister.nl
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Affiliation(s)
- M M Romeijn
- Obesity Center Máxima, Máxima Medical Center, Department of Surgery, Eindhoven/Veldhoven, the Netherlands.
| | - W K G Leclercq
- Obesity Center Máxima, Máxima Medical Center, Department of Surgery, Eindhoven/Veldhoven, the Netherlands
| | - A A P M Luijten
- Obesity Center Máxima, Máxima Medical Center, Department of Surgery, Eindhoven/Veldhoven, the Netherlands
| | - L Janssen
- Obesity Center Máxima, Máxima Medical Center, Department of Surgery, Eindhoven/Veldhoven, the Netherlands
| | - F M H van Dielen
- Obesity Center Máxima, Máxima Medical Center, Department of Surgery, Eindhoven/Veldhoven, the Netherlands
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Vieira APP, Santa Cruz F, Machado Júnior AS, Ferraz ÁAB, Kreimer F. Evaluation of the Quality of Life in Women of Reproductive Age After Bariatric Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | | | | | | | - Flávio Kreimer
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
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48
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Faul A, Chevallier JM, Poghosyan T. Dilated Gastric Pouch Resizing for Weight Loss Failure After One Anastomosis Gastric Bypass. Obes Surg 2020; 29:3406-3409. [PMID: 31115846 DOI: 10.1007/s11695-019-03972-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Some patients may experience inadequate weight loss or weight regain due to gastric pouch dilation after one anastomosis gastric bypass (OAGB). Dilated gastric pouch resizing (GPR) associated with correction of eating behavior was suggested as an option in the management of these patients. Retrospective analysis of 17 consecutives patients who underwent a GPR between 2007 and 2017 was undertaken. At revision, the mean body mass index (BMI) and percentage of total weight loss (%TWL) were 41.5 ± 11 kg/m2 and 15 ± 10, respectively. Overall morbidity rate was 6.7% (n = 1). Two years after revision, the mean BMI and %TWL were 34.1 ± 5 kg/m2 and 31 ± 13, respectively. GPR appeared to be a satisfactory option resulting in mid-term secondary weight loss in well selected patients at the expense of non-negligible morbidity rate.
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Affiliation(s)
- Adrien Faul
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France
| | - Jean-Marc Chevallier
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France
| | - Tigran Poghosyan
- Department of Digestive, Oncologic and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France.
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49
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Di Lorenzo N, Camperchioli I, Scozzarro A, Grossi C, Altorio F, Caputo A, Gottwald T, Schurr MO. Bariatric reduction system - BARS: device, technique and first clinical experience. MINIM INVASIV THER 2020; 30:187-194. [PMID: 32100601 DOI: 10.1080/13645706.2020.1729206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Roux-en-Y gastric by-pass (RYGB) is one of the most effective bariatric procedures, but the rate of weight regain (WR) can reach 63% after the second year. Enlargement of the gastrojejunal anastomosis is one of the reported causes. A newly CE-marked flexible endoscopic system, Bariatric Anastomotic Reduction System (BARS) (Ovesco Endoscopy, Tuebingen, Germany), derivative of the well-established endoscopic over-the-scope-clip (OTSC) clipping system, has been recently developed. It was tested in pre-clinical and preliminary clinical use for feasibility and effectiveness in bariatric anastomotic reduction. MATERIAL AND METHODS Using a single-channel endoscope with external supplemental working channel, the BARS device captures the two limbs of the anastomosis, reducing its size, thus slowing food passage. After preclinical assessment, six patients with at least a 15% WR and the presence of an enlarged gastrojejunostomy > 20 mm were enrolled. The mean patient age was 49 years (range 24-67). Average interval between gastric bypass and BARS procedure: 8 years (4-13). RESULTS All procedures were safely performed without complications. Mean procedure time: 52 min (37 - 75). Preliminary results: mean weight loss 6 kg (4-9) at a 3-month FU. CONCLUSIONS BARS could be a promising endoscopic system in case of WR after gastric bypass due to enlargement of the anastomosis.
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Affiliation(s)
- Nicola Di Lorenzo
- PhD program on Applied Medico-Surgical Sciences, Department of General Surgery, University of Tor Vergata, Rome, Italy.,Fondazione Salus, Avezzano, Italy
| | - Ida Camperchioli
- PhD program on Applied Medico-Surgical Sciences, Department of General Surgery, University of Tor Vergata, Rome, Italy
| | - Agostino Scozzarro
- PhD program on Applied Medico-Surgical Sciences, Department of General Surgery, University of Tor Vergata, Rome, Italy
| | - Cristina Grossi
- PhD program on Applied Medico-Surgical Sciences, Department of General Surgery, University of Tor Vergata, Rome, Italy
| | | | | | | | - Marc Oliver Schurr
- Ovesco Endoscopy AG, Tuebingen, Germany.,IHCI-Institute, Steinbeis University Berlin, Tuebingen, Germany
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50
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Fouladi F, Brooks AE, Fodor AA, Carroll IM, Bulik-Sullivan EC, Tsilimigras MCB, Sioda M, Steffen KJ. The Role of the Gut Microbiota in Sustained Weight Loss Following Roux-en-Y Gastric Bypass Surgery. Obes Surg 2020; 29:1259-1267. [PMID: 30604078 DOI: 10.1007/s11695-018-03653-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to investigate the role of the gut microbiota in weight regain or suboptimal weight loss following Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS The gut microbiota composition in post-RYGB patients who experienced successful weight loss (SWL, n = 6), post-RYGB patients who experienced poor weight loss (PWL, n = 6), and non-surgical controls (NSC, n = 6) who were age- and BMI-matched to the SWL group (NSC, n = 6) were characterized through 16S rRNA gene sequencing. To further investigate the impact of the gut microbiota on weight profile, human fecal samples were transplanted into antibiotic-treated mice. RESULTS Orders of Micrococcales and Lactobacillales were enriched in SWL and PWL groups compared to the NSC group. No significant difference was observed in the gut microbiota composition between PWL and SWL patients. However, transfer of the gut microbiota from human patients into antibiotic-treated mice resulted in significantly greater weight gain in PWL recipient mice compared to SWL recipient mice. A few genera that were effectively transferred from humans to mice were associated with weight gain in mice. Among them, Barnesiella was significantly higher in PWL recipient mice compared to SWL and NSC recipient mice. CONCLUSION These results indicate that the gut microbiota are at least functionally, if not compositionally, different between PWL and SWL patients. Some taxa may contribute to weight gain after surgery. Future studies will need to determine the molecular mechanisms behind the effects of the gut bacteria on weight regain after RYGB.
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Affiliation(s)
- Farnaz Fouladi
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte, NC, 28223, USA.
| | - Amanda E Brooks
- Department of Pharmaceutical Sciences, North Dakota State University, 1401 Albrecht Blvd, Fargo, ND, 58102, USA
| | - Anthony A Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte, NC, 28223, USA
| | - Ian M Carroll
- Department of Nutrition, School of Medicine, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - Emily C Bulik-Sullivan
- Department of Nutrition, School of Medicine, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Matthew C B Tsilimigras
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte, NC, 28223, USA
| | - Michael Sioda
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9331 Robert D. Snyder Road, Charlotte, NC, 28223, USA
| | - Kristine J Steffen
- Department of Pharmaceutical Sciences, North Dakota State University, 1401 Albrecht Blvd, Fargo, ND, 58102, USA
- Center for Biobehavioral Research/Sanford Research, 120 8th St. S., Fargo, ND, 58103, USA
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