[Predictive factors of complications in abdominal sequelae surgery of weight loss, after bariatric surgery in non-smokers]. / Facteurs prédictifs des complications de la chirurgie des séquelles abdominales d'amaigrissement, après chirurgie bariatrique chez les non-fumeurs.

The goal of this work was to find the main predictive factors of postoperative complications, other than smoking, after abdominoplasty or bodylift concerning sequelae of post-bariatric weight loss. PATIENTS AND METHOD: A retrospective monocentric study, including abdominoplasties or bodylift, after bariatric surgery was carried out between 01/01/2016 and 12/31/2019. The following were excluded: active smokers, non-bariatric patients and/or patients who had already had an abdominoplasty or body lift and/or who had undergone combined surgery. RESULTS: 105 patients were included (73 bodylifts, 32 abdominoplasties). 68% presented at least one complication. The majority of them only resulted in an extension of local care. The serious complication rate was 2.9%. The risk factors for complications were: a young subject (P=0.014), greater weight loss (P=0.03), longer delay between bariatric surgery and plastic surgery (P=0.0002), performing a bodylift versus an abdominoplasty (P<0.01), gastric banding (P=0.029). Conversely, the bypass appeared to be a factor limiting post-sequelae complications of weight loss (P=0.041). The predictive complication model from the multivariate study concludes that the type of plastic surgery and preoperative BMI play a major role in the risk of complications. CONCLUSION: Surgery for abdominal weight loss sequelae presents frequent but generally benign complications. Preoperative patient information must therefore be adapted according to initial obesity and the extent of weight loss.

[Treatment of pseudogynecomastia in massive weight loss patients: Liposuction assisted and made-to-measure desepidermization technique]. / Prise en charge chirurgicale de la pseudogynécomastie après perte de poids massive : technique de désépidermisation sur mesure assistée par lipoaspiration.

BACKGROUND: After massive weight loss (MWL), the chest in men may show significant deformities. The surgical treatment of gynecomastia after MWL remains a difficult and partially misunderstood surgery due to 4 main factors: a complex excess of skin in height and width that sometimes continues in the axilla or dorsal region, a predominantly fatty rather than glandular component, the malposition of the nipple-areola complex (NAC) that is often enlarged and an inframammary fold (IMF) that is often marked. The techniques currently described are either insufficient or lead to frequent and/or significant complications. The authors describe a new approach that dissociates the treatment of the volume and the skin with a customized resection that is simple, reproducible and safe. Our goal is to improve patient satisfaction while reducing complication rates. METHODS: Seventeen patients with adipomastia with excess skin after massive weight loss were operated on using liposuction and skin redraping technique. The authors describe the technique, indications and contraindications of the procedure and analyze the results. RESULTS: The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7kg/m2, the average weight loss before body correction is 49kg, with an average delta of BMI loss of 15,34kg/m2. The average stay in hospital is 1,3 nights. No patient had major complications (hematoma, hemorrhage, necrosis, thrombophlebitis, immediate surgical revision to treat complications). Minor complications including scar dehiscence, infection, steatonecrosis, and distant scar correction were reported in 2 patients, i.e. 11%. CONCLUSION: Liposuction assisted and desepidermization torsoplasty is a new technique for correction of pseudogynecomastia in MWL patients. The results are reproductible and the complication rates are low. There is no dead space and therefore no drains are needed. There is little pain and a short hospital stay. This technique is simple, quick and easy to learn. However, it is only applicable in adipomastia. A different technique should be used in the presence of firm glandular tissue.

Anal incontinence incidence is high in patients with obesity prior to bariatric surgery: Prevalence, risks-factors.

INTRODUCTION: Anal incontinence (AI) prevalence in general population is estimate to range from 1.4 to 19.5% (Wexner ≥ 1). Obesity could be an AI risk factor. However, AI prevalence in patients with obesity is not clearly established. The main objective of this study was to assess the prevalence of AI in patients with extreme obesity prior to bariatric surgery and to identify specific AI risk factors in this subset of patients. MATERIAL: A cross-sectional study, in a tertiary referral center in obesity was performed during one year. Patients who presented criteria for bariatric surgery (BMI>40 or BMI > 35 with co-morbidities) were asked to fill in preoperative self-questionnaires. A Wexner score ≥ 3 was used to define AI to identified patients who had a clinic impact of AI, by frequency of symptoms or alteration of quality of life. RESULTS: Two hundred and fifty patients were included. Corresponded to, 196 women (78.4%) and 54 men (21.6%). Median BMI was 44.53kg/m2. AI was diagnosed in 41 patients (prevalence 16.4%, 95CI 0.59). Constipation, urinary incontinence and the history of pregnancy (P = 0.03, OR 2.79; P = 0.01, OR 3.53 and P=0.02, OR 4.71, respectively) were significantly associated with AI. CONCLUSION: AI is frequently observed in patients with extreme obesity scheduled for bariatric surgery and should be routinely evaluated. Modifiable risk factors as constipation should be manage before surgery as well as the specific management of AI, to prevent AI exacerbation after surgery. The choice of bariatric surgical procedure should be discussed and evaluated for the treatment of patients with obesity and AI. LEVEL OF EVIDENCE: Moderate.

[Surgical components in the management of severe obesity]. / Les composantes chirurgicales dans la prise en charge de l'obésité sévère.

Bariatric surgery, combined with nutritional and psychological care and physical activity, is currently the most effective treatment for morbid obesity. The multidisciplinary team at the Caen Normandy obesity center explains the prerequisites of this therapeutic approach, and the monitoring and vigilance to be developed in partnership with the patient.

[Concomitant breast surgery with a vertical latero-thoracic incision in continuity with a brachioplasty incision: About twelve (12) cases after massive weight loss]. / Plastie brachio-thoraco-mammaire : à propos de 12 cas après amaigrissement massif.

INTRODUCTION: The need of iterative surgeries, the proximity of two anatomical areas, the combination of an aesthetic surgery with a surgery covered by health insurance are the reasons which motivated the authors to provide a simultaneous procedure on arms and breast in patients achieving massive weight loss. We propose a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision to treat the excess skin and subcutaneous tissue of the lateral chest wall, either by resection, or by increasing the breast with the patients own autologous tissue. METHODS: Between 2010 and 2017, twelve patients aged between 31 and 56 years, with 42 being the average, have undergone a technique that utilises a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision: transverse skin incisions and free nipple transplantation for correction of extreme gynaecomastia (2 cases), mastopexy with resection of the excess tissue of the lateral chest wall (8 cases), autologous breast augmentation by the use of intercostal artery perforator flaps (2 cases). Mean body mass index (BMI) was 24kg/m2 [23; 32] after average weight loss of 56kg [14; 112] following diet (3 cases) or bariatric surgery (9 cases). RESULTS: Mean operative time was 4hours [3: 6], mean length of hospital stay was 4 days [2; 9]. We observed one major complication (hematoma) and one minor complication (wound dehiscence). At a mean follow-up of 21 months (ranged from 15 days to 84 months), the lateral flank scarring was well tolerated, with the additional benefit of reducing flank fullness. CONCLUSION: The extended lateral flank scar allows reducing the excess skin and subcutaneous tissue of the lateral chest wall, while being easily concealable. This technique offers an elegant solution to this excess that used to persist after multistage surgeries.

Directive clinique No 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum.

OBJECTIF: La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum. UTILISATEURS CONCERNéS: Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières, anesthésiologistes) qui prodiguent des soins relatifs à la grossesse auprès de femmes atteintes d'obésité. POPULATION CIBLE: Femmes atteintes d'obésité qui sont enceintes ou prévoient le devenir. DONNéES PROBANTES: Des recherches ont été menées en consultant les ressources de Statistique Canada, de Medline et de Cochrane Library en vue d'en tirer la littérature relativement aux effets de l'obésité durant la grossesse sur les soins prénataux et intrapartum, la morbidité et la mortalité maternelles, l'anesthésie obstétricale ainsi que sur la morbidité et la mortalité périnatales. Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mises à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2018. Nous avons également tenu compte de la littérature grise (non publiée) obtenue sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes pertinents, dans des collections de directives cliniques et des registres d'essais cliniques, et auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs. Les membres du comité de médecine fœto-maternelle ont ensuite passé en revue le contenu et formulé des commentaires aux fins d'examen. Enfin, le conseil d'administration de la Société des obstétriciens et gynécologues du Canada (SOGC) a approuvé la publication de la version définitive de la directive. Les points de désaccord ont été abordés lors de réunions pour enfin arriver à un consensus. La qualité des données et des recommandations a été déterminée à l'aide des critères d'évaluation décrits par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: La mise en place des recommandations des présentes directives peut améliorer la reconnaissance des fournisseurs de soins obstétricaux relativement aux problèmes qui touchent les personnes enceintes atteintes d'obésité, notamment au moyen de stratégies de prévention clinique; de la communication entre l'équipe de soins de santé, la patiente et la famille; et de la planification de l'équipement et des ressources humaines. Il est à espérer que les organismes régionaux, provinciaux et fédéraux participeront à la formation et au soutien en matière de soins coordonnés pour les personnes enceintes atteintes d'obésité. MISE à JOUR DE LA DIRECTIVE CLINIQUE: Les directives de la SOGC sont automatiquement passées en revue 5 ans après leur publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de 5 ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière. PROMOTEURS: La présente directive a été élaborée à l'aide de ressources financées par la SOGC. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.

[Algorithms based on medico-administrative data in the field of endocrine, nutritional and metabolic diseases, especially diabetes]. / Algorithmes basés sur les données médico-administratives dans le champ des maladies endocriniennes, nutritionnelles et métaboliques, et en particulier du diabète.

BACKGROUND: Medico-administrative databases represent a very interesting source of information in the field of endocrine, nutritional and metabolic diseases. The objective of this article is to describe the early works of the Redsiam working group in this field. METHODS: Algorithms developed in France in the field of diabetes, the treatment of dyslipidemia, precocious puberty, and bariatric surgery based on the National Inter-schema Information System on Health Insurance (SNIIRAM) data were identified and described. RESULTS: Three algorithms for identifying people with diabetes are available in France. These algorithms are based either on full insurance coverage for diabetes or on claims of diabetes treatments, or on the combination of these two methods associated with hospitalizations related to diabetes. Each of these algorithms has a different purpose, and the choice should depend on the goal of the study. Algorithms for identifying people treated for dyslipidemia or precocious puberty or who underwent bariatric surgery are also available. CONCLUSION: Early work from the Redsiam working group in the field of endocrine, nutritional and metabolic diseases produced an inventory of existing algorithms in France, linked with their goals, together with a presentation of their limitations and advantages, providing useful information for the scientific community. This work will continue with discussions about algorithms on the incidence of diabetes in children, thyroidectomy for thyroid nodules, hypothyroidism, hypoparathyroidism, and amyloidosis.

Morbidity in combined-procedure associating abdominoplasty and breast surgery: A systematic review.

OBJECTIVES: Combined aesthetic procedures are an increasing procedure and demands of the patients. The authors have assembled concrete arguments detailing the risks of combined-surgery associating abdominoplasty and mammoplasty relative to abdominoplasty alone. The purpose of this study was to compare abdominoplasty alone versus abdominoplasty combined with breast surgery in terms of short-term complications, in support of surgical choices. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have realized a systematic review of the literature from 1969 to April 2015 in English and French languages by searching in MEDLINE®, PubMed central, Embase and Cochrane Library databases. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Statistical analysis of the results was carried out through association parameters including statistical tests and Odds ratios were calculated for each complication when data was available. RESULTS: We included 32 observational studies that met the inclusion criteria but only four with usable data. We highlighted a combined Odds ratio of respectively 5.35 and 14.71 for major complications in these studies for combined-surgery compared with abdominoplasty alone. CONCLUSIONS: The results of this systematic review appears in favor of an increase in major complications related to abdominoplasty combined with breast surgery compared to abdominoplasty alone but the level of evidence of included studies is low or moderate. Prospective cohort comparative studies are necessary to provide strong evidence. However, we recommend to avoid this procedure in massive weight loss patients or patients with thromboembolism history.

[Adult kwashiorkor: a rare complication of bariatric surgery]. / Kwashiorkor chez l'adulte : une complication rare de la chirurgie bariatrique.

INTRODUCTION: Kwashiorkor is a clinical manifestation of global protein-calorie malnutrition that is described mainly in children in developing countries initially presenting eczema-like skin disease associated with hydrops. OBSERVATION: We report the case of a 44-year-old woman with dark skin who had undergone bariatric surgery for treatment of stage-III obesity without regular monitoring and who was hospitalized in our dermatology department four years later. She had diffuse oedema and asteatotic eczema-like cutaneous lesions on pigmented skin that had developed for two months despite daily application of topical corticosteroids. Clinical signs, the collapse of serum albumin and histopathological analysis of skin tissue were evocative of kwashiorkor. Her symptoms subsided after several weeks of a nutritional programme. DISCUSSION: Kwashiorkor is a clinical entity described chiefly in children in developing countries. Cutaneous involvement comprising asteatotic eczema-like skin associated with diffuse oedema is prominent. Treatment with protein supplementation alone is effective and avoids many complications such as infections and haemodynamic disorders. Obesity is a serious and common disease in Western countries affecting one third of the world's population, and for which treatment with bariatric surgery may be indicated. Without regular monitoring, this surgery can cause severe protein deficiency. Consequently, in the future there will seemingly be a greater likelihood of kwashiorkor in adults as an iatrogenic complication of obesity treatment. Its semiology needs to be underlined because of the simplicity and efficacy of treatment.

[Bariatric surgery and patient therapeutic education]. / Chirurgie bariatrique et éducation thérapeutique du patient.

Weight loss surgery or "bariatric surgery", used in cases of severe obesity, is a complex procedure aiming to reduce food intake. An increasingly accessible technique, it requires a long postoperative follow-up and a change in eating habits. Patient therapeutic education encourages the patient to become a player in their care.

[Bariatric surgery and drugs: Review of the literature and Adverse Drug Reactions analysis in French National Pharmacovigilance Database]. / Chirurgie bariatrique et médicaments : revue de la littérature et analyse des effets indésirables dans la banque nationale de pharmacovigilance.

INTRODUCTION: Bariatric surgery is the only treatment for severe obesity (BMI>35kg/m2) currently recognized as effective both in achieving tangible and lasting weight loss, and in improving obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular complications. Bariatric surgery, like any other surgery of the digestive tract, can have an impact on nutrient absorption, as well as on drug absorption. The literature on drug management in bariatric surgery patients concerned mainly of case reports and retrospective studies involving a small number of patients. No official guidelines are available. METHODS: We conducted a literature search on the consequences of bariatric surgery in terms of drug bioavailability and/or effect. The Medline® (PubMed) database was searched using the following keywords: "bariatric surgery", "bioavailability", "gastric bypass", and "obesity". We completed this review with an analysis of reports of adverse drug reactions (ADRs) in post-bariatric surgery patients for obesity registered in the National pharmacovigilance database (PVDB). We selected all cases with the mention of "bariatric surgery and/or gastrectomy" as "medical history". After reading the cases, we excluded those in which the patient had undergone surgery for an indication other than obesity, where the route of administration was other than oral, and cases in which ADRs resulted from voluntary overdose, attempted suicide, allergy, switch to Levothyrox® new formulation, meningioma under progestative drugs, inefficacy related to generic substitution and medication error. RESULTS: The literature search identified mainly "case report" about the impact of bariatric surgery on so-called "narrow therapeutic window" drugs. We identified 66 informative cases out of a total of 565 cases selected (11%) in the PVDB. Nevertheless, the information does not allow a clear relationship between the occurrence of the ADR and the influence of bariatric surgery. CONCLUSION: There is a lack of official information and/or recommendations on medication use in subjects who have undergone bariatric surgery. Apart from under-reporting, ADRs reports remain largely uninformative. Health professional and patients would be awareness for improving, quantitatively and qualitatively the reporting of ADRs in this population.

Bariatric Surgery and Metabolic Dysfunction-Associated Fatty Liver Disease: a 2022 Update.

Non-alcoholic fatty liver disease (NAFLD) has been recently termed metabolic dysfunction-associated fatty liver disease (MAFLD) to address the strong association with the metabolic syndrome. The prevalence of MAFLD is significantly increased in obese individuals and treatment of obesity is currently the cornerstone of management of MAFLD. Bariatric and metabolic surgery nowadays emerges as a key therapeutic strategy for the treatment of the MAFLD. This review aims to provide an update on the novel studies reporting the outcomes of bariatric surgery on the spectrum of MAFLD, from hepatic steatosis to cirrhosis.

Gaps in Referral to Bariatric Surgery for Patients With Type 2 Diabetes Seen in Endocrinology Clinics.

OBJECTIVES: One-third of adults in Canada are overweight and 26.8% experience obesity. Bariatric surgery confers effective weight loss and reduces obesity-related complications, including type 2 diabetes, but remains an underutilized treatment. Our objective in this study was to determine whether a gap exists in bariatric program referrals for patients with type 2 diabetes seen in endocrinology clinics at an ambulatory tertiary care hospital in Toronto, Canada. METHODS: A retrospective chart review was conducted of 843 consecutive patients with type 2 diabetes in endocrinology clinics between January 1, 2015 and December 31, 2020. Inclusion criteria were age ≥18 years, type 2 diabetes and body mass index (BMI)>35 kg/m2. Exclusion criteria were recent active cancer, uncontrolled psychiatric disease or active substance use disorder within 6 months of the initial visit. Referrals to bariatric surgery were assessed within a 5-year follow-up period and compared with baseline referral rates from the Ontario Bariatric Network (OBN). An online survey of 48 endocrinologists in Toronto, Ontario, was also conducted to assess physician-level barriers to referral. RESULTS: The proportion of patients with class II obesity (BMI>35 kg/m2) and type 2 diabetes meeting the eligibility criteria for bariatric referral was 4.6% (n=38). A documented discussion about bariatric surgery occurred with 7 (18.0%) of these eligible patients, and 1 patient (2.6%) was referred for surgery. Aside from surgical referrals, only 2.6% of eligible patients were referred to cognitive-behavioural therapy, 36.8% were initiated on obesity pharmacotherapy and 42.1% were referred to a dietitian. Baseline OBN data demonstrated that most surgical referrals (n=6,360) were from family physicians (65.0%) and only 8.8% were from a medical specialist. Eight percent of surveyed endocrinologists reported that they discussed bariatric surgery with at least half of their eligible patients. The most frequent barrier to discussing bariatric surgery during visits was time constraints. Physicians identified that simplifying the referral process and providing bariatric surgery handouts would be helpful interventions to improve referral rates. CONCLUSIONS: Our gap analysis demonstrated a low bariatric surgery referral rate by tertiary care endocrinologists. Our study also identified a large gap in the appropriate treatment of obesity with poor utilization of behavioural, lifestyle and pharmacotherapy practices. As obesity and diabetes rates increase, better education, training and knowledge translation will be necessary to overcome weight bias and prioritize obesity management.

[Bariatric Surgery in 2022 - What Is Important for the General Practitioner?] / Bariatrische Chirurgie 2022 ­ was ist relevant für die Praxis?

Bariatric Surgery in 2022 - What Is Important for the General Practitioner? Abstract. Bariatric surgery is the most efficient treatment for obesity and associated diseases. Basic knowledge about the indications, common procedures, follow-up and possible complications has become essential for primary care practice. This article explains the current standards of care in Switzerland with a focus on relevant information for the practice: nutritional aspects after bariatric surgery, necessary clinical and laboratory examinations, early detection of complications. Only intense interdisciplinary and interprofessional collaboration leads to a treatment success in morbid obesity.

[Fatal nutrient deficiencies after gastric bypass]. / Syndrome multicarentiel catastrophique post bypass gastrique.

INTRODUCTION: Bariatric surgery is a very effective treatment for obesity. After gastric bypass, micronutrient deficiencies frequently occur which can have dramatic consequences. CASE REPORT: We report the case of a 55-year-old woman who was admitted for psychomotor retardation, bilateral leg pitting edema and psoriasis-like rash that had been ongoing for 3 months. Pancytopenia, encephalopathy and heart failure rapidly occurred leading to multiorgan dysfunction syndrome and death. We retrospectively identified severe selenium deficiency with possible secondary cardiomyopathy, niacin deficiency resulting in pellagrous encephalopathy with skin lesions and gelatinous transformation of bone marrow. CONCLUSION: Micronutrient deficiency should systematically be assessed when new symptoms occur in a patient with a history of bariatric surgery. Selenium deficiency should be considered in the presence of any heart failure in this context.

[Sleep characteristics of a population of patients seeking bariatric surgery]. / Caractéristiques du sommeil dans une population de patients candidats à une chirurgie bariatrique.

INTRODUCTION: Investigation for obstructive sleep apnea syndrome (OSAS) is mandatory before bariatric surgery. Data regarding chronic insomnia and chronic sleep deprivation are scarce in this population. METHODS: A cross-sectional study assessing the prevalence of chronic insomnia, OSAS and chronic sleep privation in an obese population referred for bariatric surgery. RESULTS: In all, 88 patients (74% women, median age 41 [33.5-50] years and median body mass index 42 [39.2-45.7] kg/m2) were included. The prevalence of chronic insomnia was 31% in the 87% suffering from OSAS that required continuous positive airway pressure therapy. Comorbid insomnia and sleep apnoea (COMISA) were found in 27% of our population. Chronic insomnia was associated with a lower quality of life (median EQ5D analogue visual scale: 60 [50-70] P=0.04) and a poor sleep quality (median Pittsburgh sleep quality index (PSQI): 8 (6-11 P<0.01) The deleterious combination of sleep privation and insomnia had a higher impact in terms of impairment of quality of life and sleep quality (median EQ5D analogue visual scale: 50 [40-65] P=0.02 et median PSQI: 11 [9-14, P<0.01) CONCLUSION: Chronic insomnia and sleep privation have synergistic deleterious effects in candidates for bariatric surgery. Further studies need to be conducted to evaluate the evolution after surgery.

[Which management of pregnancy after bariatric surgery?] / Quelle prise en charge de la grossesse après une chirurgie bariatrique ?

Obesity represents a major public health issue and a potential threat for people health. Moreover, the incidence of obesity has been increasing and therefore, the incidence of women with an history of bariatric surgery with a pregnancy desire has been also increased. Although the weight loss after bariatric surgery has positive effects on pregnancy outcomes, these surgical procedures may be associated with adverse outcomes as well, for example micronutrient deficiencies, dumping syndrome, surgical complications such as internal hernias, and obstetrical complications such as small for gestational age as instance. Nevertheless, physician knowledge about pregnancy management after bariatric surgery is currently insufficient and a multidisciplinary approach is therefore mandatory. The aim of this article is to provide to readers general and recent data regarding the management of pregnancy after bariatric surgery.

Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study.

BACKGROUND: Arterial stiffness (AS) is an independent predictor of cardiovascular risk, and could be used as a surrogate marker of improvement in cardiovascular risk following bariatric surgery. The aim of this study was to compare AS before and after surgery. METHODS: One hundred and thirty-four patients undergoing bariatric surgery between May 2016 and January 2019 were prospectively included. AS was measured on pulse wave velocity (PWV) with the pOpmètre® device pre- and postoperatively. The main endpoint was change in PWV between baseline and 3 months post-surgery. RESULTS: Overall, mean PWV was 6.87m/s preoperatively and 6.71m/s at 3 months (P=0.7148). Patients with pathologic PWV (>2 standard deviations from expected value for age) showed significant improvement at 3 months (31 patients; 10.1m/s preoperatively vs 7.5m/s at 3 months; P=0.007). These results did not correlate with improvement in other clinical or biological parameters following surgery (excess weight loss, mean blood pressure, fasting blood glucose, waist circumference, body composition). CONCLUSION: These results suggest that pathological arterial stiffness may resolve following bariatric surgery independently of the other factors influencing cardiovascular risk in obesity.

Psychosocial Predictors of Response to Telephone-Based Cognitive Behavioural Therapy in Bariatric Surgery Patients.

OBJECTIVE: Bariatric surgery is an empirically supported treatment for severe obesity; however, it does not directly target underlying behavioural and psychological factors that potentially contribute to obesity. Mounting evidence supports the efficacy of cognitive behavioural therapy (CBT) for improving eating psychopathology and psychological distress among bariatric patients, and telephone-based CBT (Tele-CBT) is a novel delivery method that increases treatment accessibility. METHODS: This study aimed to identify demographic and clinical predictors of response to Tele-CBT among 79 patients who received Tele-CBT in 3 previous studies. Listwise deletion was applied, after which 58 patients were included in a multivariate linear regression adjusted for age, sex and education status, to evaluate patient rurality index (urban or nonurban), and baseline binge eating, emotional eating and depression symptoms, as predictors of tele-CBT response. RESULTS: The predictors explained 31% of the observed variance [R2=0.312, F(4,57)=3.238, p<0.01]. Patient rurality index (beta=0.341, p<0.01) was the only statistically significant predictor of Tele-CBT response. CONCLUSIONS: Given the limited psychosocial resources available in many bariatric surgery programs, the findings suggest that Tele-CBT may be particularly beneficial for patients residing in nonurban communities with limited access to other health-care services.