Long-term quality of life in patients with bariatric surgery evaluated with BAROS.

Quality of life (QoL) significantly improves in the short term after bariatric surgery (BS). However, evidence on the long-term QoL of patients with BS is limited. AIM: To analyze the long-term QoL of patients who underwent Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: We evaluated 257 patients from three private clinics in Santiago, Chile, with ~10-y since surgery. The Bariatric Analysis and Reporting Outcome System (BAROS) was used. RESULTS: Median values for the BAROS score indicated good results of treatment:4.3 (2.3-6.0) and 4.1 (2.1-6.4) for RYGB and SG patients, respectively. The Moorehead-Ardelt Quality of Life (MAQoL) score was higher in patients with SG compared to RYGB (1.5 vs. 1.3, p = 0.047). A moderate, positive, and significant correlation was observed between the percentage excess weight loss and MAQoL score (rho= 0.48, p<0.001). CONCLUSIONS: Patients undergoing BS showed a good QoL even in the long term (~10 y).

Mental health and weight regain after bariatric surgery: associations between weight regain and psychiatric and eating-related comorbidities.

Objective: Weight regain is a common outcome of weight loss interventions. Mental health-related comorbidities, among other factors, can mediate weight regain regardless of the implemented treatment modality. This study explores whether postoperative psychopathological comorbidities are associated with weight regain after bariatric surgery. Subjects and methods: This cross-sectional study recruited 90 outpatients who underwent Roux-en-Y gastric bypass surgery. Anthropometric measurements were collected retrospectively from medical charts. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) Axis I Disorders (SCID-I) was applied to evaluate psychiatry diagnoses. Validated self-report instruments were used to assess depression, anxiety, alcohol use, impulsivity, binge eating, and body image dissatisfaction. Weight regain was defined as a ≥20% increase from the maximum weight lost. Level of evidence: Level III, cross-sectional study based on a well-designed study. Results: Overall, 55.6% of participants experienced weight regain. Notably, mental disorders such as current binge-eating disorder and lifetime diagnoses including bulimia nervosa, alcohol abuse/dependence, and obsessive-compulsive disorder were significantly associated with weight regain. However, controlled analysis found that, for mental disorders, only current binge-eating disorder (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.26-31.06, p = 0.024) remained associated with weight regain. Eating-related psychopathologies also associated with weight regain included binge eating (d = 0.55; p = 0.013), eating disinhibition (d = 0.76; p = 0.001), higher hunger levels (d = 0.39; p = 0.004), and non-planning trait impulsivity (d = 0.69; p = 0.0001). Conclusion: Postoperative presence of psychopathological comorbidities, such as eating psychopathology and trait impulsivity, were associated with weight regain after bariatric surgery. These findings highlight the importance of addressing mental health in individuals experiencing postsurgical weight regain.

Hedonic hunger, eating behavior, and food reward and preferences 1 year after initial weight loss by diet or bariatric surgery.

OBJECTIVE: The objective of this study was to investigate changes in hedonic hunger, eating behavior, and food reward and preferences at 1-year (1Y) follow-up after an initial weight loss (WL) induced by a 10-week, very low-energy diet alone (controls) or in combination with bariatric surgery. METHODS: Patients scheduled for sleeve gastrectomy or Roux-en-Y gastric bypass and controls were recruited. Body weight/composition, hedonic hunger (Power of Food Scale), eating behavior traits (Dutch Eating Behavior Questionnaire and Three-Factor Eating Questionnaire), and food reward and preferences (computerized behavioral task) were measured at baseline, 11 weeks, and 1Y follow-up. RESULTS: Changes in anthropometric variables were comparable across groups in the initial phase (week 11), and hedonic hunger decreased overall. The bariatric-surgery groups continued to lose body weight and fat mass, whereas weight regain was seen in controls at 1Y follow-up. Decreases in emotional eating, hunger, disinhibition, and food reward and increases in dietary restraint were seen at 1Y follow-up in the bariatric-surgery groups only. CONCLUSIONS: Continued WL with bariatric surgery is paralleled by favorable changes in eating behavior and food reward and preferences. By contrast, controls experienced weight regain at 1Y follow-up and no changes in eating behavior. These striking differences are likely to be important in the long-term WL management of individuals with severe obesity.

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

PURPOSE: Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS: We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS: Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION: Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Patients' Perspectives on Dietary Patterns and Eating Behaviors During Weight Regain After Gastric Bypass Surgery.

PURPOSE: Food quality, energy intake, and various eating-related problems have been highlighted as some of the components influencing weight after bariatric surgery. This study aimed to increase our knowledge of patients' perspectives on dietary patterns and eating behaviors during weight regain after bariatric surgery. MATERIALS AND METHODS: We recruited 4 men and 12 women with obesity and the experience of weight regain after bariatric surgery at an obesity clinic in Stockholm, Sweden. Data were collected during 2018-2019. We conducted a qualitative study, carried out individual semi-structured interviews, and analyzed the recorded and transcribed interview data with thematic analysis. RESULTS: Participants had regained 12 to 71% from their lowest weight after gastric bypass surgery performed 3 to 15 years before. They perceived their dietary challenges as overwhelming and had not expected weight management, meal patterns, increasing portion sizes, and appealing energy-dense foods to be problematic after surgery. In addition, difficulties with disordered eating patterns, emotional eating, and increased alcohol intake further contributed to the weight management hurdles. Insufficient nutritional knowledge and lack of support limited participants' ability to avoid weight regain, leading to restrictive eating and dieting without sustained weight loss. CONCLUSION: Eating behavior and dietary factors such as lack of nutritional knowledge, emotional eating, or disorganized meal patterns contribute to difficulties with weight management after gastric bypass surgery. Improved counseling may help patients prepare for possible weight regain and remaining challenges with food and eating. The results highlight the importance of regular medical nutrition therapy after gastric bypass surgery.

Changes in Smoking Behavior Before and After Gastric Bypass: A 7-year Study.

OBJECTIVE: To evaluate smoking history and change in smoking behavior, from 1 year before through 7 years after Roux-en-Y gastric bypass (RYGB) surgery, and to identify risk factors for post-surgery smoking. BACKGROUND: Smoking behavior in the context of bariatric surgery is poorly described. METHODS: Adults undergoing RYGB surgery entered a prospective cohort study between 2006 and 2009 and were followed up to 7 years until ≤2015. Participants (N = 1770; 80% female, median age 45 years, median body mass index 47 kg/m2) self-reported smoking history pre-surgery, and current smoking behavior annually. RESULTS: Almost half of participants (45.2%) reported a pre-surgery history of smoking. Modeled prevalence of current smoking decreased in the year before surgery from 13.7% [95% confidence interval (CI) = 12.1-15.4] to 2.2% (95% CI = 1.5-2.9) at surgery, then increased to 9.6% (95% CI = 8.1-11.2) 1-year post-surgery and continued to increase to 14.0% (95% CI = 11.8-16.0) 7-years post-surgery. Among smokers, mean packs/day was 0.60 (95% CI = 0.44-0.77) at surgery, 0.70 (95% CI = 0.62-0.78) 1-year post-surgery and 0.77 (95% CI = 0.68-0.88) 7-years post-surgery. At 7-years, smoking was reported by 61.7% (95% CI = 51.9-70.8) of participants who smoked 1-year pre-surgery (n = 221), 12.3% (95% CI = 8.5-15.7) of participants who formerly smoked but quit >1 year pre-surgery (n = 507), and 3.8% (95% CI = 2.1-4.9) of participants who reported no smoking history (n = 887). Along with smoking history (ie, less time since smoked), younger age, household income <$25,000, being married or living as married, and illicit drug use were independently associated with increased risk of post-surgery smoking. CONCLUSION: Although most adults who smoked 1-year before RYGB quit pre-surgery, smoking prevalence rebounded across 7-years, primarily due to relapse.

One Year Follow-Up of Taste-Related Reward Associations with Weight Loss Suggests a Critical Time to Mitigate Weight Regain Following Bariatric Surgery.

BACKGROUND: Weight regain is a concerning issue in bariatric patients. We previously demonstrated that taste-related reward processing was associated with six-month weight loss outcomes following Roux-en-Y gastric bypass (RYGB) but not vertical sleeve gastrectomy (VSG). Here, we assessed whether these taste factors persisted in predicting weight loss, and weight regain, at one year post-surgery. METHODS: Adult women enrolled in a longitudinal study of taste preferences following bariatric surgery completed behavioral and neuroimaging assessments at one year post-surgery. RESULTS: RYGB produced better weight loss relative to VSG, with weight regain and greater weight loss variability observed from six months to one year post-VSG. Changes in liking for high fat at 2 weeks post-surgery from baseline remained a predictor of weight loss in RYGB, but other predictors did not persist. Average liking ratings rebounded to baseline and higher self-reported food cravings and dietary disinhibition correlated with poorer weight loss at one year post-surgery. CONCLUSION: Initial anatomical and metabolic changes resulting from RYGB that reset neural processing of reward stimuli in the mesolimbic pathway appear to be temporary and may be contingent upon post-operative eating behaviors returning to preoperative obesogenic tendencies. Six months post-surgery may be a critical window for implementing interventions to mitigate weight gain.

Microstructural changes in human ingestive behavior after Roux-en-Y gastric bypass during liquid meals.

BACKGROUNDRoux-en-Y gastric bypass (RYGB) decreases energy intake and is, therefore, an effective treatment of obesity. The behavioral bases of the decreased calorie intake remain to be elucidated. We applied the methodology of microstructural analysis of meal intake to establish the behavioral features of ingestion in an effort to discern the various controls of feeding as a function of RYGB.METHODSThe ingestive microstructure of a standardized liquid meal in a cohort of 11 RYGB patients, in 10 patients with obesity, and in 10 healthy-weight adults was prospectively assessed from baseline to 1 year with a custom-designed drinkometer. Statistics were performed on log-transformed ratios of change from baseline so that each participant served as their own control, and proportional increases and decreases were numerically symmetrical. Data-driven (3 seconds) and additional burst pause criteria (1 and 5 seconds) were used.RESULTSAt baseline, the mean meal size (909.2 versus 557.6 kCal), burst size (28.8 versus 17.6 mL), and meal duration (433 versus 381 seconds) differed between RYGB patients and healthy-weight controls, whereas suck volume (5.2 versus 4.6 mL) and number of bursts (19.7 versus 20.1) were comparable. At 1 year, the ingestive differences between the RYGB and healthy-weight groups disappeared due to significantly decreased burst size (P = 0.008) and meal duration (P = 0.034) after RYGB. The first-minute intake also decreased after RYGB (P = 0.022).CONCLUSIONRYGB induced dynamic changes in ingestive behavior over the first postoperative year. While the eating pattern of controls remained stable, RYGB patients reduced their meal size by decreasing burst size and meal duration, suggesting that increased postingestive sensibility may mediate postbariatric ingestive behavior.TRIAL REGISTRATIONNCT03747445; https://clinicaltrials.gov/ct2/show/NCT03747445.FUNDINGThis work was supported by the University of Zurich, the Swiss National Fund (32003B_182309), and the Olga Mayenfisch Foundation. Bálint File was supported by the Hungarian Brain Research Program Grant (grant no. 2017-1.2.1-NKP-2017-00002).

Characteristics of Patients Reporting Presumed Problematic Drinking Behavior After Gastric Bypass: Exploring Long-Term Data From the BAROBS Study.

Objective: To explore patients' long-term experiences with drinking alcohol after Roux-n-Y gastric bypass (RYGB) for conceptualizing what may indicate problematic drinking behavior after bariatric surgery. Study Design: Three-center, observational study. Patients: 546 adult patients undergoing RYGB in the period 2003-2009 in Norway. Main Outcome Measures: Self-reported data on drinking behavior and experiences related to alcohol collected 10-15 years after surgery. Results: Out of the 959 patients undergoing RYGB in the period, 29 were diseased and 546 participated in this follow-up study (58.7%). Focusing on suspicious changes in drinking behavior, 8.8% reported drinking more, 11.5% consumed alcohol at least twice a week, and 10.6% consumed at a minimum of 6 units of alcohol at a frequency of at least once monthly. The nature of hangovers had changed for about a third of the patients, with 21.6% reporting these to feel weaker or absent. Repeated alcoholic blackouts were reported by 11.9%. A subgroup of the patients were categorized as displaying presumed problematic drinking behavior(PPDB). Among the PPDB-men there was a significant association to having had a fall last year (6 (100.0%) PPDB-patients vs. 30 (29.7%) non-PPDB, p<.001). Among the PPDB-women, there was a significant association to having had alcohol problems prior to surgery (7 (70.0%) PPDB-patients vs. 67 (17.7%) non-PPDB, p<.001). Less significant associations to PPDB reported for explorative purposes were lack of patient education (men) (16 (26.2%) PPDB-patients vs. 8 (61.5%) non-PPDB, p=.014); more than 3 months persistent musculoskeletal pain (women) (45 (15.3%) PPDB-patients vs. 29 (24.6%) non-PPDB, p=.026); subjective problems with memory (women) (58 (20.7%) PPDB-patients vs. 10 (9.1%) non-PPDB, p=.006); and, receiving professional help for mental problems last 12 months (women) (29 (22.7%) PPDB-patients vs. 45 (14.7%) non-PPDB, p=.043). Conclusion: A subset of patients display drinking behaviors that may be consistent with postsurgical alcohol problems. Screening instruments like AUDIT may not be sufficiently specific to capture several risk behaviors occurring after bariatric surgery.

Course of depressive symptomatology and its association with serum uric acid in one-anastomosis gastric bypass patients.

The changes in depressive symptomatology during the first year following one-anastomosis gastric bypass (OAGB) were evaluated and its association with uric acid (sUA). Fifty patients were included in this analysis. Beck Depression Inventory (BDI) for measuring depressive symptomatology, blood samples, and anthropometric measurements were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. There was a significant reduction in BDI total score at T6 (- 5.6 (95% CI - 2.1, - 9.1) points; p = 0.001) and at T12 (- 4.3 (95% CI - 0.9, - 7.9) points; p = 0.011). BMI loss was unrelated to depressive symptomatology. Patients with moderate to severe depressive symptomatology presented lower sUA levels than patients with none or minimal to mild (p = 0.028). ROC analysis revealed that sUA levels below 5.0 at T6 and 4.5 mg/dl at T12 had a prognostic accuracy for depression severity. Furthermore, delta sUA was significantly associated with delta BMI (ß = 0.473; p = 0.012) and delta waist circumference (ß = 0.531; p = 0.003). These findings support an improvement in depressive symptomatology in the first year postoperatively, however, without relation to BMI loss. Patients with moderate to severe depressive symptomatology presented with lower sUA levels over time. Therefore, sUA could be useful to predict moderate to severe depressive symptomatology in patients undergoing OAGB in clinical practice.

Sleeve gastrectomy vs gastric bypass in improvement of depressive symptoms following one year from bariatric surgery, Tehran Obesity Treatment Study (TOTS).

BACKGROUND: The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain. METHOD: The study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery. RESULTS: Mean age of the patients was 38.7 ±â€¯10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ±â€¯6.0 kg/m2. One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0-9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10-18), moderate (19-29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ±â€¯10.5 vs 11.1 ±â€¯9.6, and for the SG group 16.1 ±â€¯10.2 vs 9.6 ±â€¯8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (-6.04 ±â€¯10.6 vs -6.4 ±â€¯9.5, P = 0.149). CONCLUSION: Bariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.

Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study.

OBJECTIVE: Malignant bowel obstruction (MBO) is a complication of advanced malignancy and is associated with a short prognosis. MBO can infrequently be reversed by surgery or stenting. The focus of treatment is usually symptomatic management, of which percutaneous venting gastrostomy/gastrojejunostomy (PVG) is one consideration. There is little data considering the impact of PVG on quality of life; we therefore aimed to explore this. METHODS: We identified patients with a PVG inserted for MBO and those who consented to participate were interviewed. The interviews were audio recorded, transcribed and analysed using Framework. Alongside patient interviews, a data collection tool was designed and used to record patient demographics and medical information, enabling us to contextualise individual patients' experiences. RESULTS: 11 patients were interviewed and 10 patients' data were analysed (1 patient withdrew). No patients regretted having a PVG and many benefitted symptomatically and psychosocially. Challenges encountered included practical issues, pain and PVG tube complications. CONCLUSIONS: The analysis provided a detailed insight into the impact of PVG insertion and demonstrated that each patient's experience is shaped by a complex interplay of individual factors, thereby highlighting the need to improve referral criteria and individualise patient selection. Other service improvements include enhancing information provision for patients and training for healthcare professionals, thus aiming to mitigate the challenges experienced. Our study is the first in-depth exploration of patients' experiences of PVG at a tertiary cancer centre. Ensuring that the insights from this study are fed back to guide future service provision is critical in enhancing future patient experiences.

Changes in Alcohol Use after Metabolic and Bariatric Surgery: Predictors and Mechanisms.

PURPOSE OF REVIEW: This review synthesized the literature on predictors and mechanisms of post-bariatric alcohol problems, in order to guide future research on prevention and treatment targets. RECENT FINDINGS: Consistent evidence suggests an elevated risk of developing problems with alcohol following bariatric surgery. While there is a paucity of empirical data on predictors of problematic alcohol use after bariatric surgery, being male, a younger age, smoking, regular alcohol consumption, pre-surgical alcohol use disorder, and a lower sense of belonging have predicted alcohol misuse post-operatively. This review synthesizes potential mechanisms including specific bariatric surgical procedures, peptides and reinforcement/reward pathways, pharmacokinetics, and genetic influences. Finally, potential misperceptions regarding mechanisms are explored. Certain bariatric procedures elevate the risk of alcohol misuse post-operatively. Future research should serve to elucidate the complexities of reward signaling, genetically mediated mechanisms, and pharmacokinetics in relation to alcohol use across gender and developmental period by surgery type.

Neuro-hormonal mechanisms underlying changes in reward related behaviors following weight loss surgery: Potential pharmacological targets.

Currently, the only available effective treatment option for obesity and its comorbidities is weight loss surgery (WLS). Long-term maintenance of weight loss after surgery cannot be explained by caloric restriction or malabsorption alone and has been attributed to unexplained changes in eating behavior. Whether these behavioral changes are related to altered taste or reward functions, or both, are subject to debate. In contrast to reduced food cravings and food addiction following WLS, recent clinical studies have revealed that bariatric surgery patients are prone to an increased risk for substance use disorder (SUD), especially alcohol use disorder (AUD). The substitution of drugs for previously stimulating foods, and the emergence of SUD after WLS, supported by preclinical studies, strongly suggest that manipulation of gut-brain signals may bring about changes in the reward system. This paper reviews current clinical and basic science research and discusses potential underlying mechanisms of reward-related behaviors. Specifically, it explores relevant neural and hormonal changes that present post WLS and their effects on dopaminergic reward pathway and highlights targets for potential pharmacological interventions. Special emphasis is given to recent work suggesting that different types of WLS procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have differential effects on alcohol consumption in humans and rats. These differential effects may hold the key not only to understanding increased substance use following WLS but may also help elucidate the contribution of gut-brain signals to regulation of reward, in general.

Associations between Weight Loss, Food Likes, Dietary Behaviors, and Chemosensory Function in Bariatric Surgery: A Case-Control Analysis in Women.

We tested the hypothesis that successful weight loss post-bariatric surgery would be associated with healthier chemosensory function, food likes, and dietary behaviors than either unsuccessful weight loss or pre-surgery morbid obesity. In a case-control design, pre-surgical women with morbid obesity (n = 49) were compared with those 1-year post-surgery (24 Roux-en-Y Bypass, 24 Sleeve Gastrectomy) and defined by excess or percent weight loss as successful/unsuccessful. For self-reported smell/taste perception, more post-surgery than pre-surgery reported improved/distorted perception, especially if weight loss successful. Measured taste function (perceived quinine and NaCl intensity) was lower among weight loss unsuccessful versus pre-surgery patients, yet a genetic variation in taste probe (propylthiouracil bitterness) matched expected frequencies without significant pre/post-surgery difference. Regarding survey-reported liking, higher diet quality was seen in the weight loss successful (independent of surgery type) versus pre-surgical patients, with differences driven by lower sweet and refined carbohydrate liking. The post versus pre-surgical patients had greater restraint but less hunger and disinhibition. Patients reporting both higher diet quality and lower hunger showed greater % weight loss, independent of surgery type. Thus, successful weight loss 1-year post-bariatric surgery was associated with improved or distorted chemosensation and patterns of liking associated with healthier diets, especially if coupled with less hunger.

Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery.

PURPOSE: Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL. RESULTS: Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36. CONCLUSIONS: Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre- and post-surgery.

Current Controversies in Metabolic Surgery for Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) represents the most common liver disease, and it is expected to become the leading cause of end-stage liver disease in the near future. Bariatric operations have beneficial effects on NAFLD, inducing histological resolution of liver damage through weight loss-dependent and weight loss-independent mechanisms. Due to lack of randomized controlled trials, no specific guidelines have been established so far. Yet there is growing evidence that NAFLD will eventually become a formal indication for metabolic surgery. Data regarding the choice of procedure are conflicting, although gastric bypass seems to be slightly superior to sleeve gastrectomy. The purpose of this review is to provide an update on the ongoing research regarding the role of metabolic surgery in NAFLD management.

Risk of Suicide and Self-harm Is Increased After Bariatric Surgery-a Systematic Review and Meta-analysis.

BACKGROUND: Bariatric surgery is endorsed by multiple societies as the most effective treatment for obesity. Psychosocial functioning has also been noted to improve for most patients after bariatric surgery. However, some studies have shown an increase in post-operative suicide risk. The aim of this study was to review the published literature and evaluate the association of bariatric surgery with suicide events and suicide/self-harm attempts in patients who have undergone weight loss surgery. METHODS: MEDLINE and Embase were searched from inception through January 2018 for retrospective or prospective studies reporting mortality outcomes and self-harm or suicide rates after bariatric procedures. The primary outcome was the pooled event rate with 95% confidence interval (95% CI) for suicide. Secondary outcomes were suicide/self-harm attempts after bariatric surgery compared to same population prior to surgery and to matched control subjects, with the respective calculated odds ratios (OR) and 95% CI. RESULTS: From 227 citations, 32 studies with 148,643 subjects were eligible for inclusion. The patients were predominantly females (76.9%). Roux-en-Y gastric bypass (RYGB) was the most commonly performed procedure (58.9%). The post-bariatric suicide event rate was 2.7/1000 patients (95% CI 0.0019-0.0038), while the suicide/self-harm attempt event rate was 17/1000 patients (95% CI 0.01-0.03). The self-harm/suicide attempt risk was higher after bariatric surgery within the same population with OR of 1.9 (95% CI 1.23-2.95), and compared to matched control subjects, OR 3.8 (95% CI, 2.19-6.59). CONCLUSIONS: Post-bariatric surgery patients had higher self-harm/suicide attempt risk compared to age-, sex-, and BMI-matched controls. Various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved.

Perception of Hunger/Satiety and Nutrient Intake in Women Who Regain Weight in the Postoperative Period After Bariatric Surgery.

OBJECTIVE: To investigate the perception of hunger and satiety and its association with nutrient intake in women who regain weight in the postoperative period after bariatric surgery. METHODS: Cross-sectional study of adult women divided into three groups: weight regain (n = 20), stable weight (n = 20) (both at least 24 months after Roux-en-Y gastric bypass surgery), and non-operated obesity (n = 20). A visual analogue scale measured hunger/satiety perception while fasting, immediately after finishing a test meal, and 180 min after finishing the test meal. The incremental area above or under the curve was calculated. Food intake was analyzed by 3 days of food recall and adjusted for intraindividual variation. To make between-group comparisons, Mann-Whitney, ANOVA, Kruskal-Wallis, and independent-samples T tests and Pearson's correlation were used. RESULTS: There were no between-group differences in incremental areas of hunger/satiety, but protein intake was significantly lower among patients who regained weight compared with those who had stable body weight (0.99 ± 0.23 g/kg body weight vs. 1.17 ± 0.21 g/kg body weight, p = 0.047). In the group that regained weight, satiety was correlated positively with usual dietary protein density (r = 0.541; p = 0.017) and negatively with usual carbohydrate intake (r = - 0.663; p = 0.002). CONCLUSION: Women who regained weight presented similar perceptions of hunger/satiety to those of patients without weight regain and with non-operated obesity. In patients who regained weight postoperatively, satiety perception was correlated positively with usual dietary protein density and inversely with usual carbohydrate intake.

Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference?

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE: To evaluate preferences for RYGB versus SG. SETTING: Survey of U.S. adults. METHODS: An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS: Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS: Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.