Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status.

INTRODUCTION: This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery. METHOD: Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey. RESULTS: Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status. DISCUSSION: The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Maternal Malnutrition During Pregnancy Among Women with Metabolic and Bariatric Surgery.

INTRODUCTION: As the utilization of metabolic and bariatric surgery (MBS) continues to rise, it is important to address the nutritional needs of women who had MBS who become pregnant. Not meeting those nutritional needs could lead to complications associated with malnutrition. To better understand the relationship between MBS, pregnancy, and malnutrition, this study sought to determine whether differences exist in the presence of malnutrition during pregnancy in women with a history of MBS compared to women without a history of MBS. METHODS: This cross-sectional study used the National Inpatient Sample (NIS) from 2012 to 2017, which samples 20% of hospital discharges in the USA. Multivariate logistic regression models were fitted, and odds rations and 95% confidence intervals were calculated with obesity and MBS as the independent variables and malnutrition during pregnancy as the dependent variable. Covariates included in the multivariate model were age, primary payer, hypertension, hyperlipidemia, and depression. RESULTS: Compared to women who did not have MBS, women who had MBS had higher odds of malnutrition during pregnancy (aOR = 8.33, 95% CI 7.30-9.50), this result was moderated by racial category (aORBlack = 6.35, 95% CI 4.97-8.13; aORwhite = 8.25, 95% CI 7.00-9.73; aORLatina = 10.93, 95% CI 8.38-14.25). Women with obesity also had higher odds of malnutrition during pregnancy. CONCLUSIONS: The increased odds of malnutrition among women with MBS suggests that it is important to consider tailoring nutrition recommendations to address the different nutritional needs of pregnant women who had MBS and may be at risk for malnutrition.

Helping families heal in substance use treatment: A qualitative study about the role of peer support specialists with client families.

INTRODUCTION: Peer support specialists (PSS) are people with previous psychiatric illness or substance use disorders who use their experience to support those facing similar hardships. PSS offer a range of beneficial outcomes to both the PSS and clients. The most immediate social connections to those seeking treatment are often their families, yet no PSS studies are inclusive of family involvement. Strong theoretical and empirical support exists for family involvement in addiction treatment, but no studies to date on families in substance use treatment include PSS. This study offers a first look at PSS's experiences with client families. We aimed to describe experiences and attitudes of PSS in working with families of those seeking substance use treatment. METHODS: This qualitative study included 25 adult PSS with at least 1 year of work experience in substance use treatment and state credentialing board certification. Participants had one interview either in a focus group format or individually. The recruitment and data collection phase lasted from November 2020 to June 2021. The semi-structured interview protocol included six main questions and interviews lasted 60 to 75 min. Upon completion of each interview, the recordings were transcribed and inductively coded. Thematic analysis of the codes identified overarching themes and their implications were described with associated quotes. RESULTS: Thematic analysis generated three interrelated themes. First, participants described the various ways they often work with the families of their clients, which seemed to be dependent on the age of the client. Second, participants identified the negative aspects of working with families such as family drama, stress, and co-dependency issues. Last, the third theme identified the ways in which PSS assist families in healing from the effects of addiction. The themes identify a complicated and conflicting approach to work with families. Overall, it seemed PSS were operating on their own experiences or suggestions given by supervisors to guide them with no training on how to approach families. CONCLUSIONS: This study highlights a deficit in PSS training on their role with families, family intervention, and the impact of family on substance use treatment for adults and youth. More research needs to establish the PSS role with families and with clients from marginalized backgrounds. Credentialing and national associations that support PSS should develop additional training and education opportunities related to working with families for PSS, supervisors, and organizational leadership who employ PSS for substance use treatment.

Stroke and stroke risk factors in women of reproductive age with a history of metabolic or bariatric surgery.

OBJECTIVE: To determine the odds of stroke in women of reproductive age who have had metabolic or bariatric surgery (MBS). METHODS: We used the National Inpatient Sample (NIS), a publicly available dataset that samples 20% of hospital discharges. The study population includes women between the ages of 20 and 44 without a maternal admission code. Weighted logistic regression analyses were conducted to assess the odds of stroke in women with history of MBS compared to other women of reproductive age. Adjustment of odds was done for the following covariates: age, race, primary payer, severity of illness, depression, and obesity. RESULTS: Women with a history of MBS had 52% lower adjusted odds of having a stroke than women who did not have MBS (OR = 0.48, 95%CI = 0.42-0.55). Additionally, women who had MBS had lower odds of risk factors for stroke, including diabetes (OR = 0.61, 95%CI = 0.59-0.63), hypertension (OR = 0.82, 95%CI = 0.81-0.84), hypercholesterolemia (OR=0.72, 95%CI =0.68-0.77), and migraine with aura (OR = 0.86, 95%CI = 0.74-0.99). CONCLUSIONS: Among women of reproductive age with a history of MBS, there were lower odds of having a stroke and stroke risk factors when compared to women who did not have MBS. Additionally, this study showed a modest decrease in the odds of stroke among women with obesity when adjusted for other risk factors. Future research should focus on examining this finding further, with a focus on the moderation of the impact of having obesity on stroke risk independent of other stroke risk factors.

Impaired Family Functioning Affects 6-Month and 12-Month Postoperative Weight Loss.

PURPOSE: Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient's postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL). MATERIALS AND METHODS: An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates. RESULTS: Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009). CONCLUSION: Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

The Effect of Family Member Attendance at Bariatric Surgery Appointments on Patient and Family Weight-Related Outcomes.

PURPOSE: To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients' weight loss and physical activity levels and family members' weight control practices. MATERIALS AND METHODS: As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1 month pre-surgery, T3 = 2 weeks post-surgery, T4 = 2 months post-surgery). Assessments of patients' percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members' weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1-T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate. RESULTS: There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4. CONCLUSIONS: Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.

Aging impairs the unfolded protein response to sleep deprivation and leads to proapoptotic signaling.

Protein misfolding, accumulation, and aggregation characterize many aging-related diseases. Protein aggregates do not accumulate in unstressed cells primarily because of the existence of competent cellular "quality control" machinery. The endoplasmic reticulum (ER) is a major part of this quality control system. Accumulation of misfolded proteins in the ER causes ER stress and activates a signaling pathway called the unfolded protein response (UPR). The UPR limits protein load by upregulating ER chaperones such as Ig binding protein (BiP)/glucose-regulated protein 78 (GRP78) and by attenuating protein translation through eukaryotic initiation factor 2 alpha (eIF2alpha) phosphorylation. Acute sleep deprivation (6 h) in young mice leads to induction of the UPR with upregulation of BiP/GRP78 and attenuation of protein translation. We demonstrate here that aging impairs this adaptive response to sleep deprivation. Aged mice do not display an increase in BiP expression with acute sleep deprivation. In addition, there is decreased basal expression of BiP/GRP78 in aged mice. There is a decline in eIF2alpha phosphorylation in aged mouse cerebral cortex that is associated with higher levels of GADD34 (growth arrest and DNA damage 34) and proapoptotic proteins such as CCAAT/enhancer-binding protein-homologous protein and activated caspase-12, suggesting that young animals possess an efficient ER adaptive response that declines with aging.