The Effect of Chest Physiotherapy After Bariatric Surgery on Pulmonary Functions, Functional Capacity, and Quality of Life.

PURPOSE: The aim of this study was to investigate the effect of chest physiotherapy (CP) applied to patients undergoing bariatric surgery on pulmonary functions, dyspnea levels, functional capacity, and quality of life. METHODS: The patients were randomized and divided into two groups each comprising 74 patients. CP and mobilization was applied to the patients in the first group, and only mobilization was applied to the patients in the second group. The treatment of the patients was started on the first postoperative day and continued until the postoperative 4th day. CP and mobilization were applied twice a day, 8 times in total. The following parameters were evaluated: arterial blood gas, oxygen saturation, respiratory function test for pulmonary functions, pulmonary artery pressure for pulmonary hypertension, Borg dyspnea score for severity of dyspnea, 6-min walk test(6MWT) for functional capacity, Nottingham Health Profile for quality of life. RESULTS: The mean age of the patients was 38.00 ± 7.04 years. Compared with pretreatment and posttreatment dyspnea score, 6MWT, oxygen saturation, vital capacity, tidal volume, PEF, pulmonary arterial pressure, and quality of life were significantly higher in patients who underwent CP compared with the control group(p = 0.008, 0.004, 0.005, 0.027, 0.029, 0.028, 0.007, 0.012).There was a significant improvement in all the parameters of the patients who underwent chest physiotherapy when compared with the intragroup comparisons, whereas in the control group, only 6MWT and quality of life score showed a significant improvement in the border (p = 0.037, 0.046). CONCLUSION: Postoperative CP applied to patients who had bariatric surgery showed that the patients improved their respiratory functions, regulated arterial blood gases, increased oxygen saturation, functional capacity and quality of life, and decreased dyspnea levels.

Effects of the Postoepartive Dietetic/Behavioral Counseling on the Weight Loss After Bariatric Surgery.

OBJECTIVE: Weight outcomes after bariatric surgery are due to an adequate adjustment of eating behavior to the new gastrointestinal conditions created by operation. The efficacy of dietary/behavior counseling for promoting weight loss and maintenance in a growing number of bariatric patients was investigated. MATERIAL AND METHODS: One hundred seventy-six non-diabetic obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) were investigated. The first group (CO, 88 subjects, 16 male) attended a standard surgical follow-up, while in the second (DIET, 88 subjects, 15 male) the surgeon was supported by a dietitian, and patients received behavioral-dietary sessions on individual request. Data prior to the operation and at 2 years were considered, the weight outcome being regarded as successful when postoperative body mass index (BMI) value was lower than 30 kg/m2. RESULTS: Weight results were better (p < 0.01) in the RYGBP than in the SG patients. In comparison to CO, in the DIET group a greater adherence to the bariatric program was observed (76% vs. 41%, < 0.01), while body weight data and prevalence of successful cases at 2 years (87 ± 23 vs. 83 ± 16 kg and 27% vs.33%, respectively) were similar. CONCLUSIONS: After RYSG and SG, postoperative dietetic/behavioral sessions delivered on patient's request does not influence weight results. The dietetic intervention promotes the adherence to bariatric program and prevents postoperative follow-up loss. In a dietitian/behavioral strategy after RYGBP and SG, a cognitive reinforcement of the compliance to bariatric program and a strengthening of the motivation to changes could promote better weight results.

Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss-a Retrospective Study.

BACKGROUND: The aim of the study was to compare physical activity (PA) in patients who had undergone massive weight loss (MWL), before and after body contouring procedures. METHODS: All patients undergoing body contouring surgery after MWL between 2007 and 2017 with a minimum follow-up of 6 months after the last procedure were included in this retrospective study. Excluded were those with a body mass index > 35 kg/m2 and those with comorbidities leading to impaired PA. Quality of life (QOL) was assessed using the Moorehead-Ardelt QOL Questionnaire II. Evaluation of PA was obtained with the International Physical Activity Questionnaire (IPAQ) short form and the Freiburg PA Questionnaire. Functional impairment during exercise was analyzed using a self-designed functional impairment score (FIS). RESULTS: In the 45 patients completing the survey (37 female, 8 male), an improvement in QOL (p < 0.001) and PA scored by the IPAQ (p = 0.017) was found. The Freiburg PA Questionnaire showed no difference in PA before and after body contouring surgery (p = 0,274). Furthermore, scores of the FIS indicated a decrease of functional impairment during physical activity after body contouring surgery (p < 0.001). CONCLUSION: Body contouring improves QOL and PA in patients after massive weight loss. The results of our study confirm the important role of plastic surgery in the treatment and maintenance of health of patients with former obesity.

Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women.

OBJECTIVE: Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up. METHODS: One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women's Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing. RESULTS: At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman's Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (-0.3). CONCLUSIONS: Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.

Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?

BACKGROUND: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. METHODS: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35-45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. RESULTS: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43-45 vs 45.01-47) were compared. CONCLUSION: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.

Physical Activity Patterns Among Individuals Before and Soon After Bariatric Surgery.

PURPOSE: Post-operative changes in moderate-to-vigorous physical activity (MVPA) may contribute to improved weight loss and long-term weight maintenance of individuals after bariatric surgery. Patients experience minimal changes in MVPA > 6 months after surgery, but no studies have investigated early changes in physical activity after surgery. This study aims to assess MVPA changes during the rapid weight loss phase through self-reporting and objective measures. METHODS: Physical activity patterns were assessed as minutes per day spent doing MVPA. A walking cadence of ≥ 100 steps per minute defined MVPA. Individuals completing gastric bypass (N = 7) and sleeve gastrectomy (N = 17) procedures (21 females, 3 males, age 42.2 ± 12.6 years, body mass 121.8 ± 24.8 kg, BMI 44.0 ± 6.5) completed office visits at 12 ± 6 days pre- and 35 ± 10 days post-operative. Each wore an ActiGraph GT3X tri-axial accelerometer at the hip for 7 days before and again for 7 days 30.6 ± 10 days after surgery. Assessments also included a subjective question about their anticipated and perceived post-operative MVPA (scale of - 3 to 3 with 3 being much more physically active and - 3 being much less). RESULTS: Participants did not change their minutes per day of MVPA significantly (pre-operative 1.5 ± 2.1; post-operative 2.6 ± 5.6, NS). Participants predicted their post-operative physical activity level would increase (2.8 ± 0.4). The self-reported activity level on the same scale after surgery was significantly less than predicted (1.9 ± 1.0, p < 0.05) but still suggested that participants thought they were more physically active. CONCLUSION: Consistent with reports > 6 months after surgery, MVPA did not increase in the early post-operative period, despite patient expectations. The early post-operative period may be a time for behavioral intervention.

Trajectories of Fetal Adipose Tissue Thickness in Pregnancies After Gastric Bypass Surgery.

PURPOSE: Recent studies showed that women after surgery are at higher risk of delivering small-for-gestational infants. Thus, this study aims to investigate longitudinal changes of fetal subcutaneous adipose tissue thickness (FSCTT) of fetuses conceived after gastric bypass surgery as compared to BMI-matched controls. METHODS: Retrospective cohort study measuring ultrasound-derived longitudinal trajectories of abdominal FSCTT in 41 singleton pregnancies after gastric bypass surgery compared to 41 BMI-matched controls and 64 obese mothers. RESULTS: FSCTT was significantly lower in fetuses of women after GB as compared to BMI-matched controls in the second (mean difference 1.38 mm, p < 0.001) and third trimester of gestation (mean difference 3.37 mm, p < 0.001). Longitudinal analysis revealed significant differences in mean FSCTT trajectories between offspring's in GB mothers, BMI-matched, or obese controls. The ratio of FSCTT and abdominal circumference remained constant in the BMI-matched control group whereas it significantly decreased in fetuses of women after GB. Despite remarkable differences were observed in longitudinally assessed FSCTT, further analyses in the GB subgroup revealed that FSCTT were not influenced by OGTT mean or 120 min glucose values, biochemically hypoglycemia, time since bariatric surgery, or weight loss since surgery. CONCLUSION: In fetuses of mothers with history of bariatric surgery, abdominal FSCTT was markedly reduced. While the underlying mechanisms are not fully understood, a multifactorial genesis including nutritional deficiencies and altered metabolism after bariatric surgery is assumed.

Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery.

BACKGROUND: The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is commonly used to assess psychological factors that may adversely impact weight loss. Research is limited on the specific MMPI-2-RF scales that may predict poor postoperative outcomes following bariatric surgery. The current study compared preoperative MMPI-2-RF profiles associated with postoperative weight change to novel component scores in a bariatric surgery sample. METHODS: One hundred twenty-seven patients completed a preoperative medical evaluation, a test of reading ability, and the MMPI-2-RF. Percent weight loss was obtained postoperatively at 6 and 12 months. RESULTS: Principal components analysis (PCA) generated five novel subcomponents from within the internalizing, externalizing, and interpersonal substantive scales of the MMPI-2-RF. Among these components, higher externalizing and social conflict scores at baseline were predictive of less percent weight change postoperatively at 6 months. A similar trend was observed with higher insecurity scores predicting less weight loss at 6 months postoperatively. At 12-month follow-up, higher insecurity scores at baseline remained predictive of lower percentage weight loss, while social conflict trended toward significance in the same direction. Model comparisons of traditional MMPI-2-RF scales were found to be more sensitive than the novel subcomponents. Specifically, demoralization (RCd), antisocial behavior (RC4), hypomanic activation (RC9), family problems (FML), and shyness (SHY) significantly predicted weight change after surgery. CONCLUSION: Results suggested that specific problems scales were not more effectively differentiated into more sensitive and specific component scores, but demonstrated supportive evidence that the traditional MMPI-2-RF scales indicating higher degrees of behavioral dysregulation, poor self-efficacy, and lower social support predict reduced postoperative weight loss.

Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial.

BACKGROUND: Weight regain after bariatric surgery often starts after 1-2 y, but studies evaluating strategies to prevent weight regain are lacking. The aim of this intervention was to evaluate the efficacy of a 2-y-group-based lifestyle intervention starting approximately 2 y after Roux-en-Y gastric bypass (RYGB) compared with usual care on weight regain and related metabolic risk factors. METHODS: A total of 165 patients with a mean of 21 months (range 14-32) after RYGB were randomized to a lifestyle intervention group (LIG) or a usual care group (UCG). Of the 165 participants 86% completed the study. The LIG was offered 16 group meetings over 2 y with focus on healthy diet, physical activity, and behavioural strategies to prevent weight regain, in addition to usual care. RESULTS: Mean (SD) total weight loss at study start was 30.1 ± 8.2%, while weight regain during the intervention was 4.9 ± 7.4 and 4.6 ± 9.2% in the LIG and UCG, respectively (P = 0.84). There were no differences in metabolic risk factors between the groups. The LIG participants attended 8 ± 4 group meetings, with no difference in weight regain between participants with high compared to lower participation. In all the participants, a positive association between weight increase from nadir to study start and weight regain during the intervention was found. Participants who reported physical activity ≥ 150 min/wk had smaller % weight regain compared with less active participants (ß = - 5.2 [SE 2.0, 95% CI - 9.1 to - 1.4]). CONCLUSION: We found no difference in weight regain between LIG and UCG.

Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials.

The combination of bariatric surgery and physical exercise has been suggested as a promising strategy to positively influence obesity, not only body weight but also all associated comorbidities. An electronic search of intervention studies was carried out in which an exercise training program was implemented after bariatric surgery. The quality of each study was assessed and the data were meta-analyzed using a random effect model. Twenty-six articles were included in the systematic review and 16 in the meta-analysis. As the main conclusion, exercise in patients who have undergone bariatric surgery does not seem to be effective in enhancing weight loss (SMD = 0.15; 95% CI = - 0.02, 0.32; p = 0.094). However, the variability in the protocols used makes it too early to reach a definite conclusion.

Laparoscopic Magenstrasse and Mill Gastroplasty (M&M): Midterm Results.

BACKGROUND: The Magenstrasse and Mill gastroplasty (M&M) is a gastric restrictive procedure without band or stomach resection. Short-term evaluation of the laparoscopic procedure showed low morbidity and satisfactory results on weight loss. Evidence of the validity of the technique in the longer term is scarce. METHODS: Data from patients who underwent M&M procedure from May 2012 to September 2015 were retrospectively reviewed. Preoperative clinical characteristics and data up to 4 years after operation were analyzed. RESULTS: A total of 132 patients were included in this study with a mean age of 46 ± 13.4 years. The mean body mass index (BMI) at the time of procedure was 43 ± 4.5 kg/m2. Mean percentage of excess weight loss (%EWL) was 67, 67, 58, and 57% at 1, 2, 3, and 4 years, respectively. The remission rate for diabetes was 36%. About half of the insulin-dependent patients could stop their insulin treatment. Hypertension was resolved in 33.8% of the patients after 4 years. Incidence of vitamin and mineral deficiency was low throughout the study period, less than or equal to 3% for vitamin B12 and 1% for ferritin. Incidence of gastroesophageal reflux did not exceed 15% during the study. Over 75% of the patients reported a good or very good quality of life following the surgery. CONCLUSION: These results confirm the validity of M&M as a bariatric procedure. The low incidence of vitamin deficiencies and gastroesophageal reflux might be the important asset of M&M over other existing techniques.

First Successful Large-Scale Introduction of an Enhanced Recovery after Bariatric Surgery (ERABS) Program in the Middle East: The Results and Lessons Learned of Tawam Hospital/Johns Hopkins, a Tertiary Governmental Center in the UAE.

BACKGROUND: Although enhanced recovery after bariatric surgery (ERABS) has proven to be safe and cost-effective, this concept is relatively new in the Middle East. METHODS: A retrospective analysis of consecutive registered cohorts of patients who underwent primary and purely laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were compared before introduction of ERABS (2010-2014) and after ERABS (2015-2017) at Tawam Hospital/Johns Hopkins, the UAE. RESULTS: A total of 462 eligible bariatric patients (LSG 414 and LRYGB 48) were operated on before and 1602 (LSG 1436 and LRYGB 166) after introduction of the ERABS. Significant improvements of mean patient time of the patient being within the OR for LSG (from 2:27 to 1:23 min, p = 0.000) and LRYGB (from 3:17 to 1:59 min, p = 0.000) were achieved when comparing pre-ERABS with after introduction of ERABS. Furthermore, there was a significant decrease in LOS in both LSG (from 3.2 to 1.5 days, p = 0.000) and in LRYGB (from 3.5 to 1.7 days, p = 0.000). Major (CD classification III-IV) complications decreased significantly in LSG (from 13.8 to 0.8%, p = 0.000) and were similar in LRYGB (from 4.2% to 3.0%, p = NS). The readmission rate for LSG (from 2.9 to 2.6%, p = NS) or LRYGB (from 0 to 4.8%, p = NS) and the reoperation rates after LSG (from 0.7 to 0.5%, p = NS) and LRYGB (from 0 to 2.4%, p = NS) did not differ between both groups following introduction of ERABS. CONCLUSIONS: Implementation of a standardized ERABS program in the Middle East is feasible and safe and leads to reduced LOS and OR times.

Bariatric Surgery Associated with Practice of Moderate to Intense Physical Activity Related to Weight Loss, Activity Level in Daily Life, Dyspnea, and Quality of Life of Sedentary Individuals with Morbid Obesity: a Prospective Longitudinal Study.

AIM: To evaluate the association of moderate-to-intense physical activity with the effects of bariatric surgery on weight loss, level of activities of daily living, dyspnea, and quality of life in sedentary individuals with grade II and III obesity. METHOD: Seventy-eight candidates for bariatric surgery were evaluated for anthropometry, dyspnea, quality of life, level of activities of daily living, and physical activity. After surgery, all patients were instructed to perform moderate-to-intense physical activity. All 78 patients were reassessed 6 months after bariatric surgery, and 52 patients were reassessed 3 years after bariatric surgery. RESULTS: Adherence to physical activity during the postoperative period was 36% at 6 months and 38% at 3 years. Compared with the patients who did not adhere to physical activity, weight loss was higher in the adherent patients at 6 months (29 ± 4% vs. 26 ± 5%; p = 0.01) and 3 years (32 ± 8% vs. 26 ± 6%, p = 0.005). The level of activities of daily living and quality of life also improved in the patients that adhered to physical activity at both 6 months and 3 years after bariatric surgery. However, no difference in dyspnea was observed between the adherent and non-adherent patients. Adherence to physical activity was an independent factor for postoperative weight loss. CONCLUSION: Moderate-to-intense physical activity after bariatric surgery increases weight loss, quality of life, and level of activities of daily living, but does not directly influence dyspnea in individuals with morbid obesity.

An Application May Help Improve Protein Consumption after Bariatric Surgery.

This brief communication suggests that in patients who had bariatric surgery and in whom protein intake is lower than 60 g/d, the use of an application is likely to improve protein intake.

Cirurgias bariátricas realizadas pelo Sistema Único de Saúde no período 2010-2016: estudo descritivo das hospitalizações no Brasil / Cirugías bariátricas realizadas por el Sistema Único de Salud en el período 2010-2016: estudio descriptivo de las hospitalizaciones en Brasil / Bariatric surgeries performed by the Brazilian National Health System in the period 2010-2016: a descriptive study of hospitalizations

Objetivo: caracterizar as hospitalizações pelo Sistema Único de Saúde (SUS) para realização de cirurgias bariátricas no Brasil, no período 2010-2016. Métodos: estudo descritivo de séries temporais, com dados do Sistema de Informações Hospitalares do SUS (SIH/SUS); sua população-alvo, pacientes na idade de 16 ou mais anos. Resultados: foram realizadas 46.035 internações (6.576/ano; 4,3/100 mil hab./ano); a média de idade foi de 39,0 anos (desvio-padrão: 10,4); o sexo feminino predominou (85,4%) e a faixa etária de 35-39 anos concentrou 18,0% dos casos; 16.923 pacientes (36,8%) necessitaram de unidade de tratamento intensivo (UTI); ocorreram 99 (0,2%) óbitos intra-hospitalares; a mediana de permanência hospitalar foi de 3 dias, e o intervalo interquartil, de 2 dias; o gasto médio anual foi de R$ 39.410.919,37 e o valor médio por internação atingiu R$ 5.992,75 (R$ 1.464,15/dia). Conclusão: as cirurgias bariátricas caracterizaram-se como procedimentos com adultos jovens do sexo feminino, uso frequente de UTI e baixa letalidade.

Objetivo: caracterizar hospitalizaciones por el Sistema Único de Salud (SUS) para cirugía bariátrica en Brasil, en el período 2010-2016. Métodos: estudio descriptivo con datos del Sistema de Información Hospitalaria del SUS (SIH/SUS); la población objeto se constituyó de pacientes con edad de 16 años o superior. Resultados: se realizaron 46.035 admisiones (6.576/año; 4,3/100 mil habitantes/año); la edad promedio fue de 39,0±10,4 años; el sexo femenino predominó (85,4%) y el grupo de edad de 35-39 años concentró 8.308 (18,0%) casos; 16.923 pacientes (36,8%) necesitaron unidad de tratamiento intensivo (UCI); se produjeron 99 (0,2%) muertes intrahospitalarias; la mediana de permanencia hospitalaria fue de 3 días y el rango intercuartil de 2 días; el gasto promedio anual fue de R$ 39.410.919,37 y el valor promedio por hospitalización de R$ 5.992,75 (R$ 1.464,15/día). Conclusión: las cirugías bariátricas se caracterizaron como procedimientos de mujeres adultas jóvenes, uso relativamente frecuente de la UCI y baja letalidad.

Objective: to characterize Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in Brazil, in the period 2010-2016. Methods: this was a descriptive study of time series using data from the SUS Hospital Information System (SIH/SUS); the target population consisted of patients aged 16 years and older. Results: there were 46,035 hospitalizations (6,576/year; 4.3/100,000 inhabitants/year); average age was 39.0 years old (SD:10.4); female sex predominated (85.4%), and the 35-39 age group accounted for 18.0% of cases; 16,923 patients (36.8%) needed to be admitted to the intensive care unit (ICU); there were 99 (0.2%) in-hospital deaths; the median hospital stay was 3 days, and the interquartile range was 2 days; average annual expense was R$ 39,410,919.37 and the average cost of hospitalization was R$ 5,992.75 (R$ 1,464.15/day). Conclusion: bariatric surgeries were characterized as procedures involving young female adults, frequent ICU use and low lethality.

Occupational Performance Issues of Adults Seeking Bariatric Surgery for Obesity.

OBJECTIVE: We sought to describe the occupational performance issues of a sample of bariatric surgery candidates and to explore the relationships among occupational performance, satisfaction with performance, demographic characteristics, and mental health factors. METHOD: We reviewed the health records of 241 bariatric surgery candidates and analyzed their scores on the Canadian Occupational Performance Measure (COPM) and standardized mental health questionnaires. RESULTS: Exercise and eating behavior were the most common occupational performance issues. Cognitive and affective issues were reported more frequently than physical issues. Occupational performance and satisfaction correlated negatively with anxiety and depression and positively with self-esteem. Self-esteem contributed 27% of the variance in occupational performance. CONCLUSION: COPM scores revealed a wide range of occupational performance issues and significant associations with mental health factors, supporting a psychosocial approach to occupational therapy with this population. Routine mental health screening can help ensure that mental health factors are adequately addressed.

Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis.

BACKGROUND: The risk of cardiovascular disease is reduced by bariatric surgery, but it is unknown if exercise after bariatric surgery reduces this risk even further. OBJECTIVE: To investigate if Roux-en-Y-gastric bypass (RYGB) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation, fibrin clot properties, and fibrinolysis. SETTING: Bariatric center, Hospital of Southwest Jutland, Denmark. METHODS: Sixty obese patients underwent RYGB and 6 months after RYGB were randomized to 26 weeks of physical training or a control group. Biomarkers within coagulation activation, fibrin clot properties, and fibrinolysis were measured presurgery, and 6, 12, and 24 months postsurgery. RESULTS: Six months after RYGB, the endogenous thrombin potential decreased from 1744 (1603-2003) to 1416 (1276-1582) nM × min (P<.001). Alterations in fibrin clot properties resulted in an increased clot lysis from 23.8% (16.1%-38.9%) to 40.3% (28.5%-59.35; P<.0001). Furthermore, fibrinogen was reduced from 12.6 (11.1-14.7) to 11.5 (9.90-13.3) µM (P<.001), and plasminogen activator inhibitor antigen was reduced from 40.5 (28.4-49.4) to 24.4 (15.4-32.7) ng/mL (P<.0001). Physical training after RYGB increased fibrinolytic activity from 58.0 (36.0-75.5) to 88.0 (66.0-132.0) IU/mL compared with 52.5 (30.0-80.0) to 64.0 (49.0-100.0) IU/mL in controls (P<.01) and reduced plasminogen activator inhibitor antigen from 23.5 (16.7-35.4) to 18.1 (14.3-25.4) ng/mL compared with 24.4 (13.9-28.7) to 24.2 (14.1-29.6) ng/mL in controls (P<.05). No effects of physical training were observed on markers of coagulation activation and fibrin clot properties. CONCLUSION: We observed favorable long-term reductions in markers of thrombin generation, improved fibrin clot properties, and increases in fibrinolysis after RYGB. Supervised physical training after RYGB further increased fibrinolysis.

Fat-Free Mass and Skeletal Muscle Mass Five Years After Bariatric Surgery.

OBJECTIVE: This study investigated changes in fat-free mass (FFM) and skeletal muscle 5 years after surgery in participants from the Longitudinal Assessment of Bariatric Surgery-2 trial. METHODS: A three-compartment model assessed FFM, and whole-body magnetic resonance imaging (MRI) quantified skeletal muscle mass prior to surgery (T0) and 1 year (T1), 2 years (T2), and 5 years (T5) postoperatively in 93 patients (85% female; 68% Caucasian; age 44.2 ± 11.6 years) who underwent gastric bypass (RYGB), sleeve gastrectomy, or adjustable gastric band. Repeated-measures mixed models were used to analyze the data. RESULTS: Significant weight loss occurred across all surgical groups in females from T0 to T1. FFM loss from T0 to T1 was greater after RYGB (mean ± SE: -6.9 ± 0.6 kg) than adjustable gastric band (-3.5 ± 1.4 kg; P < 0.05). Females with RYGB continued to lose FFM (-3.3 ± 0.7 kg; P < 0.001) from T1 to T5. A subset of males and females with RYGB and MRI-measured skeletal muscle showed similar initial FFM loss while maintaining FFM and skeletal muscle from T1 to T5. CONCLUSIONS: Between 1 and 5 years following common bariatric procedures, FFM and skeletal muscle are maintained or decrease minimally. The changes observed in FFM and muscle during the follow-up phase may be consistent with aging.

Optimising the Bariatric Patients' Outcome through Cardiac Rehabilitation Approach.

Bariatric surgery offers a therapeutic alternative with favourable weight management, cardiovascular, metabolic and functional outcomes. Bariatric individuals often have functional impairments pre-operatively that can be addressed to improve post-operative results and eventual functional independence. Multidisciplinary team offers the best approach to address peri-operative needs and sustainable weight loss thereafter. We exemplified the application of cardiac rehabilitation therapeutic model in managing two bariatric clients with specific bariatric-related challenges. Our approach focuses on adaptive physical activity, sustainable lifestyle changes to promote post-operative weight loss through education and problem solving as well as secondary prevention of cardiovascular disease. Putting emphasis on addressing physical and psychosocial barriers towards physical activity alongside nutritional aspects potentially confers sustained if not better outcomes on weight reduction and functional improvement.

Bariatric Outcomes: Self-Management for Sustained Surgical Success: A Multicomponent Treatment for Dysregulated Overeating in Bariatric Surgery Patients.

Binge eating disorder, food addiction, and dysregulated overeating are common among people with severe obesity and prevalent among bariatric surgery populations. These problematic eating habits share commonalities with other addictions. Effective, holistic self-management is needed to promote long-term weight loss and psychosocial adjustment among patients who are severely obese who undergo surgery, especially those with clinically remarkable levels of binge eating, food addiction, or dysregulated overeating.This article aims to briefly review binge eating disorder, food addiction, and obesity-as well as issues surrounding surgery for individuals who are severely obese-and introduce the Bariatric Outcomes: Self-management for Sustained Surgical Success (BOSSSS) program. The BOSSSS program is holistic, skill based, and designed to promote weight loss, prevent weight regain, and improve well-being in patients with severe obesity with a history of bariatric surgery.Preliminary survey data suggest that bariatric surgery patients report a lack of skill-based emotional and behavioral support designed to help them over the long term. The BOSSSS program is rooted in self-determination theory, integrating mobile health technology across program components. Self-determination theory-based interventions are personalized and encourage autonomy, competence, and social support among participating patients and providers. The behavioral self-regulation training within BOSSSS is energy balance self-monitoring and titration. Emotional self-regulation is addressed via a specialized version of dialectical behavior skills therapy, emphasizing promotion of coping skills and use of adaptive, healthy substances in immediate environments. The BOSSSS program has been well received by patients and could be implemented by nurses and other health professionals with minimal support.