Systematic Review of Mindfulness-Based Interventions for Weight Management Among Pre- and Post-bariatric Surgery Patients.

Context: Bariatric surgery has been an effective treatment for severe obesity. However, it can be challenging for bariatric-surgery patients to reach and maintain long-term weight loss. Behavioral interventions may be beneficial in reducing weight and improving the psychological outcomes of bariatric patients. Objective: The review intended to evaluate the benefits of mindfulness training for weight management among pre- and postoperative, bariatric-surgery patients and to help determine the design of the most effective mindfulness program for them. Design: The research team performed a systematic narrative review by searching the Medline, Excerpta Medica Database (EMBASE), PsycINFO, Web of Knowledge, PubMed, and CENTRAL databases. The search terms included mindfulness-based therapy, stress reduction, relaxation therapy, meditation, and acceptance and commitment therapy. Eligible studies included those using interventions that examined the impact of mindfulness on weight loss for bariatric-surgery patients. Due to the heterogeneity of the included studies, the research team conducted a narrative synthesis rather than a meta-analysis. Setting: The review took place in the Community Health Sciences Department at the College of Applied Medical Sciences of King Saud University in Riyadh, Kingdom of Saudi Arabia. Outcome Measures: Primary outcomes included indicators of body-weight change, such as kilograms, pounds, or BMIs. Secondary outcomes included changes: (1) in eating behavior, such as in binge eating, grazing behavior, craving behavior, and emotional eating, (2) in caloric intake, (3) in mental health, including a reduction in anxiety or depression, (4) in quality of life, (5) mindfulness acceptability and practice, (6) in physical activity, and (7) in glycated hemoglobin (HbA1c). Results: The research team included eight studies in the review. One study aimed to explore the impact of mindfulness on pre-operative patients, and the remaining seven studies measured the impact among postoperative individuals. Most studies suggested that mindfulness-based interventions can have a positive impact on weight outcomes and eating behaviors. The team also found promising effects for mental health outcomes, including anxiety and depression. It's important to note that the included studies reported no strategies that examined treatment fidelity and the monitoring of an intervention's delivery. Conclusions: Preliminary results suggest that mindfulness-based interventions can be useful in tackling eating disorders and in promoting weight loss among bariatric individuals. Further studies are warranted in this area to make explicit recommendations that inform pre- and post-bariatric guidelines. The field needs further well-developed studies to understand the impact of mindfulness on weight loss in the long term.

Quality of Life after Bariatric Surgery-A Systematic Review.

BACKGROUND: Most studies analyzing the health-related quality of life (HRQOL) after bariatric treatment ceased at five years post-surgery or even earlier, and it is unclear whether the HRQOL benefit persists for a longer time. This paper reviews sparse evidence regarding HRQOL in patients who underwent bariatric surgery at least nine years prior. MATERIALS AND METHODS: A of PubMed, Scopus and Google Scholar between 2007-2021 was carried out for the studies investigating HRQOL as an outcome measure in patients after bariatric surgery of any type and having at least a 9-year follow-up. Inconsistent reporting of weight loss or postgraduate study results unrelated to QoL were not included in the study. The study used the PICO procedure. RESULTS: The review of 18 identified publications demonstrated that bariatric treatment seems to provide a persistent benefit in terms of HRQOL, especially its physical component score. Due to psychological predispositions, some patients appear to be less likely to benefit from bariatric treatment, whether in terms of HRQOL or bodyweight reduction. Inconsistent and imprecise studies may limit the evidence included in a review. CONCLUSIONS: The early identification of such patients and providing them with holistic care, including psychological intervention, would likely further improve the outcomes of bariatric treatment.

Proof of Concept for a Mindfulness-Informed Intervention for Eating Disorder Symptoms, Self-Efficacy, and Emotion Regulation among Bariatric Surgery Candidates.

Up to 64% of patients seeking bariatric (weight-loss) surgery report eating disorder (ED) symptoms (addictive-like eating, binge eating, emotional eating, grazing) that can interfere with post-surgical weight loss. This prospective proof-of-concept study aimed to evaluate the impact of a pre-surgical mindfulness-informed intervention (MII) on ED symptoms and potential mechanisms-of-action to inform optimization of the intervention. Surgery-seeking adults attended four, 2-hour, MII sessions held weekly. Participants completed validated questionnaires assessing ED symptoms, eating self-efficacy, emotion regulation, and mindful eating pre-MII, post-MII, and at a 12-week follow-up. The MII consisted of mindfulness training, with cognitive, behavioral, and psychoeducational components. Fifty-six patients (M = 47.41 years old, 89.3% female) participated. Improvements in addictive-like eating, binge eating, emotional eating, and grazing were observed from pre- to post-MII. ED symptom treatment gains were either maintained or improved further at 12-week follow-up. Eating self-efficacy and emotion regulation improved from pre-MII to follow-up. Scores on the mindful eating questionnaire deteriorated from pre-MII to follow-up. In mediation analyses, there was a combined indirect effect of emotion regulation, eating self-efficacy, and mindful eating on grazing and binge eating, and an indirect effect of emotion regulation on emotional eating and addictive-like eating. Participation in the MII was associated with improvements in ED symptoms and some mechanisms-of-action, establishing proof-of-concept for the intervention. Future work to establish the MII's efficacy in a randomized controlled trial is warranted.

The effects of bariatric surgery on psychological aspects of eating behaviour and food intake in humans.

Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1-2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.

Feasibility and acceptability of an integrated behavioral medicine service within a post-bariatric surgery clinic.

BACKGROUND: Long-term medical and psychological follow-up after weight loss surgery is associated with improved patient outcomes. Weight regain after weight loss surgery is a common concern that has behavioral and psychological components; however, most patients do not attend behavioral medicine (BMED) follow-up appointments post-surgery. Innovative treatment models are needed to improve access to BMED to optimize long-term outcomes. OBJECTIVES: This study aimed to examine the feasibility and acceptability of an integrated BMED service within a bariatric surgery clinic. SETTING: University medical center, outpatient clinic. METHODS: Patients (n = 198) in a post-bariatric surgery clinic were screened for psychosocial/behavioral concerns and offered a same-day BMED consult, when appropriate. Patients rated their satisfaction with the consult and their confidence in being able to carry out the plan created during the consult. RESULTS: The top 3 concerns identified during screenings were emotional eating, body image, and cravings. The top 3 concerns addressed during consults were emotional eating, mood, and cravings. The mean length of consult was 26.1 minutes. The mean severity of problems addressed was 7 of 10. Patients' confidence ratings had a mean of 9.4 of 10 (1 = low, 10 = high) and satisfaction ratings had a mean of 9.8 of 10. CONCLUSIONS: In this clinic, the integration of a BMED service provided 40% of patients with behavioral intervention for psychosocial/behavioral concerns during routine surgery follow-up appointments. Patients indicated high satisfaction with consults and reported high confidence in being able to carry out the plan created during the consult.

Quality of Life One Year After Bariatric Surgery: the Moderator Role of Spirituality.

BACKGROUND: This study aimed to assess quality of life in obese patients 1 year after bariatric surgery taking into consideration the influence of socio-demographic, clinical, and psychological variables. METHODS: A sample of 90 patients undergoing bariatric surgery was assessed in two moments: before surgery and 1 year after surgery. RESULTS: Social support, problem-focused coping strategies, and quality of life increased after surgery, while eating disorder behaviour and impulsiveness decreased. The presence of eating disorder behaviour predicted worse physical and mental quality of life and higher satisfaction with social support predicted better physical and mental quality of life. In addition, higher impulsiveness predicted worse mental quality of life. Spirituality moderated the relationship between impulsiveness and mental/physical quality of life. CONCLUSIONS: Interventions should focus on promoting social support and coping strategies particularly spirituality since it played an important role in quality of life.

Patient Perspectives on Adherence with Micronutrient Supplementation After Bariatric Surgery.

BACKGROUND: Adherence to post-bariatric surgery nutritional supplements can be poor and is associated with higher micronutrient deficiency rates. There is currently no available study specifically seeking patients' perspectives on the reasons behind poor adherence and how to address it. METHODS: Bariatric surgery patients living in the UK were invited to take part in an anonymous survey on SurveyMonkey®. RESULTS: A total of 529 patients (92.61% females, mean age 47.7 years) took part. Most of these patients had undergone either a Roux-en-Y gastric bypass (63.0%) or sleeve gastrectomy (24.0%). Most of the patients were in full-time (49.0%, n = 260/529) or part-time (15.7%, n = 83/529) employment. Approximately 54.0% (n = 287/529) of the respondents reported having trouble taking all their supplements. Males were significantly more likely to report complete compliance. The most important reported reason for poor compliance was difficulty in remembering (45.6%), followed by too many tablets (16.4%), side effects (14.3%), cost (11.5%), non-prescribing by GP (10.8%), bad taste (10.1%), and not feeling the need to take (9.4%). Patients suggested reducing the number of tablets (41.8%), patient education (25.7%), GP education (24.0%), reducing the cost (18.5%), and more information from a healthcare provider (12.5%) or a pharmacist (5.2%) to improve the compliance. CONCLUSIONS: This study is the first attempt to understand patient perspectives on poor adherence to post-bariatric surgery nutritional recommendation. Patients offered a number of explanations and also provided with suggestions on how to improve it.

Guided imagery relaxation therapy on preoperative anxiety: a randomized clinical trial.

OBJECTIVE: to evaluate the effect of relaxation therapy with guided imagery on state anxiety and cortisol in the immediate preoperative period in patients submitted to bariatric surgery by videolaparoscopy. METHOD: a randomized, triple-blind clinical trial in a large teaching hospital in the interior of Minas Gerais. Twenty-four patients who would undergo video-laparoscopic bariatric surgery were randomly allocated in two groups, namely 12 in the control group and 12 in the experimental group. State anxiety was assessed by the State-Trait Anxiety Inventory, and blood cortisol levels were measured before and after the intervention or standard care. Descriptive analyzes were used for the quantitative variables and Student's t-test for independent samples, in the analysis of the differences between the state anxiety scores and cortisol levels. RESULTS: the experimental group presented a statistically significant reduction of the state anxiety scores (p = 0.005) as well as of cortisol levels (p <0.001) after the intervention. CONCLUSION: guided imagery relaxation therapy is an effective nursing intervention for the reduction of state anxiety and blood cortisol levels in the preoperative period in patients undergoing video-laparoscopic bariatric surgery. Brazilian Registry of Clinical Trials: RBR-5qywrf.

Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement.

BACKGROUND: Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE: To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING: Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS: This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS: A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION: Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.

A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery.

BACKGROUND: Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. METHODS: A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. RESULTS: The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02 % throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. CONCLUSIONS: These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.

The effects of healing touch on pain, nausea, and anxiety following bariatric surgery: a pilot study.

CONTEXT: Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch. OBJECTIVE: A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery. DESIGN: Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales. RESULTS: Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients.

Which facets of mindfulness are related to problematic eating among patients seeking bariatric surgery?

There has been growing research indicating the potential positive benefits of mindfulness-based interventions for obesity, but few studies have examined the relationship of mindfulness processes to obesity-related behaviors, particularly among clinical populations such as bariatric surgery candidates. The current study examined the relationship of specific mindfulness facets to a variety of problematic eating behaviors assessed through diagnostic interviews in a clinical sample of 820 patients seeking bariatric surgery. Results indicated that greater mindfulness on specific facets, particularly acting with awareness, was related to less binge and emotional eating. Greater mindfulness was also related, though less consistently, to less habitual overeating and grazing. The observing facet was generally unrelated to problematic eating, but in a few cases being more observant related to having greater eating problems. The results of the study and future directions are discussed in relation to research on problematic eating in obesity and mindfulness-based interventions.

The effect of bariatric surgery on psychiatric course among patients with bipolar disorder.

OBJECTIVE: Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder. METHODS: A matched cohort study (2006-2009) with mean follow-up of 2.17 years was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. RESULTS: A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83-1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (-0.4 visits/year, 95% CI: -0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: -0.1 to 1.0). CONCLUSIONS: Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery.

[Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients]. / Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica.

OBJECTIVE: To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. METHOD: An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables RESULTS: The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. CONCLUSIONS: The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

Monitoring and normalising a lack of appetite and weight loss. A discursive analysis of an online support group for bariatric surgery.

A significant adjustment in eating practices is required before and after bariatric surgery, yet we know relatively little about how patients manage these changes. In this paper, we explored how members of an online bariatric support group constructed their appetite and weight loss. Two hundred and eighty four online posts were collected, covering a period of just over a year, and analysed using discursive psychology. We found that a lack of appetite post-surgery was oriented to as something that was positively evaluated yet a cause for concern. Indeed, members monitored their food intake and marked out food consumption as a necessary activity in line with notions of healthy eating. Through monitoring members also normalised periods of weight stabilisation and were inducted into a group philosophy which encouraged a more holistic approach to post-surgery 'success'. Our analysis also highlights how monitoring and policing work as social support mechanisms which help to maintain weight management. Thus we argue, in line with others, that weight management, typically depicted as an individual responsibility, is bound up with the social practices of the online support group. We suggest that clinical advice about a loss of appetite and periods of weight stabilisation post-surgery perhaps need further explanation to patients.

Health-related quality of life following a surgical weight loss intervention.

Nursing is concerned with the well-being of the whole person; therefore, understanding the patient's perspective of the impact of a surgical weight loss intervention (SWLI) is essential. The purpose of this study was to examine the self-reported health-related quality of life of individuals after a SWLI. A convenience sample of participants in a post-SWLI support group completed the SF-12v2, a demographic form and a global quality of life measure. Findings indicate that although overall quality of life was rated excellent or very good, self-report of health-related quality on social functioning, vitality, and mental health was less positive. The findings of this pilot study indicate the need for research regarding the understanding of the meaning of psychosocial and physiological well-being to the person who undergoes a SWLI and a need for a more holistic support focus inclusive of psychosocial development strategies. As nurses committed to the wholeness of individuals, it is critical that we recognize the social and emotional needs of this emerging group of patients and implement strategies to enhance individual wholeness and well-being after SWLI.

Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies.

This review is an update of the long-term follow-up of nutritional and metabolic issues following bariatric surgery, and also discusses the most recent guidelines for the three most common procedures: adjustable gastric bands (AGB); sleeve gastrectomy (SG); and roux-en-Y gastric bypass (GBP). The risk of nutritional deficiencies depends on the percentage of weight loss and the type of surgical procedure performed. Purely restrictive procedures (AGB, SG), for example, can induce digestive symptoms, food intolerance or maladaptative eating behaviours due to pre- or postsurgical eating disorders. GBP also has a minor malabsorptive component. Iron deficiency is common with the three types of bariatric surgery, especially in menstruating women, and GBP is also associated with an increased risk of calcium, vitamin D and vitamin B12 deficiencies. Rare deficiencies can lead to serious complications such as encephalopathy or protein-energy malnutrition. Long-term problems such as changes in bone metabolism or neurological complications need to be carefully monitored. In addition, routine nutritional screening, recommendations for appropriate supplements and monitoring compliance are imperative, whatever the bariatric procedure. Key points are: (1) virtually routine mineral and multivitamin supplementation; (2) prevention of gallstone formation with the use of ursodeoxycholic acid during the first 6 months; and (3) regular, life-long, follow-up of all patients. Pre- and postoperative therapeutic patient education (TPE) programmes, involving a new multidisciplinary approach based on patient-centred education, may be useful for increasing patients'long-term compliance, which is often poor. The role of the general practitioner has also to be emphasized: clinical visits and follow-ups should be monitored and coordinated with the bariatric team, including the surgeon, the obesity specialist, the dietitian and mental health professionals.

Psychological considerations for bariatric surgery among older adults.

Older adults are increasing in weight along with the rest of the United States population. Likewise, their rates of bariatric surgery have been on the rise with changes in insurance coverage, evidence of the safety of surgery, and importance of quality of life during older age. Unfortunately, limited research has addressed the unique experiences of older adults and there are no specific guidelines that provide an effective strategy for presurgical psychological evaluation of this group. Therefore, this review aims to address considerations for psychological evaluation of older adults by adapting the current guidelines available, within the framework of a "patient-centered" approach that emphasizes individual needs. Considerations reviewed include psychosocial (e.g., developmental stage, quality of life, level of stress, and coping ability) and cognitive concerns (e.g., capacity to give informed consent, realistic expectations, and adherence to permanent lifestyle change).