Factors Associated with Excess Skin After Bariatric Surgery: a Mixed-Method Study.

PURPOSE: After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences. MATERIALS AND METHODS: A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5 ± 9.9 years, Mtime post-MBS 34.2 ± 27.6 months). During phase I, ES quantity (arms, abdomen, thighs) and inconveniences and sociodemographic, anthropometric, clinical, and behavioral outcomes were assessed. In phase II, 7 focus groups were performed with 37 participants from phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data. RESULTS: Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r = .36, p < .01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r = .48, p < .05) and current BMI (r = .35, p < .05). Greater ES inconvenience was associated with higher social physique anxiety and age (R2 = .50, p < .01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes. CONCLUSION: Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

Physical activity motives, barriers, and preferences in people with obesity: A systematic review.

BACKGROUND: Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. METHODS: Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). RESULTS: From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity. CONCLUSIONS: Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.

Biopsychosocial correlates of physical activity and sedentary time in adults with severe obesity.

Adults with severe obesity have poorer health, are less active and spend more time sedentary compared to people with a lower body mass index (BMI). There is a pressing need to understand the factors associated with low physical activity (PA) and excessive sedentary time to develop more effective behaviour change interventions for this population. The purpose of this study was to identify biopsychosocial correlates of PA and sedentary time in adults living with severe obesity. Forty-four adults living with severe obesity (age = 50.5 ± 13.3 years; BMI = 44.3 ± 7.8 kg/m2 ) completed a survey including questions on sociodemographic characteristics, comorbidities, psychosocial factors (eg, social physique anxiety [SPA], social support for PA, PA level self-perception), quality of life, daily pain and self-reported moderate-to-vigorous intensity PA (MVPA). Participants also completed the 6-minute walk test (6MWT) to assess physical fitness and wore an accelerometer to assess objective PA and sedentary time. In stepwise linear multivariate analyses, higher objective MVPA was associated with higher 6MWT distance, being single and lower SPA (R2 = 0.46, P < .001), whereas higher self-reported MVPA was associated with greater PA level self-perceptions (R2 = 0.47, P < .001). Greater objective light intensity PA was associated with greater quality of life and self-efficacy for PA (R2 = 0.26, P = .001). Greater sedentary time was associated with having more comorbidities (R2 = 0.25, P < .001). This study shows that adults living with severe obesity who have more comorbidities, poorer quality of life and/or lower self-efficacy perception for PA are more likely to be sedentary and to practice less light intensity PA. Additionally, those who were in a relationship, had higher SPA and/or had lower physical fitness practiced less MVPA. Future research is needed to determine causal effects.

What Is Known About the Correlates and Impact of Excess Skin After Bariatric Surgery: a Scoping Review.

Although bariatric surgery (BS) improves health among adults with severe obesity, it results in excess skin in more than 70% of adults. The purpose of this study was to synthesize current knowledge on (1) the impact of excess skin experienced by adults after BS and (2) the correlates of excess skin quantity and inconveniences. PubMed, PsyArticles, and CINAHL databases were searched in May 2016 for relevant studies. Titles, abstracts, and full texts of studies retrieved were screened independently by two reviewers against inclusion criteria: (1) peer-reviewed primary research studies, (2) samples with adults who underwent BS, and (3) studies reporting the impact of excess skin and/or excess skin correlates. Thirteen quantitative and eleven qualitative studies met inclusion criteria. Negative physical, psychosocial, and daily life impacts of excess skin were reported in 67, 75, and 83% of studies, respectively. Women reported more excess skin and greater inconveniences of excess skin than did men. Based on the quantitative studies, pre-BS BMI, time since BS, and type of BS were not significantly associated with inconveniences of excess skin; findings were inconclusive for other correlates found (e.g. age, weight loss, BMI). Excess skin may adversely impact adults' physical and psychosocial functioning, as well as their activities of daily life after BS. However, evidence is lacking to determine which adults may be at heightened risk of developing or being negatively impacted by excess skin. More research on correlates of excess skill is needed to inform the development of tailored interventions in those more vulnerable to developing excess skin after BS to mitigate adverse consequences.

The adoption of physical activity and eating behaviors among persons with obesity and in the general population: the role of implicit attitudes within the Theory of Planned Behavior.

Obesity can be prevented by the combined adoption of a regular physical activity (PA) and healthy eating behaviors (EB). Researchers mainly focused on socio-cognitive models, such as the Theory of Planned Behavior (TPB), to identify the psychological antecedents of these behaviors. However, few studies were interested in testing the potential contribution of automatic processes in the prediction of PA and EB. Thus, the main objective of this study was to explore the specific role of implicit attitudes in the pattern of prediction of self-reported PA and EB in the TPB framework, among persons with obesity and in adults from the general population. One hundred and fifty-three adults participated to this cross-sectional study among which 59 obese persons (74% women, age: 50.6 ± 12.3 years, BMI: 36.8 ± 4.03 kg m-²) and 94 people from the general population (51% women; age: 34.7 ± 8.9 years). Implicit attitudes toward PA and EB were estimated through two Implicit Association Tests. TPB variables, PA and EB were assessed by questionnaire. Regarding to the prediction of PA, a significant contribution of implicit attitudes emerged in obese people, ß = .25; 95%[CI: .01, .50]; P = .044, beyond the TPB variables, contrary to participants from the general population. The present study suggests that implicit attitudes play a specific role among persons with obesity regarding PA. Other studies are needed to examine which kind of psychological processes are specifically associated with PA and EB among obese people.

Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis.

BACKGROUND: In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals. METHODS: An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I². RESULTS: Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose. CONCLUSIONS: Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.