Knowledge and attitude of candidates to gastroplasty about perioperative: randomized clinical trial.

OBJECTIVES: to evaluate the effectiveness of educational intervention in the knowledge and attitude of candidates for gastroplasty. METHODS: randomized controlled clinical trial with 56 preoperative patients (intervention=28; control=28). The control group received routine care from the health institution and the intervention group participated in a book-mediated educational intervention. Forms were used for clinical-epidemiological characterization and evaluation of knowledge/attitude about bariatric surgery, which were reapplied seven weeks after intervention. RBR-297fzx. RESULTS: in the pre-test there was no significant difference between the groups (p=0.254). In the post-test, the group that received verbal guidance had a mean score of 19.5 (± 6.17) and the group reading the booklet averaged 31.1 (± 2.96), p=0.000. The attitude is adequate, especially for care such as vitamin supplement intake, water intake and physical activity practice. CONCLUSIONS: the educational intervention mediated by booklet was effective in improving knowledge and attitude when compared to verbal guidance. Thus, it can be replicated during the preoperative preparation.

The effect of weight loss and exercise on Health-Related Quality of Life (HRQOL) following Endoscopic Bariatric Therapies (EBT) for obesity.

INTRODUCTION: Endoscopic bariatric therapies (EBT) have demonstrated to induce weight loss and improve comorbidities in obese patients. However, little is known about its impact on health-related quality of life (HRQOL) outcomes and physical activity status. This study aimed to evaluate the change in HRQOL and physical activity following EBT induced weight loss in obese patients. METHODS: We approached 181 patients who underwent EBT in a standardized multidisciplinary follow-up program to participate in the study. We provided them two questionnaires-a) Short Form-36 health survey with the physical (PSC) and mental (MSC) summary component scores to capture generic HRQOL, and b) international physical activity questionnaire (IPAQ) for physical activity (PA). We administered the survey at baseline and at 9 months post-procedure. We expressed the procedure outcome as percentage total body weight loss (%TBWL). We expressed continuous variables as mean (SD) or median and categorical variables as percentages. We used non-parametric tests for comparison and performed multivariable linear regression analysis to identify factors associated with improvement in HRQOL. RESULTS: The mean age was 42.2 (11.3) years, and the mean BMI was 38 (5.9)kg/m2. A majority of them were female (n-132, 73%). The EBT included intragastric balloons (n-136, 75%) and endoscopic sleeve gastroplasty (n-24, 25%). The mean %TBWL achieved after the intervention was 16.9 (9.7)%. We noticed a significant improvement in the median PSC (77.8 vs. 90.4, p < 0.001) and MSC (67 vs. 80.2, p < 0.001) scores after EBT. Similarly, we observed a significant positive change in physical activity compared to baseline (1606.2 vs. 2749 MET-minutes/week, p = < 0.001). Linear regression analysis showed an increase in %TBWL was associated with significant improvement in PSC (ß = 0.193, p = 0.003) and MSC (ß = 0.166, p = 0.02) scores of HRQOL, and likewise, increase in PA was independently associated with improvement in MSC (ß = 0.192, p = 0.01). We did not find any difference in outcome based on gender or the type of intervention. CONCLUSION: EBT improves HRQOL in obese patients regardless of the type of intervention. The weight loss induced by EBT and the improvement in PA positively influence the health outcomes and quality of life.

Preliminary evidence that endoscopic gastroplication reduces food reward.

Morbidly obese patients are most successfully treated with bariatric surgery. Although restrictive gastric surgery physically limits food intake, it is also suggested that eating behavior and food-reward mechanisms are affected. Therefore, eating behavior and food-reward were assessed in ten patients that underwent gastric volume reduction by endoscopic gastroplication. Patients participated in test days before and one, three and twelve months after the procedure. Weight loss, food intake, appetite, gastric emptying rate, food-reward (i.e. liking and wanting) and eating behavior were assessed. Body mass index decreased from 38.3 (37.6-42.6) to 33.9 (31.0-35.9) kg/m2 after one year. Ad libitum food intake decreased significantly after one month, but not after one year. Gastric emptying rate did not change. AUC of VAS scores for desire to eat, quantity, fullness, hunger, snacking and satiety changed after one month, but not all remained significantly changed after one year. Thirst did not change. Liking scores of food items decreased significantly in the fasted as well as the satiated state after the procedure. Wanting scores did not change. Uncontrolled eating decreased significantly after three and twelve months; emotional eating was only significantly decreased after three months. The results show that food intake decreases, while VAS scores for appetite and eating behavior change accordingly. Liking, but not wanting of food items changed to benefit the weight losing patient. The effects were stronger at one-month follow-up than at 12 months, which may be a risk of relapse after initial successful weight loss. The effects of new bariatric procedures on food-reward should be studied in future randomized trials to further elucidate their impact. REGISTERED AT CLINICALTRIALS. GOV: NCT02381340.

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding.

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Knowledge and attitude of candidates to gastroplasty about perioperative: randomized clinical trial / Conocimiento y actitud de candidatos a la gastroplastia sobre perioperatorio: ensayo clínico aleatorizado / Conhecimento e atitude de candidatos à gastroplastia sobre perioperatório: ensaio clínico randomizado

ABSTRACT Objectives: to evaluate the effectiveness of educational intervention in the knowledge and attitude of candidates for gastroplasty. Methods: randomized controlled clinical trial with 56 preoperative patients (intervention=28; control=28). The control group received routine care from the health institution and the intervention group participated in a book-mediated educational intervention. Forms were used for clinical-epidemiological characterization and evaluation of knowledge/attitude about bariatric surgery, which were reapplied seven weeks after intervention. RBR-297fzx. Results: in the pre-test there was no significant difference between the groups (p=0.254). In the post-test, the group that received verbal guidance had a mean score of 19.5 (± 6.17) and the group reading the booklet averaged 31.1 (± 2.96), p=0.000. The attitude is adequate, especially for care such as vitamin supplement intake, water intake and physical activity practice. Conclusions: the educational intervention mediated by booklet was effective in improving knowledge and attitude when compared to verbal guidance. Thus, it can be replicated during the preoperative preparation.

RESUMEN Objetivos: evaluar la efectividad de la intervención educativa en el conocimiento y la actitud de los candidatos a la gastroplastia. Métodos: ensayo clínico controlado aleatorizado con 56 pacientes del preoperatorio (intervención=28; Control=28). El grupo control recibió la atención de rutina de la institución de salud y el grupo intervención participó de intervención educativa mediada por un folleto. Se utilizaron formularios para la caracterización clínico-epidemiológica y evaluación del conocimiento/actitud sobre cirugía bariátrica, que se volvieron a aplicar siete semanas después de la intervención. RBR-297fzx. Resultados: en la pre-prueba, no hubo diferencias significativas entre los grupos (p=0,254). En la prueba posterior, el grupo que recibió orientación verbal tuvo un promedio de aciertos de 19,5 (± 6,17) y el grupo que leyó el folleto tuvo un promedio de aciertos de 31,1 (± 2,96), p=0,000. La actitud es adecuada, especialmente para los cuidados como tomar el suplemento vitamínico, tomar agua y practicar actividad física. Conclusiones: la intervención educativa mediada por un folleto demostró ser efectiva para mejorar el conocimiento y mantener una actitud positiva hacia la cirugía bariátrica, en comparación con la orientación verbal. Por lo tanto, se puede replicar durante la preparación preoperatoria.

RESUMO Objetivos: avaliar efetividade de intervenção educativa no conhecimento e atitude de candidatos à gastroplastia. Métodos: ensaio clínico controlado randomizado com 56 pacientes do pré-operatório (intervenção=28 e controle=28). O grupo controle recebeu cuidados de rotina da instituição de saúde e o grupo intervenção participou de intervenção educativa mediada por cartilha. Foram utilizados formulários para caracterização clínica-epidemiológica e avaliação do conhecimento/atitude sobre cirurgia bariátrica, os quais foram reaplicados sete semanas após intervenção. RBR-297fzx. Resultados: no pré-teste, não houve diferença significativa entre os grupos (p=0,254). No pós-teste, o grupo que recebeu orientação verbal teve média de acertos de 19,5 (± 6,17) e o grupo que leu a cartilha acertou, em média, 31,1 (± 2,96) p=0,000. A atitude é adequada, principalmente, para cuidados como tomada do suplemento vitamínico, ingesta hídrica e prática de atividade física. Conclusões: a intervenção educativa mediada por cartilha mostrou-se eficaz na melhoria do conhecimento e manutenção de atitude positiva em relação à cirurgia bariátrica, quando comparada à orientação verbal. Assim, pode ser replicada durante o preparo pré-operatório.

Laparoscopic vertical clip gastroplasty - quality of life.

BACKGROUND: Over the last decade, several techniques have emerged and the bariatric trends have changed. A new bariatric procedure that has been proposed is laparoscopic vertical clip gastroplasty (LVCG), which mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The introduction of a new procedure in the bariatric armamentarium necessitated a period of preclinical and clinical studies and a validation of the procedure concerning the quality of life. SETTING: Private hospital, Dominican Republic. OBJECTIVES: The purpose of this manuscript was to evaluate patient satisfaction, measured by various questionnaires after LVCG. METHODS: From November 2012 to February 2017, 138 patients underwent LVCG and demographic data were collected prospectively. A total of 82 were evaluated for quality of life with a minimum follow-up of 6 months after the procedure. The quality of life was also analyzed regarding the complications and resolution of different medical conditions included in the Bariatric Analysis and Reporting Outcome System score. RESULTS: Eighty-five patients (73.9%) agreed to participate in the study and a total of 82 patients completed the questionnaires at all points in time. Seventy-one patients were female, with an average age of 34 (19-38). Mean body mass index before operation was 42.4 kg/m2 and declined significantly in both the first and second year postoperatively to 33.7 kg/m2 (1-year follow-up) in 65 patients and 34.3 kg/m2 (2-year follow-up) in 37 patients. The results showed failure for 1.2% of patients and were fair for 6.1% of cases. Quality of life was assessed as good for 26 patients (31.8%), as very good for 39 patients (47.5%), and as excellent for 11 patients (13.4%). CONCLUSIONS: LVCG represents a new bariatric procedure that mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The procedure consists of a nonadjustable clip that is vertically placed parallel to the lesser curvature. After >3 years of clinical use, the weight loss results seem to be encouraging and up to 92.7% of patients have an improved quality of life.

Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

BACKGROUND: Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. OBJECTIVES: This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. SETTING: Hospital center and university in Portugal. METHODS: The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS: Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t387 = -5.35, P = .001), higher highest (t387 = -3.40, P = .001) and lower lowest body mass index (t381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F1,216 = 8.30, P<.001). CONCLUSIONS: Despite the preoperative similarities between patients undergoing reoperative or primary surgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes.

"It just made me feel so desolate": Patients' narratives of weight gain following laparoscopic insertion of a gastric band.

AIMS AND OBJECTIVES: To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity. BACKGROUND: Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people's longer-term experiences following LAGB insertion. DESIGN: A narrative-based qualitative interview study. METHODS: A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants' experiences. FINDINGS: Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery. CONCLUSION: Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long-term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction. RELEVANCE TO CLINICAL PRACTICE: Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients' needs when weight loss plateaus or weight is regained and intensify support during these periods.

Patients' reasons for and against undergoing Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy.

BACKGROUND: The most common bariatric procedures, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (LAGB), and sleeve gastrectomy (SG), generally induce significant weight loss and health improvements. However, little is known about how patients decide which procedure to undergo. OBJECTIVE: Investigate patients' reasons for and against undergoing RYGB, LAGB, and SG. SETTING: Online questionnaire. METHODS: Data were analyzed from 236 Australian adults with current RYGB (15.7%), LAGB (22.0%), or SG (62.3%) who completed a questionnaire including an open-ended question about why they underwent their procedure. Data were coded for content and analyzed. RESULTS: Patients most often underwent RYGB because of its evidence base and success rate and the patient's characteristics, whereas the most common reason for SG was a medical practitioner's recommendation, preference, or choice, followed by the patients' evaluation of information gathered from their own research and observations of others' success. The most common reasons for undergoing LAGB related to characteristics of the procedure, including its reversibility and a perception of LAGB as less invasive. The most common reason against undergoing both RYGB and SG was a desire to avoid postsurgical complications and risks such as leaks or malabsorption, whereas the most common reason against LAGB was information and evidence from other people's unsuccessful experiences and failure rates. CONCLUSIONS: Patients' reasons for and against procedures differed by procedure. In addition to the surgeon's influence, patients demonstrated clear procedure preferences based on their own research, knowledge, and experiences. Preferences should be understood to assist patients to select the most appropriate procedure for their circumstances.

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.

BACKGROUND: Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited. OBJECTIVE: To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. SETTING: 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015. RESULTS: Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]). CONCLUSIONS: Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

Sexual life after weight loss surgery.

BACKGROUND: Previous research revealed a relationship between higher body mass index (BMI) and lower sexual functioning. However, the role of psychosocial variables, such as body image, in this relationship has been understudied. OBJECTIVE: To assess sexual life before and after weight loss surgery (WLS) and examine the role of body image and BMI in these changes. SETTING: WLS center at a major urban community hospital. METHODS: 327 participants (275 women and 52 men) who underwent either laparoscopic Roux-en-Y gastric bypass surgery (n = 225) or laparoscopic adjustable gastric band (n = 102) were assessed on measures of sexual life preoperatively and at 1, 3, 6, 12, and 24 months after surgery. The number of completers were n = 126 at 1-month follow-up, n = 84 at 3 months, n = 86 at 6 months, n = 84 at 12 months, and n = 55 at 24 months. RESULTS: There was a significant increase in quality of sexual life over time, F(5,479.5) = 24.3, P<.001. Greater body image dissatisfaction predicted lower quality of sexual life when controlling for BMI, F(1,580.3) = 36.9, P<.001, but BMI did not predict quality of sexual life when controlling for body dissatisfaction, F(1,566.6)<.01, P = .94. A mediation analysis revealed that the relationship BMI had with sexual life was through its influence on body dissatisfaction. CONCLUSION: Participants experienced improvements in quality of sexual life over time after WLS, and decrease in body image dissatisfaction was the strongest predictor of these improvements. These results underscore the importance of body image, independent of weight loss, in postsurgical sexual life.

Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study.

BACKGROUND: The literature is rather mixed regarding the stability and the role of pre- and postoperative problematic eating behaviors (PEBs) on weight outcomes after bariatric surgery. OBJECTIVES: To investigate the stability of loss of control (LOC) eating and picking and/or nibbling from pre- to postoperative assessments, and to investigate whether pre- and postoperative PEBs are predictors of different weight loss trajectories. SETTING: Central Hospital, University, Portugal. METHODS: This longitudinal study assessed LOC eating and picking and/or nibbling before and approximately 2 years after laparoscopic adjustable gastric banding or Roux-en-Y gastric bypass through face-to-face interviews and 2 self-report measures. Weight across follow-up time was retrieved from hospital charts. Of the 130 patients invited to participate in the study, 100 were assessed preoperatively, and of these, 61 were also assessed postoperatively. RESULTS: Frequency of PEBs is similar pre- and postoperatively (37.7% and 45.9%, respectively) (McNemar χ2P = .832). Yet, about 40% ceased preoperative PEBs. Those with LOC preoperatively were more likely to develop picking and/or nibbling postoperatively (McNemar χ2P<.05). About 39.5% developed PEBs de novo after surgery. The presence of PEBs postoperatively was a significant predictor of different weight loss trajectories after both laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. Worse weight loss outcomes were found particularly at 17-20 months postsurgery. Preoperative PEBs were not a significant predictor. CONCLUSIONS: Our data do not support the stability of all PEBs across time, highlighting that the absence of preoperative PEBs does not preclude an unfavorable weight loss outcome after surgery. Postoperative but not preoperative PEBs are predictors of poorer weight loss trajectories after surgery.

Does Post-operative Psychotherapy Contribute to Improved Comorbidities in Bariatric Patients with Borderline Personality Disorder Traits and Bulimia Tendencies? A Prospective Study.

BACKGROUND: Borderline personality disorder (BPD) and eating disorders may affect the outcomes of bariatric surgery. This study was aimed to evaluate the influence of a post-operative dialectical behavioral therapy (DBT) intervention on weight loss and comorbidities in a sample of comorbid obese Italian patients with BPD traits and bulimia tendencies who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). METHODS: One hundred fifty-four LRYGB or LAGB patients showing BPD and bulimia traits and type II diabetes, hypertension, and/or sleep apnea (OSAS) voluntarily adhered to DBT (n = 72) or treatment as usual (n = 82) for 12 months after surgery. Total weight loss (%TWL) and remission/improvement of comorbidities were considered as outcomes. Differences between treatment groups and between LRYGB and LAGB subgroups were evaluated through Student's t test for TWL and chi-square test for comorbidities. RESULTS: DBT was more effective than treatment as usual (TAU) in reducing weight loss (p < .001). Reduction of comorbidities was higher in patients treated with DBT, as for diabetes (p = .68), hypertension (p = .02), and OSAS (p = .03). LRYGB outcomes seem to be significantly better than those of LAGB, mainly in TAU group. CONCLUSION: Our findings confirm the effectiveness of DBT in enhancing post-bariatric weight loss and reduction of comorbidities in patients showing BPD traits and bulimia tendencies. Further in-depth investigations and a longer follow-up are needed to strengthen these results.

Psychological contributors to noncompletion of an adolescent preoperative bariatric surgery program.

BACKGROUND: Noncompletion of preoperative bariatric programs is a significant problem among adolescents. Adult studies suggest that psychological factors contribute to noncompletion of preoperative bariatric programs. OBJECTIVE: The aim of this study was to determine the association between adolescent psychological functioning and completion of the preoperative phase of a bariatric program. SETTING: The study was conducted at a tertiary care children's hospital affiliated with a university medical center. METHODS: Seventy-four adolescents and their parents completed an assessment measure of psychological functioning with the Behavior Assessment System for Children, Second Edition. We compared these scores between adolescents who completed the preoperative phase of the bariatric program and proceeded to surgery (completers) to those who did not (noncompleters) using multivariate analysis of covariance and logistic regression analyses, adjusting for demographic characteristics and baseline body mass index. RESULTS: The mean age was 16.0 (1.1) years, most were female (79.8%), and the group was diverse (48.6%, Caucasian; 33.8%, black; 17.6%, other, including Hispanic, Asian, and biracial). Average body mass index was 50.5 (7.6) kg/m2. Forty-two percent of participants were noncompleters. Noncompleters were reported by parents to have more clinically significant externalizing and internalizing behaviors and fewer adaptive behaviors. Noncompleters self-reported more clinically significant internalizing symptoms, emotional problems, and poor personal adjustment. CONCLUSION: Adolescents who did not complete the preoperative phase of a bariatric surgery program had more clinically significant psychological symptoms across multiple domains compared with those who successfully proceeded to bariatric surgery. Early identification and treatment of psychological symptoms may be important in helping adolescents successfully proceed to surgery.

Patient and Parent Perspectives of Adolescent Laparoscopic Adjustable Gastric Banding (LAGB).

BACKGROUND: Adolescent obesity is a significant global health challenge and severely obese adolescents commonly experience serious medical and psychosocial challenges. Consequently, severe adolescent obesity is increasingly being treated surgically. The limited available research examining the effectiveness of adolescent bariatric surgery focuses primarily on bio-medical outcomes. There is a need for a more comprehensive understanding of the behavioural, emotional and social factors which affect adolescents' and parents' experience of weight loss surgery. METHODS: Patient and parents' perspectives of adolescent LAGB were examined using a qualitative research methodology. Individual, semi-structured interviews were conducted with eight adolescent patients and five parents. Thematic analysis was used to identify key themes in the qualitative data. RESULTS: Patients and parents generally considered adolescent laparoscopic adjustable gastric banding (LAGB) to be a life-changing experience, resulting in physical and mental health benefits. Factors considered to facilitate weight loss following surgery included parental support and adherence to treatment guidelines. Many adolescents reported experiencing surgical weight loss stigma and challenging interpersonal outcomes after weight loss for which they felt unprepared. CONCLUSIONS: Patients and parents perceived LAGB positively. There are opportunities to improve both the experience and outcomes of adolescent LAGB through parental education and enhancements to surgical aftercare programmes.

Laparoscopic adjustable gastric banding in adolescents: Results at two years including psychosocial aspects.

BACKGROUND/PURPOSE: Obesity now affects 3%-4% of the pediatric population and contributes to the increase in cardiac mortality in adulthood. Bariatric surgery is the best treatment for weight loss and the obesity-associated comorbidities in adults. We report here our experience of laparoscopic adjustable gastric banding (LAGB) in adolescents. METHODS: The medical charts of the first 16 patients operated on in our center were reviewed. Data were compiled concerning weight loss, physical and biological comorbidities, health-related quality of life (QOL) and surgical complications before surgery and during 24months of follow-up. RESULTS: The maximal pre-operative median body mass index was 43.0kg·m(-2), decreasing to 33.0kg·m(-2) at 2years post-LAGB, which corresponded to a 49.2% excess body weight loss (p<0.001). Most comorbidities (glucose intolerance, hypertension and sleep apnea) resolved within the first year post-LAGB and QOL was improved on the PedsQL™ scales. No severe surgical complications were noted, with only three re-interventions for device failure (2) or band removal (1). CONCLUSION: LAGB is well tolerated in adolescents and shows a beneficial impact on weight loss and obesity-related comorbidities. Associated with global management, it may have a positive impact on patients' QOL and social and psychological status.

Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates.

INTRODUCTION: Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown. METHODS: Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed. MATERIALS: The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131). RESULTS: CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures. CONCLUSIONS: Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.

Psychosocial presentation of revisional LAGB patients: a qualitative study.

This qualitative study offers insight into the experiences, expectations, perceptions and beliefs that may lead to laparoscopic adjustable gastric band patients' failure to achieve expected weight loss and seek revisional bariatric surgery. The 23 participants from two sites were interviewed and data were analysed from a grounded theory methodology in order to build a causal model. Analysis of participants' reports identified 'unrealistic expectations of the LAGB' as the core category. Additionally, the restriction of the band had a negative impact on participants' social interactions, leading to feelings of deprivation and, thus, to a desire for reward from food choices and consequently an increase of consumption of high-calorie-dense foods. These foods were chosen because of their specific texture or ability to provide reward. The resulting increase in weight or failure to achieve excess weight loss, led to feelings of shame and loneliness and emotional eating resulting in increased the consumption of rewarding foods. Thus, identifying unrealistic expectations of laparoscopic adjustable gastric band (LAGB) and emotional eating behaviours are important in those who are present initially for primary bariatric and revisional bariatric surgery, as they may contribute specifically to these patients' weight regain and consequent failure to achieve excess weight loss.

Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions.

BACKGROUND AND AIMS: Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. MATERIAL AND METHODS: This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. RESULTS AND CONCLUSIONS: Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.

Weight regain among women after metabolic and bariatric surgery: a qualitative study in Brazil / Reganho de peso em mulheres após cirurgia metabólica e bariátrica: estudo qualitativo no Brasil

INTRODUCTION: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome. METHOD: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP), in the state of São Paulo, Brazil. RESULTS: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists. CONCLUSION: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem (AU)

INTRODUÇÃO: Com o aumento do número de cirurgias bariátricas ao longo dos anos, têm chamado atenção os aspectos que contribuem ou impedem os resultados, entre eles o reganho de peso, mostram-se relevantes. Fatores psicológicos influenciam diretamente essa situação indesejada, mas há poucos estudos e controvérsias sobre o grau de participação desses fatores. Nós propomos uma investigação qualitativa para analisar os significados do reganho de peso depois da cirurgia para mulheres e como esses fatores influenciam esse resultado. MÉTODO: Este estudo usa o método clínico-qualitativo, por meio de entrevista semiestruturada com questões abertas em uma amostra intencional, fechada por saturação, com oito mulheres operadas no ambulatório de cirurgia bariátrica do Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), no estado de São Paulo. RESULTADOS: Um sentimento de derrota e fracasso surge com o reganho de peso, que colabora para o isolamento social; não há arrependimento, mas gratidão pela cirurgia; entre as pacientes, há uma ideia de sentir-se rejeitada maior que uma rejeição que existe de fato. CONCLUSÃO: Constatamos a necessidade de novos estudos qualitativos que auxiliem a equipe de saúde a entender melhor os fatores psicológicos dinâmicos envolvidos no significado do reganho de peso após a cirurgia bariátrica entre as mulheres para adotar condutas adequadas para lidar com esse problema (AU)