Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre.

INTRODUCTION: Outcomes of long-term (5-10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. METHODS: Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. RESULTS: Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5-11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. CONCLUSIONS: IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.

Applying the quarter-hour rule: can people with insomnia accurately estimate 15-min periods during the sleep-onset phase?

The 'quarter-hour rule' (QHR) instructs the person with insomnia to get out of bed after 15 min of wakefulness and return to bed only when sleep feels imminent. Recent research has identified that sleep can be significantly improved using this simple intervention (Malaffo and Espie, Sleep, 27(s), 2004, 280; Sleep, 29 (s), 2006, 257), but successful implementation depends on estimating time without clock monitoring, and the insomnia literature indicates poor time perception is a maintaining factor in primary insomnia (Harvey, Behav. Res. Ther., 40, 2002, 869). This study expands upon previous research with the aim of identifying whether people with insomnia can accurately perceive a 15-min interval during the sleep-onset period, and therefore successfully implements the QHR. A mixed models anova design was applied with between-participants factor of group (insomnia versus good sleepers) and within-participants factor of context (night versus day). Results indicated no differences between groups and contexts on time estimation tasks. This was despite an increase in arousal in the night context for both groups, and tentative support for the impact of arousal in inducing underestimations of time. These results provide promising support for the successful application of the QHR in people with insomnia. The results are discussed in terms of whether the design employed successfully accessed the processes that are involved in distorting time perception in insomnia. Suggestions for future research are provided and limitations of the current study discussed.