Impact of pain in overweight to morbidly obese women: preliminary findings of a cross-sectional study.

OBJECTIVES: To evaluate the effect of body mass index (BMI) on the prevalence, intensity and interference of pain in women, and how it affects quality of life and level of physical activity; and to determine independent predictors of pain intensity. DESIGN: Cross-sectional observational study. SETTINGS: Obesity treatment clinic, community and university laboratory. PARTICIPANTS: Seventy-three of 133 women aged 25-75 years reported the presence of pain for at least 2 weeks and were categorised according to BMI (normal weight, overweight, obese or morbidly obese). MAIN OUTCOME MEASURES: BMI and questionnaires [McGill Pain Questionnaire (MPQ), Brief Pain Inventory (BPI), Short-Form Health Survey-36 (SF-36) and Baecke Physical Activity Questionnaire]. RESULTS: Pain intensity was 3 and 4.5 times higher in the MPQ and BPI, respectively, in morbidly obese women compared with women of normal weight. Morbidly obese women had 10.7 times higher pain interference and lower scores on the SF-36 domains of physical function and role function-physical compared with women of normal weight. Obese and morbidly obese women had less pain relief from treatment. Regression analysis showed that high BMI and low level of physical activity contributed to the intensity of pain, and these variables explained 16% of the variance of pain intensity. CONCLUSIONS: This study found that the prevalence and intensity of pain are greater in morbidly obese women than women of normal weight, and pain is negatively associated with physical activity. The causal inter-relationships between pain, obesity and physical activity are complex and require further study.

A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life.

BACKGROUND: Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. METHOD: Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS: The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. CONCLUSION: After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

Gene polymorphisms and increased DNA damage in morbidly obese women.

Obesity is characterized by increased adipose tissue mass resulting from a chronic imbalance between energy intake and expenditure. Furthermore, there is a clearly defined relationship among fat mass expansion, chronic low-grade systemic inflammation and reactive oxygen species (ROS) generation; leading to ROS-related pathological events. In the past years, genome-wide association studies have generated convincing evidence associating genetic variation at multiple regions of the genome with traits that reflect obesity. Therefore, the present study aimed to evaluate the relationships among the gene polymorphisms ghrelin (GHRL-rs26802), ghrelin receptor (GHSR-rs572169), leptin (LEP-rs7799039), leptin receptor (LEPR-rs1137101) and fat mass and obesity-associated (FTO-rs9939609) and obesity. The relationships among these gene variants and the amount of DNA damage were also investigated. Three hundred Caucasian morbidly obese and 300 eutrophic (controls) women were recruited. In summary, the results demonstrated that the frequencies of the GHRL, GHSR, LEP and LEPR polymorphisms were not different between Brazilian white morbidly obese and eutrophic women. Exceptions were the AA-FTO genotype and allele A, which were significantly more frequent in obese women than in the controls (0.23% vs. 0.10%; 0.46 vs. 0.36, respectively), and the TT-FTO genotype and the T allele, which were less frequent in morbidly obese women (p<0.01). Furthermore, significant differences in the amount of genetic lesions associated with FTO variants were observed only in obese women. In conclusion, this study demonstrated that the analyzed SNPs were not closely associated with morbid obesity, suggesting they are not the major contributors to obesity. Therefore, our data indicated that these gene variants are not good biomarkers for predicting risk susceptibility for obesity, whereas ROS generated by the inflammatory status might be one of the causes of DNA damage in obese women, favoring genetically related diseases as obesity comorbidities.