Bariatric Times

JUL 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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10 Review Bariatric Times • July 2016 INTRODUCTION Presently, obesity is a major public health problem where greater than 35 percent of adults in the United States population have obesity, which is defined as having a body mass index (BMI) greater than 30kg/m 2 . 1 The rapid rise in class II and III obesity (BMI>35kg/m 2 ) over the past 30 years is particularly alarming, as higher BMIs are associated with greater physical and mental health problems. Bariatric surgery has emerged as the most effective treatment available for patients suffering from medically complicated obesity (BMI > 35kg/m 2 ), 2 yet less than one percent of patients in the United States who may derive benefit from bariatric surgery actually undergo an operation. 3 Common barriers to undergoing bariatric surgery include lack of insurance coverage, fear that surgery is too risky, lack of understanding about the level and severity of one's obesity, and the perception that bariatric surgery is "the easy way out." 4 In recent years the understanding of the mechanisms of action of bariatric surgery has evolved from mechanical restriction and malabsorption of nutrient intake to a physiological model of bariatric surgery. Specifically, the current model proposes that bariatric surgery changes physiological signals that regulate energy balance and metabolic function resulting in the experience of reduced hunger, increased satiety, changes in food preference, reduced attention to food stimuli in the environment, and increased energy expenditure. 5–7 The weight loss operations most commonly performed in the United States are Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). 3 These operations result in weight losses of approximately 35 percent and 25 to 30 percent of initial body weight 12 to 24 months after surgery, respectively 8–10 with longitudinal data showing maintenance of 75 percent of lost weight after 10 years for RYGB. 11 Significant health improvements occur within three months after the weight loss operation, in particular improvement or remission of type 2 diabetes mellitus (T2DM). 12 Other health conditions that resolve or significantly improve following bariatric surgery include obstructive sleep apnea (OSA), hypertension, dyslipidemia, and hepatic steatosis, resulting in significant reductions in all-cause- mortality over 7 to 10 years after the operation. 13 Bariatric surgery has also been associated with improved mood, body image, self- efficacy, and quality of life. 14–17 Unequivocally, bariatric surgery improves physical and mental health for many patients with obesity in the first one to two years following the operation. However, the stability of these improvements over time has not been well documented. Many patients have high expectations for improvements in medical comorbidities, quality of life, body image, and relationships after bariatric surgery. 18 If patients' expectations are unmet, this may contribute to nonadherence to recommended lifestyle changes, weight regain, and the return of medical comorbidities in the future. A significant challenge for providers, therefore, is guiding by GRETCHEN E. AMES, PhD, ABPP; MATTHEW M. CLARK, PhD, ABPP; KAREN B. GROTHE, PhD, ABPP; MARIA L. COLLAZO-CLAVELL, MD; ENRIQUE F. ELLI, MD Bariatric Times. 2016;13(7):10–18. Talking to Patients about Expectations for Outcome after Bariatric Surgery: Weight Loss, Quality of Life, Body Image, and Relationships GRETCHEN E. AMES, PhD, ABPP Department of Psychiatry and Psychology, Mayo Clinic Jacksonville, Florida MATTHEW M. CLARK, PhD, ABPP Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota KAREN B. GROTHE, PhD, ABPP Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota MARIA L. COLLAZO-CLAVELL, MD Department of Endocrinology, Mayo Clinic, Rochester, Minnesota ENRIQUE F. ELLI, MD Division of General Surgery, Mayo Clinic, Jacksonville, Florida ABSTRACT Research studies have demonstrated that patients have unrealistic expectations for weight loss after having bariatric surgery. If patients' expectations are unmet, this may contribute to nonadherence to recommended lifestyle changes, weight regain, and the return of medical comorbidities in the future. In this article, the authors review available literature on patients' presurgery expectations for changes in weight, quality of life, body image, and relationships after bariatric surgery and provide recommendations on how healthcare providers can guide patients toward achieving an accurate understanding of treatment outcome. Patient vignettes on the topics of expectations for weight loss, body image, and relationships further illustrate how healthcare providers might talk to patients about expectations for outcomes after bariatric surgery. KEYWORDS weight loss, bariatric surgery, body image, expectations, quality of life, counseling, psychology

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