Bariatric Times

MAY 2017

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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20 News and Trends Bariatric Times • May 2017 MENTAL HEALTH DOES NOT AFFECT BARIATRIC SURGERY WEIGHT LOSS RESULTS New Study Compares Bariatric Surgery Outcomes According to P reoperative Mental Illness SILVER SPRING, Maryland—People w ith pre-existing mental health conditions had nearly identical results in weight loss after bariatric surgery as compared to those with no known mental health conditions. Published in Obesity, the scientific journal of The Obesity Society (TOS), this is the first large scale study of its kind to examine the relationship of preoperative mental illness to weight loss and health care use after bariatric surgery. "Many clinicians are hesitant to consider bariatric surgery in the mentally ill population due to the assumption that they will not fare well. This research counters those assumptions, showing no difference, on average, in weight loss in the mentally ill versus non-mentally ill population," said TOS spokesperson Scott Kahan, MD, MPH, FTOS, Director of National Center for Weight and Wellness. "No prior research has evaluated this research question in a large and detailed study group. While all potential surgical patients should receive a thorough evaluation prior to considering surgery, this research suggests that there appears to be no outright reason to deny consideration of bariatric surgery in patients with mental illness who otherwise are good surgical candidates." Researchers reviewed electronic health record (EHR) data from over 8,000 adults with and without mental illness, from several health care systems across the United States in 2012-2013, to study weight loss and health care use patterns after bariatric surgery including post-surgery emergency department visits and hospitalization days. The study divided patients with mental illness into three groups: (1) mild to moderate depression or anxiety, (2) severe depression or anxiety and (3) bipolar, psychosis or schizophrenia spectrum disorders. In the study, groups were compared on weight loss by using generalized estimating equations using B-spline bases, and on all-cause emergency department (ED) visits and hospital d ays using zero-inflated Poisson and negative binomial regression, up to 2 years after surgery. The results concluded that mental illness was not predictive of differential weight loss up t o 2 years after bariatric surgery. "Our findings suggest that this powerful weight loss tool can be equally effective for different groups of patients regardless of pre-existing mental health conditions," said Kristina Henderson Lewis, MD, MPH, SM, Assistant Professor, Department of Epidemiology & Prevention Division of Public Health Sciences at Wake Forest Baptist Medical Center. Dr. Lewis cautioned that the majority of patients in this study came from systems where patients are psychologically screened prior to surgery, supporting the use of such screening to identify clinically-stable patients. Importantly, patients with pre-operative mental illness were observed to have higher use of the emergency department and hospital after bariatric surgery, a finding that may have clinical implications and requires further study. In an accompanying editorial published in Obesity, James Mitchell, MD, discussed the impact of pre- surgery mental illness on post-surgery weight loss, as well as post-surgery emergency department visits and hospitalization. He pointed out that while more research is needed on this topic, "The most important finding is that those with mental illness, even in its more severe forms, can experience significant weight loss after bariatric procedures that is similar to the weight loss seen in the non-mentally ill patients. The current findings suggest that health care providers need to strongly consider bariatric surgical procedures for their severely obese mentally ill patients who are in a period of relative stability." About The Obesity Society. The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: HEART ATTACKS, STROKES, AND OTHER MAJOR HEALTH EVENTS PLAY KEY ROLE IN DRIVING OLDER AMERICANS WITH OBESITY TO ADDRESS THEIR WEIGHT New Data Show Need for Healthcare Improvements for Older Americans with Obesity AUSTIN, Texas (PRNewswire)—A statistically significant greater proportion of older people with obesity (PwO) (16%) than younger ones (12%) reported that a specific medical event such as a heart attack or stroke greatly influenced their desire to manage their weight, according to new data from the Awareness, Care and Treatment In Obesity Management (ACTION) Study. These health event motivators may have led to a vigilant weight loss effort among older PwO study participants, who experienced greater success than younger ones (13%:9% respectively). The new data, which compare attitudes and behaviors of obesity management between PwO who are 65+ versus PwO who are 64 and younger, were presented at the 26th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists. 1 According to study co-author and ACTION steering committee member Angela Golden, DNP, FNP-C, FAANP, the research could be instrumental in helping health care practitioners (HCPs) better understand the need to "flip" this trend, to ensure that PwO get the help they need before a health crisis. "Obesity is linked to more than 230 other medical conditions, often more prevalent in the older generation," she said. "We know that even a 5- to 10- percent weight loss may significantly reduce health risks associated with obesity, so there is a pressing need for the health care community to focus on ensuring early and comprehensive access to obesity care. Collaboration between people with obesity and HCPs is a key part of the solution for addressing and treating this chronic, progressive disease and improving health outcomes." According to Golden, this will require PwO, especially older ones, a nd HCPs to shift the dialogue in the medical setting. Study findings show that currently, of those PwO who discussed their weight with HCPs, a lesser proportion (56%) of older PwO r eport that they "seek support" from their HCP for weight loss as compared with younger PwO (65%). Additionally, fewer older PwO (50%) reported having received a "formal diagnosis" of obesity as compared with younger PwO (56%).1 These findings held true despite older PwO reporting greater prevalence of obesity-related conditions such as high blood pressure, high cholesterol, diabetes and sleep apnea (variable by condition, as much as twice the prevalence as the younger group). 1 The ACTION Study was a cross- sectional U.S.-based study, conducted through online surveys, included over 3,000 adults with obesity (BMI ≥ 30 kg/m2 based on self-reported height and weight), of which 946 or 31% were 65 or older. REFERENCES 1. Look M, Golden A, Kyle T, et al. Insights and Perceptions of Obesity Management in Older People with Obesity: Results of National Study. Poster presentation presented at: AACE 2017; May 3–7, 2017; Austin, TX. About ACTION. The "Awareness, Care and Treatment In Obesity Management" (ACTION) study is the first U.S. nationwide study to investigate barriers to obesity management from the perspective of people with obesity, health care professionals and employers. In addition, the study aims to generate insights to guide collaborative action to improve obesity care, education and support. Sponsored by Novo Nordisk, the ACTION study was led by a multi- disciplinary steering committee comprised of representatives from The Obesity Society, the Obesity Action Coalition, and the Integrated Benefits Institute, as well as obesity experts in the fields of primary care, endocrinology, physiology and nursing. The study involved more than 3,000 people with obesity, 600 health care News and Trends MAY 2017

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