Bariatric Times

DEC 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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19 Journal Watch Bariatric Times • December 2017 Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the T oronto Bari-PSYCH study. Sockalingam S, Hawa R, Wnuk S, et al. Gen Hosp Psychiatry. 2017;47:7–13. doi: 10.1016/j.genhosppsych.2017.04.005 . Epub 2017 Apr 20. Synopsis: The authors examined the effect of pre-operative psychiatric factors on quality of life (QOL) and weight loss two years after surgery. In this prospective cohort study, titled the Toronto Bariatric Psychosocial Cohort Study, 156 patients were assessed pre- surgery between 2010 and 2014 for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at one and two years post-surgery. At two years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (p<0.001), younger age (p=0.005), and a history of a mood disorder as significant predictors of physical QOL. Only a history of a mood disorder (p=0.032) significantly predicted mental QOL (p=0.006). Pre-surgery weight (p<0.001) and a history of a mood disorder (p=0.047) were significant predictors of weight loss two years post-surgery. The authors found that bariatric surgery had a sustained impact on physical QOL but not mental QOL at two years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. They concluded that further research is needed to determine if these results are due to bariatric surgery candidate selection within this program. PMID: 28807141 Guiding patients toward the appropriate surgical treatment for obesity: should presurgery psychological correlates i nfluence choice between Roux- en-Y gastric bypass and vertical sleeve gastrectomy? Ames GE, Heckman MG, Diehl NN, et al. Obes Surg. 2 017;27(10):2759–2767. doi: 10.1007/s11695-017-2876-2. Synopsis: This study investigated psychological correlates and their influence on weight loss for patients who underwent Roux- en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG). Four hundred twenty-two patients (RYGB = 305; VSG = 117) completed screening questionnaires pre-surgery and underwent surgery between August 2012 and April 2015. The researchers concluded that patients who are psychologically higher functioning are more likely to complete the evaluation process and undergo bariatric surgery. For patients who had surgery, psychological correlates were not associated with weight loss outcome for either RYGB or VSG. PMID: 28815388 Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients. Paul L, van der Heiden C, Hoek HW. Curr Opin Psychiatry. 2017;30(6):474-479. doi: 10.1097/YCO.0000000000000359. Synopsis: The authors report on the recent literature of predictors of weight loss and the efficacy of cognitive behavioral therapy (CBT) in bariatric patients. They conclude that CBT seems to be effective in reducing risk factors for weight regain after bariatric surgery, such as disordered eating behavior and depression. Controlled studies with long-term follow-up and larger sample sizes are needed to investigate the long-term effect of CBT interventions on weight loss results and psychological well-being. PMID: 28795980 Effect of BMI on quality of life and depression levels after b ariatric surgery. Sierzantowicz R R, Lewko J, Hady HR, et al. Adv Clin Exp Med. 2017; 2 6(3):491–496. doi: 10.17219/acem/ 62246. Synopsis: To assess the effect of body mass index (BMI) on quality of life and depression levels depending on the type of bariatric surgery, researchers examined a group that included 57 women and 43 men aged 20 to 60 years (mean age 40 years) with BMI from 36 to 40kg/m 2 (31%) and over 40kg/m 2 (69%). Twelve patients (12%) underwent laparoscopic adjustable gastric binding (LAGB), 58 (58%) sleeve gastrectomy, and 30 (30%) Roux- en-Y gastric bypass (RYGB). The Bariatric Analysis and Reporting Outcome System (BAROS) was used to assess quality of life (QoL). The severity of mood disorders was assessed using the Self-Rating Scale of Depression and Anxiety. Six months or one year after bariatric surgery, the number of patients with BMI over 40kg/m 2 had decreased from 69 to 14 percent. The researchers found that the time since bariatric surgery contributed to a significant (p< 0.01) difference in BAROS outcomes. In the long- term perspective, they observed better quality of life. They concluded that MA-QoL II is a useful tool in assessing bariatric surgery, including quality of life. PMID: 28791825 Pre-surgery weight loss goals, depressive symptoms, and weight loss among women undergoing bariatric surgery. Freese KE, Althouse AD, Ramanathan R. Bariatr Surg Pract Patient Care. 2017;12(2):67–71. doi: 10.1089/bari.2016.0038. Synopsis: The authors conducted a subanalysis to determine whether preoperative weight loss goals are associated with postoperative weight loss and whether the effect is modified by preoperative depressive symptoms. Sixty-three women from an ongoing cohort study who were undergoing first-time bariatric surgery at a large, academic hospital in Pittsburgh, Pennsylvania, were included. Pre-surgery weight loss goals were positively associated with percentage excess body mass index loss (%EBMIL) 12 months after bariatric surgery, adjusting for preoperative body mass index, age, race, and marital status; this relationship was negatively modified by depressive symptoms. The association between goal %EBMIL and postoperative %EBMIL was attenuated when type of surgery was added to the model. They concluded that this initial report suggests that weight loss goals and depressive symptoms might be associated with achieved weight loss after bariatric surgery. If confirmed in larger cohorts, these findings might indicate that more personalized approaches will be needed when discussing weight loss goals with patients. PMID: 28660099 A q u i c k l o o k a t t h e n o t e w o r t h y a r t i c l e s i n b a r i a t r i c a n d m e t a b o l i c r e s e a rc h THIS MONTH'S TOPIC: PSYCHOLOGICAL ASPECTS OF BARIATRIC SURGERY Journal Watch

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