Background
Post-operative nutritional deficiencies are a common complication following bariatric surgery. The incidence and time of occurrence are not clear, and the efficacy of supplementation ...remains questionable. Clear guidelines for nutritional follow-up and counselling are needed.
Methods
Preoperative and post-operative deficiencies were determined in a group of 427 gastric bypass patients. The predictive value of preoperative laboratory findings for the development of post-operative deficiencies, the time of occurrence and the effect of supplementation of common deficiencies was studied.
Results
Most common preoperative deficiencies were of folic acid (21.3 %), vitamin D3 (17.5 %) and iron (21.8 %). Post-operative, a significant increase in the number of patients with anaemia and deficiencies of ferritin and vitamin B12 was found. Most deficiencies occur between 12 and 15 months post-operatively, but vitamin D3 deficiency occurs significantly earlier at 9.7 months. A preoperative iron, folic acid or ferritin deficiency results in a significant higher risk for developing a post-operative deficiency despite supplementation, and ferritin deficiency occurs significantly earlier in these patients. Oral treatment of post-operative vitamin B12 and vitamin D3 deficiencies was successful in more than 80 % of the patients in contrast to oral treatment of anaemia which was only successful in 62.5 % of the patients.
Conclusion
Our study emphasizes the importance of preoperative assessment and treatment of nutritional deficiencies in morbidly obese patients undergoing gastric bypass surgery. Despite limited efficacy, post-operative oral supplementation should be encouraged as it decreases the incidence of deficiencies.
Purpose
The RAND-36 is the most frequently used patient-reported outcome measure (PROM) to evaluate health-related quality of life (HRQoL) in bariatric surgery. However, the RAND-36 has never been ...adequately validated in bariatric surgery. The purpose of this study was to validate the RAND-36 in Dutch patients undergoing bariatric surgery.
Material and Methods
To validate the RAND-36, the following measurement properties were assessed in bariatric surgery patients: validity (the degree to which the RAND-36 measures what it purports to measure (HRQoL)), reliability (the extent to which the scores of the RAND-36 are the same for repeated measurement for patients who have not changed in HRQoL), responsiveness (the ability of the RAND-36 to detect changes in HRQoL over time).
Results
Two thousand one hundred thirty-seven patients were included. Validity was not adequate due to the irrelevance of some items and response options, the lack of items relevant to patients undergoing bariatric surgery, and the RAND-36 did not actually measure what it was intended to measure in this study (HRQoL in bariatric surgery patients). Reliability was insufficient for the majority of the scales (the scores of patients who had not changed in HRQoL were different when the RAND was completed a second time (intraclass correlation coefficient (ICC) values 0.10–0.69)). Responsiveness was insufficient.
Conclusion
The RAND-36 was not supported by sufficient validation evidence in patients undergoing bariatric surgery, which means that the RAND-36 does not adequately measure HRQoL in this patient population. Future research studies should use PROMs that are specifically designed for assessing HRQoL in patients undergoing bariatric surgery.
Graphical abstract
Summary
Quality of life is a key outcome that is not rigorously measured in obesity treatment research due to the lack of standardization of patient‐reported outcomes (PROs) and PRO measures (PROMs). ...The S.Q.O.T. initiative was founded to Standardize Quality of life measurement in Obesity Treatment. A first face‐to‐face, international, multidisciplinary consensus meeting was conducted to identify the key PROs and preferred PROMs for obesity treatment research. It comprised of 35 people living with obesity (PLWO) and healthcare providers (HCPs). Formal presentations, nominal group techniques, and modified Delphi exercises were used to develop consensus‐based recommendations. The following eight PROs were considered important: self‐esteem, physical health/functioning, mental/psychological health, social health, eating, stigma, body image, and excess skin. Self‐esteem was considered the most important PRO, particularly for PLWO, while physical health was perceived to be the most important among HCPs. For each PRO, one or more PROMs were selected, except for stigma. This consensus meeting was a first step toward standardizing PROs (what to measure) and PROMs (how to measure) in obesity treatment research. It provides an overview of the key PROs and a first selection of the PROMs that can be used to evaluate these PROs.
Purpose
Sleeve gastrectomy (SG) is the most popular type of bariatric surgery. It has often been compared to Roux-en-Y gastric bypass (RYGB) in terms of clinical outcomes. However, health-related ...quality of life (HRQoL) has been sparsely studied after SG. The goal was to study HRQoL after SG using a generic (RAND-36) and an obesity-specific (impact of weight on quality of life-lite, IWQOL-lite) questionnaire and to compare the results with RYGB.
Methods
HRQoL and weight were measured before and 9, 15, and 24 months after surgery. RAND-36 physical health summary (PHS) and mental health summary (MHS), and IWQOL-lite total score were calculated. A mixed model analysis was conducted to study the change in HRQoL and compare SG with RYGB.
Results
A total of 219 patients (8.7%) underwent a SG and 2309 patients (91.3%) a RYGB. PHS, MHS, and IWQOL-lite significantly improved after SG when comparing baseline to all follow-up moments (
p
< 0.001 in all). There were no significant differences when comparing SG with RYGB: change in PHS (
β
− 0.10, 95% CI − 1.24 to 1.04,
p
= 0.861), MHS (
β
− 0.51, 95% CI − 1.56 to 0.52,
p
= 0.330), and IWQOL-lite (
β
0.310, 95% CI − 0.85 to 1.47,
p
= 0.601).
Conclusion
HRQoL significantly improved after SG. In the included populations, weight loss was comparable and the extent to which HRQoL improved did not differ between SG and RYGB, when measured with the RAND-36 or IWQOL-lite. This might be partly caused by the fact that these questionnaires do not assess specific bariatric HRQoL and/or complaints.
Background
Health-Related Quality of Life (HRQL) is a key outcome of success after bariatric surgery. Not all patients report improved HRQL scores postoperatively, which may be due to patient-level ...factors. It is unknown which factors influence HRQL after surgery. Our objective was to assess patient-level factors associated with HRQL after surgery.
Methods
This international cross-sectional study included 730 patients who had bariatric surgery. Participants completed BODY-Q scales pertaining to HRQL and satisfaction with body, and demographic characteristics were obtained. The sample was divided into three groups based on time since surgery: 0 – 1 year, 1 – 3 years and more than 3 years. Uni- and multivariable linear regression analyses were conducted to identify variables associated with the BODY-Q scales per group.
Results
The 0 – 1 year postoperative group included 377 patients (50.9%), the 1 – 3 years postoperative group 218 (29.4%) and the more than 3 years postoperative group 135 patients (18.2%). Lower current body-mass index (BMI), more weight loss (%TWL), being employed, having no comorbidities, higher age and shorter time since surgery were significantly associated with improved HRQL outcomes postoperatively. None of these factors influenced all BODY-Q scales. The effect of current BMI increased with longer time since surgery.
Conclusion
Factors including current BMI, %TWL, employment status, presence of comorbidities, age and time since surgery were associated with HRQL postoperatively. This information may be used to optimize patient-tailored care, improve patient education and underline the importance of long-term follow-up with special attention to weight regain to ensure lasting improvement in HRQL.
Graphical abstract
Despite the publication of the American Society for Metabolic and Bariatric Surgery (ASMBS) Outcome Reporting Standards in 2015, there is still a great variety in definitions used for reporting ...remission of co-morbidities after bariatric surgery. This hampers meaningful comparison of results.
To assess compliance with the ASMBS standards in current literature, and to evaluate use of the standards by applying them in a report on the outcomes of 5 co-morbidities after bariatric surgery.
Two clinics of the Dutch Obesity Clinic, location Den Haag and Velp, and three affiliated hospitals: Haaglanden Medical Center in Den Haag, Groene Hart Hospital in Gouda, and Vitalys Clinic in Velp.
A systematic search in PubMed was conducted to identify studies using the ASMBS standards. Besides, the standards were applied to a cohort of patients who underwent a primary bariatric procedure between November 2016 and June 2017. Outcomes of co-morbidities were determined at 6 and 12 months after surgery.
Ten previous studies applying ASMBS definitions were identified by the search, including 6 studies using portions of the definitions, and 4 using complete definitions for 3 co-morbidities or in a small population. In this study, the standards were applied to 1064 patients, of whom 796 patients (75%) underwent Roux-en-Y gastric bypass and 268 patients (25%) underwent sleeve gastrectomy. At 12 months, complete remission of diabetes (glycosylated hemoglobin <6%, off medication) was reached in 63%, partial remission (glycosylated hemoglobin 6%-6.4%, off medication) in 7%, and improvement in 28% of patients (n = 232/248, 94%). Complete remission of hypertension (normotensive, off medication) was noted in 8%, partial remission (prehypertensive, off medication) in 23% and improvement in 63% (n = 397/412, 96%). Remission rate for dyslipidemia (normal nonhigh-density lipoprotein, off medication) was 57% and improvement rate was 19% (n = 129/133, 97%). Resolution of gastroesophageal reflux disease (no symptoms, off medication) was observed in 54% (n = 265/265). Obstructive sleep apnea syndrome improved in 90% (n = 157/169, 93%).
Compliance with the ASMBS standards is low, despite ease of use. Standardized definitions provided by the ASMBS guideline could be used in future research to enable comparison of outcomes of different studies and surgical procedures.
Multidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of ...patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients’ needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored.
A qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis.
Patients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact.
Patients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.
Summary
Background
Patients that have psychiatric comorbidity are thought to lose less weight than the general bariatric population and are therefore sometimes denied surgery. However, there is no ...scientific evidence for this assumption. The aim of this study is to evaluate the weight loss and health‐related quality of life (HRQoL) in patients with psychiatric disorders who undergo bariatric surgery and compare these patients with a general bariatric population.
Method
Patients who underwent bariatric surgery in 2015 were included. Patients who received individual counselling and had a current DSM IV axis 1 or 2 diagnosis were included in the psychiatric group (n = 163), all other patients in the generic group (n = 2362).Weight and HRQoL were assessed before and 12‐, 24‐, 36‐ and 48‐months after surgery. Data was analysed using regression analyses.
Results
The maximum total weight loss (TWL) was 27.4% in the psychiatric group vs 31.0% in the generic group. Difference in %TWL between the psychiatric and generic group was significant from baseline to all follow‐up moments (P < .001).
Improvement of PHS was significantly higher in the generic group from baseline to 12‐month (P = .002), 24‐month (P = .0018), 36‐month (P = .025) and 48‐monthfollow‐up (P = .003). Change in mental HRQoL was only different comparing baseline to 48‐monthfollow‐up (P = .014).
Conclusion
Although weight loss and change in physical HRQoL was lower in patients with pre‐operative psychiatric disorders, results of this group were still excellent. Thus, patients with psychiatric diagnoses benefit greatly from bariatric surgery and these patients should not be denied weight loss surgery.
Summary
Body image concerns may play a role in weight changing behaviour. The objective of this study was to assess body image in different weight groups. Participants reported satisfaction with (AE) ...and investment in (AO) appearance, and the discrepancy between current and ideal body size (BS). These scores were compared between weight groups based on body‐mass index (BMI) using analysis of variance. One‐sample t‐tests and Cohen's d effect sizes examined the magnitude of differences within each weight group relative to neutral midpoints of the scales; cluster analysis identified body image profiles. A total of 27 896 women were included in this study. AE scores were highest for people with underweight and normal weight, AO scores were highest for the underweight group and lowest in class III obesity, and BS scores were largest in the obese groups (all p < .001) Cluster analysis identified eight body image profiles. In people with obesity, the most prevalent profiles included a preference for a smaller body and low satisfaction with appearance, but differed in investment in appearance (low vs. high). Most people with underweight were allocated to profiles showing high investment in their appearance, preference of a larger body, but differences in satisfaction with appearance (neutral vs. high). While people with a higher BMI have on average more body image concerns, different body image profiles exist in all weight groups. Future research should examine whether and which individuals in terms of body image profile may benefit more from weight interventions.
BACKGROUND:There is a need for a reliable classification system to grade contour deformities and to inform reimbursement of body contouring surgery after massive weight loss. We developed the PRS ...Rainbow Classification, which uses select photographs to provide standardized references for evaluating patient photographs, to classify contour deformities in postbariatric patients. To assess the reliability of the PRS Rainbow Classification to classify contour deformities in massive weight loss patients.
METHODS:Ten independent experienced plastic surgeons, 7 experienced medical advisors of the healthcare insurance company, and 10 laypersons evaluated 50 photographs per anatomical region (arms, breast, abdomen, and medial thighs). Each participant rated the patient photographs on a scale of 1–3 in an online survey. The inter-observer and the intra-observer reliabilities were determined using intra-class correlation coefficients (ICCs). The ICC analyses were performed for each anatomical region.
RESULTS:Inter-observer reliability was moderate to good in the body regions “arms,” “abdomen,” “medial thighs,” with mean ICC values of 0.678 95% confidence interval (CI), 0.591–0.768, 0.685 (95% CI, 0.599–0.773), and 0.658 (95% CI, 0.569–0.751), respectively. Inter-observer reliability was comparable within the 3 different professional groups. Intra-observer reliability (test–retest reliability) was moderate to good, with a mean overall ICC value of 0.723 (95% CI, 0.572–0.874) for all groups and all 4 body regions.
CONCLUSIONS:The moderate to good reliability found in this study validates the use of the PRS Rainbow Classification as a reproducible and reliable classification system to assess contour deformities after massive weight loss. It holds promise as a key part of instruments to classify body contour deformities and to assess reimbursement of body contouring surgery.
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