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Obesity, bariatric

Matthew J Klebanoff, Jagpreet Chhatwal, Jacob D Nudel, Kathleen E Corey, Lee M Kaplan, Chin Hur
Importance: Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. Objective: To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. Design, Setting, and Patients: A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery...
October 26, 2016: JAMA Surgery
Sarah Trainer, Tonya Benjamin
AIMS: To explicate the processes by which a patient's choice to undergo bariatric surgery is made to feel like a medical necessity, to explore the ways widespread societal stigmatization of weight and bariatric surgery shapes patient and provider discourse about surgery and to discuss patient rationalizations of the choice to have surgery. BACKGROUND: Severe obesity is currently highly stigmatized. Bariatric surgery has become an increasingly used option for individuals seeking to lose drastic amounts of weight...
October 25, 2016: Journal of Advanced Nursing
Jordan J Nostedt, Noah J Switzer, Richdeep S Gill, Jerry Dang, Daniel W Birch, Christopher de Gara, Robert J Bailey, Shahzeer Karmali
Nonalcoholic fatty liver disease is becoming one of the most common causes of liver disease in the western world. The most significant risk factors are obesity and the metabolic syndrome for which bariatric surgery has been shown to be an effective treatment. However, the effects of bariatric surgery on nonalcoholic fatty liver disease, specifically liver fibrosis and cirrhosis, are not well established. We review published bariatric surgery outcomes with respect to nonalcoholic liver disease. On the basis of this review we suggest that bariatric surgery may provide a viable treatment option for the treatment of nonalcoholic fatty liver disease, including patients with fibrosis and compensated cirrhosis, and that this topic should be a target of future investigation...
2016: Canadian Journal of Gastroenterology & Hepatology
L A Peterson, J K Canner, L J Cheskin, G P Prokopowicz, M A Schweitzer, T H Magnuson, K E Steele
OBJECTIVE: To investigate the association between adverse surgical outcomes following bariatric surgery and proxy measures of vitamin D (VitD) status (season and latitude) in the Nationwide Inpatient Sample (NIS). BACKGROUND: Obesity is an independent risk factor for VitD deficiency (25(OH)D < 20 ng ml(-1)). VitD deficiency compounds the chronic inflammation of obesity, increasing the risk of adverse outcomes following bariatric surgery. Epidemiology has long used season and latitude as proxies for group VitD, as VitD status is largely determined by sun exposure, which is greatest during summer and at the Equator...
December 2015: Obesity Science & Practice
Vasileios Charalampakis, Abd A Tahrani, Ahmed Helmy, Janesh K Gupta, Rishi Singhal
One of the most effective methods to tackle obesity and its related comorbidities is bariatric surgery. Polycystic ovary syndrome (PCOS) and endometrial hyperplasia (EH), which are associated with increased risk of endometrial carcinoma, have been identified as potentially new indications for bariatric surgery. PCOS is the most common endocrine disorder in women in the reproductive age and is associated with several components of the metabolic syndrome such as obesity, insulin resistance and hypertension. EH is a pre-cancerous condition which arises in the presence of chronic exposure to estrogen unopposed by progesterone such as both in PCOS and obesity...
October 17, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Reena Sudan, Ranjan Sudan, Elizabeth Lyden, Jon S Thompson
BACKGROUND: Food cravings and consumption of craved foods after Roux-en-Y gastric bypass (RYGB) are poorly understood. Food cravings after bariatric surgery may explain why some patients fail to change eating behaviors after RYGB, and understanding these cravings may provide better information for nutritional counseling to either enhance weight loss or prevent weight regain. OBJECTIVES: To study cravings in RYGB patients and compare them with cholecystectomy (CC) control patients...
September 9, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Hisham Hussan, Peter P Stanich, Darrell M Gray, Somashekar G Krishna, Kyle Porter, Darwin L Conwell, Steven K Clinton
BACKGROUND: Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown. METHODS: The National Inpatient Sample Database (2006-2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m(2) and BMI >35 kg/m(2)) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization. RESULTS: There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012...
October 21, 2016: Obesity Surgery
Michael G White, Marc A Ward, Megan K Applewhite, Harry Wong, Vivek Prachand, Peter Angelos, Edwin L Kaplan, Raymon H Grogan
BACKGROUND: With over 110,000 bariatric operations performed in the United States annually, it is important to understand the biochemical abnormalities causing endocrine dysfunction associated with these procedures. Here we compare 2 malabsorptive procedures, duodenal switch and Roux-en-Y gastric bypass, to determine the role malabsorption plays in secondary hyperparathyroidism in this population. METHODS: Data from all super-obese patients undergoing duodenal switch or Roux-en-Y gastric bypass between August 2002 and October 2005 were prospectively collected...
October 18, 2016: Surgery
Adrian Meule, Martina de Zwaan, Astrid Müller
BACKGROUND: Impulsivity is a multifaceted construct and constitutes a common risk factor for a range of behaviors associated with poor self-control (e.g., substance use or binge eating). The short form of the Barratt Impulsiveness Scale (BIS-15) measures impulsive behaviors related to attentional (inability to focus attention or concentrate), motor (acting without thinking), and non-planning (lack of future orientation or forethought) impulsivity. Eating-related measures appear to be particularly related to attentional and motor impulsivity and recent findings suggest that interactive effects between these two facets may play a role in eating- and weight-regulation...
October 5, 2016: Comprehensive Psychiatry
Tamer M S Salama, Karim Sabry, Yaser El Ghamrini
PURPOSE: Single anastomosis sleeve ileal bypass (SASI) procedure appears as a new metabolic and bariatric surgery based on Santoro's operation, in which a sleeve gastrectomy is followed by a side-to-side gastroileal anastomosis. The study is aimed to evaluate the short-term outcomes of laparoscopic single anastomosis sleeve ileal bypass with respect to postoperative weight loss and metabolic and nutritional effects on patients. METHODS: Forty-five morbidly obese patients with a mean age of 31...
October 21, 2016: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Christian Carpéné, Francisco Les, Mounia Hasnaoui, Simon Biron, Picard Marceau, Denis Richard, Jean Galitzky, Denis R Joanisse, Pascale Mauriège
Semicarbazide-sensitive amine oxidase (SSAO), identical to primary amine oxidase or vascular adhesion protein-1, is a membrane enzyme that generates hydrogen peroxide. SSAO is highly expressed at the adipocyte surface, and its plasma levels increase with type 2 diabetes. Since visceral adipose tissue (AT) is more tightly associated with obesity complications than subcutaneous (SC) abdominal fat, we compared SSAO activity in plasma and 4 distinct AT locations in 48 severely obese women (body mass index (BMI), averaging 54 ± 11 kg/m(2)), with or without a dysmetabolic profile...
October 21, 2016: Journal of Physiology and Biochemistry
Dora M Gorman, Carel W le Roux, Neil G Docherty
Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes...
October 2016: Diabetes & Metabolism Journal
D Edholm, S Axer, J Hedberg, M Sundbom
BACKGROUND AND AIMS: Unsatisfactory weight loss after gastric bypass or sleeve gastrectomy in super-obese patients (body mass index > 50) is a growing concern. Biliopancreatic diversion with duodenal switch results in greater weight loss, but is technically challenging to perform, especially as a laparoscopic procedure (Lap-DS). The aim of this study was to compare perioperative outcomes of Lap-DS and the corresponding open procedure (O-DS) in Sweden. MATERIAL AND METHODS: The data source was a nationwide cohort from the Scandinavian Obesity Surgery Registry and 317 biliopancreatic diversion with duodenal switch patients (mean body mass index = 56...
October 7, 2016: Scandinavian Journal of Surgery: SJS
Ryan D Sheldon, Kayla M Kanosky, Kevin D Wells, Lili Miles, James W Perfield, Stavra Xanthakos, Thomas H Inge, R Scott Rector
BACKGROUND: Mechanisms responsible for progression of nonalcoholic fatty liver disease (NAFLD) to steatohepatitis (NASH) remain poorly defined. METHODS: To examine the potential contribution of adipose tissue to NAFLD progression, we performed a complete transcriptomic analysis using RNA-sequencing (RNA-seq) on intra-abdominal adipose tissue (IAT) from severely obese adolescents (Mage 16.9±0.4 yrs; BMI z-score 2.7±0.1) undergoing bariatric surgery and liver biopsy categorized into 3 groups; No steatosis (Normal, n=8), steatosis only (n=13), or NASH (n=10) by liver histology...
October 7, 2016: Physiological Genomics
Paul L Schneider, Zhaoping Li
OBJECTIVE: To provide a thorough analysis of the range of ethical concerns that may present in relation to the care of the morbidly obese inpatient over the course of several years of care. METHODS: A narrative of the patient's complex medical care is given, with particular attention to the recommendations of three separate ethics committee consultations that were sought by his health care providers. An ethical analysis of the relevant issues is given within the Principles of Biomedical Ethics framework, highlighting the principles of autonomy, beneficence, non-maleficence, and justice...
2016: Narrative Inquiry in Bioethics
Andrew J Beamish, Torsten Olbers, Aaron S Kelly, Thomas H Inge
Obesity is a major global health problem, and its multisystem effects are inextricably linked with elevated cardiovascular risk and adverse outcomes. The cardiovascular benefits of reversing obesity in adults are well-established. Compared with other weight-loss strategies, programmes that incorporate bariatric surgery for weight loss are beneficial for sustained BMI reduction. A marked improvement in cardiovascular risk factors, including hypertension, dyslipidaemia, inflammation, and type 2 diabetes mellitus, has been observed after bariatric surgery...
October 20, 2016: Nature Reviews. Cardiology
Colleen Tewksbury, Noel N Williams, Kristoffel R Dumon, David B Sarwer
Bariatric surgery is the most robust treatment for extreme obesity. The impact of preoperative medical weight management sessions designed, in theory, with the primary goal of promoting preoperative weight loss, is unclear. This paper reviews studies that have investigated the relationship between preoperative weight loss and bariatric surgical outcomes, both with respect to postoperative weight loss and complications. We conclude that the most robust of preoperative interventions has not been implemented or evaluated in a manner which would conclusively assess the value of this element of care...
October 20, 2016: Obesity Surgery
Gisele Farias, Rubia D Thieme, Laila M Teixeira, Maria Emilia V D Heyde, Solange C Bettini, Rosana B Radominski
BACKGROUND: Bariatric surgery is one of the main treatments for severity obesity, but weight regain after surgery is an important issue. OBJECTIVES: To compare the clinical and nutritional profiles of good and poor weight loss responders in the late postoperative period after bariatric surgery. METHODS: A cross-sectional study with patients undergoing Roux-en-Y gastric bypass in a University Hospital. Patients were divided into good weight loss responders (GWLR) and poor weight loss responders (PWLR) defined as ≥ 50% or < 50% excess weight loss (EWL), respectively, at least 2 years post-surgery...
September 20, 2016: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
Michael Feichtinger, Tina Stopp, Sandra Hofmann, Stephanie Springer, Sophie Pils, Alexandra Kautzky-Willer, Herbert Kiss, Wolfgang Eppel, Andrea Tura, Latife Bozkurt, Christian S Göbl
AIMS/HYPOTHESIS: A history of gastric bypass surgery can influence the results of the OGTT recommended during pregnancy. Therefore, we compared OGTT glucose kinetics and pregnancy outcome between pregnant gastric bypass patients and BMI-matched, lean and obese controls. METHODS: Medical records were used to collect data on glucose measurements during the 2 h 75 g OGTT as well as on pregnancy and fetal outcome for 304 women (n = 76 per group, matched for age and date of delivery)...
October 18, 2016: Diabetologia
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