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Psychological factors in “failed” bariatric surgery
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Abstracts / Surgery for Obesity and Related Diseases 6 (2010) 224 –234
sham-operated body weight-matched controls (sham ad libitum fed 3.63 ⫾ .04 kcal/kg/h versus sham body weight-matched 3.42 ⫾ .05 kcal/kg/h versus bypass 4.12 ⫾ .03 kcal/kg/h, P ⬍.001). Diet-induced thermogenesis was elevated after gastric bypass compared with that in sham-operated body weight-matched controls 3 hours after a test meal (sham-operated body weightmatched .41% ⫾ 1.9% versus bypass 10.5% ⫾ 2.0%, P ⬍.05). Conclusions: Gastric bypass surgery in rats prevented the expected decrease in energy expenditure subsequent to body weight loss. Diet-induced thermogenesis was greater after gastric bypass surgery compared with that in body weight-matched controls. The increased energy expenditure might be an additional mechanism explaining the physiologic basis of weight loss after gastric bypass surgery. PREDICTORS OF REMISSION OF TYPE 2 DIABETES MELLITUS AFTER LAPAROSCOPIC GASTRIC BANDING AND BYPASS N. Hamzaa, M. H. Abbasb, A. Darwishc, Z. Shafeekc, J. Newa, B. J. Ammoria, aSalford Royal Hospital, Manchester, United Kingdom, bQueens Hospital, Burton-on-Trent, United Kingdom, c Manchester Royal Infirmary, Manchester, United Kingdom Background: Type 2 diabetes mellitus (T2DM) is associated with obesity and carries considerable morbidity and mortality. The objective of this study was to evaluate the effect of laparoscopic bariatric surgery on the control of T2DM in morbidly obese patients in a UK population and to determine the predictors of diabetic remission after bariatric surgery. Methods: Of 487 patients who underwent laparoscopic bariatric procedures from 2002 to 2007, 74 (15.2%) had established T2DM. The results shown represent the mean values. A multivariate analysis identified factors predictive of remission of T2DM after bariatric surgery. Results: The body mass index before laparoscopic Roux-en-Y gastric bypass (LRYGB; n ⫽ 48) and laparoscopic adjustable gastric banding (LAGB; n ⫽ 26) were comparable (52 versus 51 kg/m2, P ⫽ .508). T2DM underwent remission or improved in 41% and 59% of patients, respectively, at 16.9 months of followup. Although the duration of follow-up was significantly longer in patients who underwent LAGB (23 versus 13.4 months, P ⫽ .001), the percentage of excess weight loss was significantly greater after LRYGB (59.4% versus 48.8%, P ⫽ .031), with an associated greater remission of T2DM (50% versus 24%, P ⫽ .034). Multivariate analysis revealed a greater percentage of excess weight loss and younger age as independent predictors of postoperative remission of T2DM, and LRYGB, longer follow-up, and female gender were independent predictors of a greater percentage of excess weight loss. Conclusions: Excess weight loss was the only predictor of remission of T2DM that can be influenced by the choice of bariatric procedure. LRYGB offered greater weight loss and chance of remission of diabetes compared with LAGB and within a shorter period. PSYCHOLOGICAL FACTORS IN “FAILED” BARIATRIC SURGERY Matilda Anne Moffett, Akeil Samier, Keith Seymour, Sean Woodcock, General Surgery Department, North Tyneside General Hospital, Newcastle, United Kingdom
Background: This study evaluated the contribution of psychological factors in clinical cases of failed bariatric surgery (poor weight loss or weight regain after surgery). It included the role of a clinical psychologist in a bariatric surgery service. Methods: During the period of 12 months, the clinical data from 9 patients from North Tyneside General Hospital were retrospectively analyzed. The 7 female and 2 male patients, who had experienced failed bariatric surgery (weight regain or poor/ceased weight loss), were referred to a clinical psychologist as a part of the bariatric team. Of these 9 patients, 1 had undergone laparoscopic sleeve gastrectomy, 6 had undergone laparoscopic gastric banding, and 2 had undergone gastric bypass from 2003 to 2009. Their body mass index ranged from 35 to 59 kg/m2. All patients completed a quality-of-life measure and questionnaires to evaluate anxiety, depression, and a range of eating behaviors. All participants received an initial assessment evaluation and one-to-one psychological intervention (range 4 sessions to a maximum of 16 sessions). Results: Only 1 of the patients with failed surgery had received the relevant psychological intervention before surgery. All patients presented with a variety of mood disturbances and psychological difficulties around their relationship with food and eating behavior. After the psychological intervention, the patients experienced an improvement in self-reported control over eating and improved self-esteem, depression, anxiety, quality of life, and weight loss. Conclusions: Postoperative failures in bariatric surgery can result from unresolved psychological difficulties. As such, a clinical psychologist has an important role in the bariatric service. Early indications suggest that psychological treatment improves a range of mood disturbances, quality of life, and control over eating. The implications are that psychological intervention might prevent the need for re-do surgery, which carries more risk than the primary procedure and is not yet secured financially by the primary care trust, in some patients. RENAL CYTOKINES AND BIOCHEMICAL PROFILES AFTER BARIATRIC SURGERY Sukhpreet Singh Dubba, Marco Buetera, Abhijit Gilla, Ahmed Ahmeda, Andrew Frankelb, Carel Le Rouxa, Frederick Tama, aImperial College London, London, United Kingdom, bUniversity College London, London, United Kingdom Background: Obesity-related glomerulopathy is an emerging epidemic, mirroring the increasing incidence of obesity. Monocyte chemotactic protein-1 (MCP-1), macrophage migration inhibitory factor (MIF), chemokine (C-C motif) ligand 18 (CCL-18), and hemofiltrate CC chemokine 15 (CCL-15) are novel cytokines that could be pathologically involved in obesity-induced renal injury and were explored in this study. Methods: Blood pressure and urine and blood samples were collected from 34 morbidly obese patients before and 4 weeks after bariatric surgery. The biochemical parameters, including serum creatinine, albumin, and C-reactive protein, along with urine albumin and creatinine, were recorded. The urinary chemokines MCP-1, MIF, CCL-18, and CCL-15 were detected using enzymelinked immunosorbent assay. Results: The average postoperative weight loss was 9.26 ⫾ .78 kg. After surgery, a significant decrease occurred in the systolic blood pressure (142.9 ⫾ 3.22 to 128.1 ⫾ 2.12 mmHg, P ⬍.001) and diastolic blood pressure (87.1 ⫾ 1.47 to 79.2 ⫾ 1.11 mmHg,
Abstracts / Surgery for Obesity and Related Diseases 6 (2010) 224 –234
sham-operated body weight-matched controls (sham ad libitum fed 3.63 ⫾ .04 kcal/kg/h versus sham body weight-matched 3.42 ⫾ .05 kcal/kg/h versus bypass 4.12 ⫾ .03 kcal/kg/h, P ⬍.001). Diet-induced thermogenesis was elevated after gastric bypass compared with that in sham-operated body weight-matched controls 3 hours after a test meal (sham-operated body weightmatched .41% ⫾ 1.9% versus bypass 10.5% ⫾ 2.0%, P ⬍.05). Conclusions: Gastric bypass surgery in rats prevented the expected decrease in energy expenditure subsequent to body weight loss. Diet-induced thermogenesis was greater after gastric bypass surgery compared with that in body weight-matched controls. The increased energy expenditure might be an additional mechanism explaining the physiologic basis of weight loss after gastric bypass surgery. PREDICTORS OF REMISSION OF TYPE 2 DIABETES MELLITUS AFTER LAPAROSCOPIC GASTRIC BANDING AND BYPASS N. Hamzaa, M. H. Abbasb, A. Darwishc, Z. Shafeekc, J. Newa, B. J. Ammoria, aSalford Royal Hospital, Manchester, United Kingdom, bQueens Hospital, Burton-on-Trent, United Kingdom, c Manchester Royal Infirmary, Manchester, United Kingdom Background: Type 2 diabetes mellitus (T2DM) is associated with obesity and carries considerable morbidity and mortality. The objective of this study was to evaluate the effect of laparoscopic bariatric surgery on the control of T2DM in morbidly obese patients in a UK population and to determine the predictors of diabetic remission after bariatric surgery. Methods: Of 487 patients who underwent laparoscopic bariatric procedures from 2002 to 2007, 74 (15.2%) had established T2DM. The results shown represent the mean values. A multivariate analysis identified factors predictive of remission of T2DM after bariatric surgery. Results: The body mass index before laparoscopic Roux-en-Y gastric bypass (LRYGB; n ⫽ 48) and laparoscopic adjustable gastric banding (LAGB; n ⫽ 26) were comparable (52 versus 51 kg/m2, P ⫽ .508). T2DM underwent remission or improved in 41% and 59% of patients, respectively, at 16.9 months of followup. Although the duration of follow-up was significantly longer in patients who underwent LAGB (23 versus 13.4 months, P ⫽ .001), the percentage of excess weight loss was significantly greater after LRYGB (59.4% versus 48.8%, P ⫽ .031), with an associated greater remission of T2DM (50% versus 24%, P ⫽ .034). Multivariate analysis revealed a greater percentage of excess weight loss and younger age as independent predictors of postoperative remission of T2DM, and LRYGB, longer follow-up, and female gender were independent predictors of a greater percentage of excess weight loss. Conclusions: Excess weight loss was the only predictor of remission of T2DM that can be influenced by the choice of bariatric procedure. LRYGB offered greater weight loss and chance of remission of diabetes compared with LAGB and within a shorter period. PSYCHOLOGICAL FACTORS IN “FAILED” BARIATRIC SURGERY Matilda Anne Moffett, Akeil Samier, Keith Seymour, Sean Woodcock, General Surgery Department, North Tyneside General Hospital, Newcastle, United Kingdom
Background: This study evaluated the contribution of psychological factors in clinical cases of failed bariatric surgery (poor weight loss or weight regain after surgery). It included the role of a clinical psychologist in a bariatric surgery service. Methods: During the period of 12 months, the clinical data from 9 patients from North Tyneside General Hospital were retrospectively analyzed. The 7 female and 2 male patients, who had experienced failed bariatric surgery (weight regain or poor/ceased weight loss), were referred to a clinical psychologist as a part of the bariatric team. Of these 9 patients, 1 had undergone laparoscopic sleeve gastrectomy, 6 had undergone laparoscopic gastric banding, and 2 had undergone gastric bypass from 2003 to 2009. Their body mass index ranged from 35 to 59 kg/m2. All patients completed a quality-of-life measure and questionnaires to evaluate anxiety, depression, and a range of eating behaviors. All participants received an initial assessment evaluation and one-to-one psychological intervention (range 4 sessions to a maximum of 16 sessions). Results: Only 1 of the patients with failed surgery had received the relevant psychological intervention before surgery. All patients presented with a variety of mood disturbances and psychological difficulties around their relationship with food and eating behavior. After the psychological intervention, the patients experienced an improvement in self-reported control over eating and improved self-esteem, depression, anxiety, quality of life, and weight loss. Conclusions: Postoperative failures in bariatric surgery can result from unresolved psychological difficulties. As such, a clinical psychologist has an important role in the bariatric service. Early indications suggest that psychological treatment improves a range of mood disturbances, quality of life, and control over eating. The implications are that psychological intervention might prevent the need for re-do surgery, which carries more risk than the primary procedure and is not yet secured financially by the primary care trust, in some patients. RENAL CYTOKINES AND BIOCHEMICAL PROFILES AFTER BARIATRIC SURGERY Sukhpreet Singh Dubba, Marco Buetera, Abhijit Gilla, Ahmed Ahmeda, Andrew Frankelb, Carel Le Rouxa, Frederick Tama, aImperial College London, London, United Kingdom, bUniversity College London, London, United Kingdom Background: Obesity-related glomerulopathy is an emerging epidemic, mirroring the increasing incidence of obesity. Monocyte chemotactic protein-1 (MCP-1), macrophage migration inhibitory factor (MIF), chemokine (C-C motif) ligand 18 (CCL-18), and hemofiltrate CC chemokine 15 (CCL-15) are novel cytokines that could be pathologically involved in obesity-induced renal injury and were explored in this study. Methods: Blood pressure and urine and blood samples were collected from 34 morbidly obese patients before and 4 weeks after bariatric surgery. The biochemical parameters, including serum creatinine, albumin, and C-reactive protein, along with urine albumin and creatinine, were recorded. The urinary chemokines MCP-1, MIF, CCL-18, and CCL-15 were detected using enzymelinked immunosorbent assay. Results: The average postoperative weight loss was 9.26 ⫾ .78 kg. After surgery, a significant decrease occurred in the systolic blood pressure (142.9 ⫾ 3.22 to 128.1 ⫾ 2.12 mmHg, P ⬍.001) and diastolic blood pressure (87.1 ⫾ 1.47 to 79.2 ⫾ 1.11 mmHg,