Phillip J. Dijkhorst, Leontien M. G. Nijland, Ruben N. van Veen, Steve M. M. de Castro
{"title":"Factors associated with decision regret after bariatric surgery","authors":"Phillip J. Dijkhorst, Leontien M. G. Nijland, Ruben N. van Veen, Steve M. M. de Castro","doi":"10.1111/cob.12633","DOIUrl":"10.1111/cob.12633","url":null,"abstract":"<div>\u0000 \u0000 <p>It is assumed that the individuals who undergo bariatric surgery will experience significant improvements in their health and overall well-being. However, it is yet to be examined whether these individuals may also experience subsequent decision regret. The level of regret regarding the choice to undergo bariatric surgery was assessed 1 year after bariatric surgery using the Decision Regret Scale (DRS). Associations of regret with patient characteristics, complications, weight loss and quality of life (BODY-Q) were investigated using linear regression analyses. In total, 115 patients completed the DRS (92% underwent Roux-en-Y gastric bypass Roux-en-Y gastric bypass and 8% underwent sleeve gastrectomy (SG)). Two out of 115 patients indicated absolute regret about their decision to undergo bariatric surgery because of insufficient weight loss and complications. The median decision regret score was zero (range 0–80). Most patients experienced no decision regret (50.4%), followed by mild regret (34.8%) and moderate to strong regret (14.8%). Higher levels of regret were associated with having osteo-articular disorders, gastro-oesophageal reflux disease or a history of psychiatric disorders at baseline. Patients with mild regret demonstrated significantly more weight loss and better psychological function. Major surgical complications were not associated with increased decision regret. Only two out of 115 patients (1.7%) indicated absolute regret about their decision to undergo bariatric surgery, and 15% reported moderate-to-strong regret according to the results of the DRS. These findings should be considered when providing pre-operative counselling and could assist patients in their decision-making process.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine B. Kaak, Candice P. Holliday, Madhuri S. Mulekar, Elly Trepman, Nicolette P. Holliday
{"title":"Women's perceptions of body mass graphics and their preferences for weight counselling","authors":"Katherine B. Kaak, Candice P. Holliday, Madhuri S. Mulekar, Elly Trepman, Nicolette P. Holliday","doi":"10.1111/cob.12632","DOIUrl":"10.1111/cob.12632","url":null,"abstract":"<div>\u0000 \u0000 <p>Health care providers may lack data-driven guidance about best practises for discussing weight. We assessed women's self-perception of body mass index (BMI) and preferences for weight counselling by provider characteristics and the initiating question. A voluntary, anonymous survey was completed by 756 women (age ≥ 19 year) at our tertiary care obstetrics and gynaecology clinics in autumn 2021. The respondents' height and weight were collected before respondents selected graphics from a validated Body Image Scale that they felt best represented their current body size and which graphs should prompt weight loss or gain recommendations. Respondents were asked their preferences about provider characteristics for discussion about weight and to identify which of six initiating questions from a provider was most and least preferred. Blank responses were allowed. In 708 responses, 366 women (52%) selected the most accurate graphic that corresponded to their BMI; the selected graphic represented a lower than actual BMI in 268 women (38%) and higher in 74 women (10%). In 648 responses, 374 women (58%) preferred a female provider, but provider body shape, ethnicity/race and age were not important to most women. The most preferred question to initiate a discussion about weight was “A lot of women have trouble achieving or maintaining a healthy weight; is that something we can discuss?” in 181 of 555 women (33%), and the least preferred question was “Do you feel like you are at an appropriate weight?” in 172 of 554 women (31%). Provider knowledge about patient preferences regarding questions may facilitate the discussion about weight.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lynne Johnston, Kacey Jackson, Charlotte Hilton, Yitka N H Graham
{"title":"Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required","authors":"Lynne Johnston, Kacey Jackson, Charlotte Hilton, Yitka N H Graham","doi":"10.1111/cob.12626","DOIUrl":"10.1111/cob.12626","url":null,"abstract":"<p>In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m<sup>2</sup>) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (<i>M</i> = 43.20, <i>SD</i> = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (<i>N</i> = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.12626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138497971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mackenzie Fong, Lorraine McSweeney, Ashley Adamson, Claire Mathews, Scott Lloyd, Charlotte Rothwell
{"title":"A cross-sectional survey study exploring provision and delivery of expanded community tier 2 behavioural weight management services in England","authors":"Mackenzie Fong, Lorraine McSweeney, Ashley Adamson, Claire Mathews, Scott Lloyd, Charlotte Rothwell","doi":"10.1111/cob.12629","DOIUrl":"10.1111/cob.12629","url":null,"abstract":"<p>Guidelines recommend provision of local behavioural weight management (tier 2) programmes for adults living with overweight and obesity. Following the publication of the UK Government's publication ‘Tackling Obesity: empowering adults and children to live healthier lives’ in July 2021, Government invested around £30 million of additional funding to support the expansion of local authority commissioned tier 2 provision for adults living with excess weight. We conducted a cross-sectional survey study to scope the types of services available, to whom they were made available, and barriers and facilitators to service delivery. An e-survey was disseminated to local authority commissioned tier 2 service providers in England from September to October 2022. Through a combination of closed and open (qualitative) questions, the survey collected data on referral routes, participant eligibility criteria, service content and format, and challenges and enablers to service delivery. Quantitative data were analysed descriptively whilst thematic content analysis was applied to qualitative data. We received 52 responses (estimated response rate = 59%) representing all nine England regions and 89 unique local authorities. Most services were multi-component (84.3%), were 12 weeks duration (78.0%), were group-based (90.0%), were primarily delivered in-person (86.0%), and were free to participants (90.2%). Five responses indicated provision of support for other health and wellbeing issues, for example, mental health, assistance with debt. To improve future WMS service commissioning and delivery, WMS providers need to be allowed adequate time and resource to properly prepare for service delivery. Referral systems and criteria should be made clear and straightforward to both referrers and service users, and strategies to manage surplus referrals should be explored.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.12629","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Koya Ferrell, Isaiah Brown, Abel Amare, Timothy S. McNeel, Dennis Buckman, Sharon H. Jackson
{"title":"Positive association between adiposity and inflammation in US adults: A cross-sectional study","authors":"Koya Ferrell, Isaiah Brown, Abel Amare, Timothy S. McNeel, Dennis Buckman, Sharon H. Jackson","doi":"10.1111/cob.12625","DOIUrl":"10.1111/cob.12625","url":null,"abstract":"<div>\u0000 \u0000 <p>Identification of biomarkers involved in multifaceted obesity-related inflammatory processes paired with reliable anthropometric measures of visceral adiposity is important for developing epidemiologic screening tools. This retrospective observational study used linear regression models to examine the association between inflammation and visceral fat in a nationally representative sample of 10 655 US adults. Inflammation was measured using a cumulative inflammation index (CII) generated from white blood cell ratios and uric acid. Intra-abdominal adiposity was assessed using sagittal abdominal diameter (SAD). Overall, 67.7%, 18.3%, and 13.9% of adults sampled were normoglycemic, prediabetic, and diabetic, with mean SAD of 21.7 ± 0.11 cm, 24.2 ± 0.14 cm, 26.0 ± 0.18 cm and CII of 4.3 ± 0.05, 4.7 ± 0.09, 5.1 ± 0.09, respectively. For each unit increase in SAD, CII was 0.12 higher (95% CI 0.10, 0.14) in US adults who were normoglycemic, 0.09 higher (95% CI 0.07, 0.12) in prediabetics and 0.10 higher (95% CI 0.07, 0.14) in diabetics. The association between SAD and CII was independent of diabetes status. These findings demonstrate an independent association between adiposity and inflammation, supporting increased visceral fat is associated with increased visceral-associated inflammation. Future studies are needed to define and characterise obesity-related inflammatory mediators and their role in chronic disease risk such as diabetes.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"‘We're outside the norm again because of the thing that allowed us to be inside the norm’: An interpretative phenomenological analysis of the experience of developing an alcohol use disorder after bariatric surgery","authors":"Esin Er, Cécile Flahault, Anne-Marie Etienne","doi":"10.1111/cob.12630","DOIUrl":"10.1111/cob.12630","url":null,"abstract":"<div>\u0000 \u0000 <p>Studies indicate that bariatric surgery is associated with an increased risk of alcohol use disorder (AUD). It is considered some patients develop the disorder after surgery, without having antecedents of preoperative alcohol problems. This qualitative study aimed to explore the experiences of people who developed AUD postoperatively and understand how they make sense of the onset of this disorder. A semi-directed interview was carried out with eight adults who had undergone bariatric surgery and developed AUD de novo postoperatively. Data were analysed using interpretative phenomenological analysis. Four superordinate themes emerged: (1) ‘losing control over drinking and self after surgery’; (2) ‘feelings of guilt, shame and loss contrasted with perceptions of still being lucky’; (3) ‘trying to make sense of the onset of AUD’; and (4) ‘retrospective evaluation of bariatric surgery and preoperative information’. These themes indicated loss of control was a central aspect of participant's experiences of postoperative alcohol consumption. AUD was associated with negative emotions and cognitions, but several participants still considered themselves lucky. All tried to make sense of this disorder's onset; many felt they would not have developed AUD if they had not undergone surgery. The onset of AUD influenced their current perceptions and feelings about surgery and the preoperative information regarding AUD risks. Taken together, these results provide insight into the subjective experience of suffering from new-onset AUD post-surgery. However, more studies are necessary to gain a better understanding of the physical and psychological implications of postoperative AUD.</p>\u0000 </div>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Time for a new agenda for behavioural treatment of overweight and obesity","authors":"Jonathan Pinkney, Mark Tarrant","doi":"10.1111/cob.12628","DOIUrl":"10.1111/cob.12628","url":null,"abstract":"","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chileka Chiyanika, Lorena Tsui Fun Cheung, Kin Hung Liu, Alice Pik Shan Kong, Simon Kin Hung Wong, Enders Kwok Wai Ng, Winnie Chiu Wing Chu
{"title":"Changes in mesenteric fat thickness and its clinical impact in bariatric surgery","authors":"Chileka Chiyanika, Lorena Tsui Fun Cheung, Kin Hung Liu, Alice Pik Shan Kong, Simon Kin Hung Wong, Enders Kwok Wai Ng, Winnie Chiu Wing Chu","doi":"10.1111/cob.12627","DOIUrl":"10.1111/cob.12627","url":null,"abstract":"<p>Obesity, especially central obesity is associated with increased risk of metabolic syndrome, non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus. The study aimed to investigate the associations of the changes of abdominal fat thicknesses with changes of anthropometric indexes and improvements of metabolic phenotypes in patients with obesity and T2DM before and after bariatric surgery. Between April 2016 and January 2017, 34 adult patients with concurrent obesity and T2DM scheduled for different bariatric surgeries were prospectively evaluated by ultrasound before and 1-year after bariatric surgery to determine abdominal fat thicknesses (mesenteric fat, preperitoneal fat and subcutaneous fat) and NAFLD. At 1 year, of the 25 patients that finished the study, significant decrease in mesenteric-fat-thickness was associated with significant reduction of obesity, that is, BMI (−24%, <i>p</i> < .001), remission of metabolic syndrome (32%, <i>p</i> = .008), NAFLD (60%, <i>p</i> < .001) and T2DM (44%, <i>p</i> < .001). Lower baseline mesenteric fat thickness was associated with remission of metabolic syndrome. Lower baseline mesenteric-fat-thickness may have the potential to predict metabolic syndrome remission after bariatric surgery.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.12627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72013658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dayna Lee-Baggley, Nadège Fils-Aimé, Isabelle Audet, Maxime Barakat
{"title":"Improving implementation of best practices in obesity management: Physician experiences in obesity care","authors":"Dayna Lee-Baggley, Nadège Fils-Aimé, Isabelle Audet, Maxime Barakat","doi":"10.1111/cob.12624","DOIUrl":"10.1111/cob.12624","url":null,"abstract":"<p>In this study, we sought to analyse experiences in weight management among physicians working in the area of obesity and contrast these experiences with best practices. By understanding experiences of physicians working in obesity management, we can better support implementation of best practices in their day-to-day practice. An online survey of Canadian primary care physicians, internists and endocrinologists recruited from a nationwide market research database was conducted. The survey captured demographic characteristics and perceptions about weight loss and its management. One hundred and ninety-two physicians (140 primary care, 22 internists and 30 endocrinologists) were recruited and completed the survey. Challenges identified by the physicians in helping patients lose weight included patients' poor compliance and lack of time and resources to address the issue. Most physicians reported considering obesity to be a chronic disease, but most did not incorporate a multi-dimensional, chronic disease model of obesity treatment (i.e., combination of lifestyle interventions with psychological, medical and/or surgical interventions). Endocrinologists reported management practices consistent with a chronic disease model more frequently than primary care physicians. These data highlight the need for improvement in obesity management, particularly in primary care. Despite proliferation of guidelines on best practices, implementation of these practices into daily practice remains low.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.12624","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41232899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucas Guimarães Almeida, Abdulrahman Dera, Jessica Murphy, Sylvia Santosa
{"title":"Improvements in cardiorespiratory fitness, muscle strength and body composition to modest weight loss are similar in those with adult- versus childhood-onset obesity","authors":"Lucas Guimarães Almeida, Abdulrahman Dera, Jessica Murphy, Sylvia Santosa","doi":"10.1111/cob.12623","DOIUrl":"10.1111/cob.12623","url":null,"abstract":"<p>Adults who have had obesity from childhood are at greater risk of obesity-related comorbidities compared to those who only develop obesity in adulthood. The main way of mitigating these risks in obesity is with weight loss, which has been shown to positively affect the cardiorespiratory fitness (CRF) and body composition of adults. However, it is unclear whether the response of these outcomes to weight loss may be influenced by age of obesity onset. The objective of our study was to investigate how age of obesity onset mitigates the responsiveness of CRF, muscle strength and body composition to modest weight loss. Measurements were conducted at baseline and 12 weeks. In total, 37 participants (childhood-onset = 19, adult-onset = 18) lost 3.7% ± 0.4% through aerobic exercise and diet. The YMCA cycle ergometer test (YMCA) and the 20-m shuttle run test (20MSR) were used to estimate CRF (mL kg<sup>−1</sup> min<sup>−1</sup>) and a handgrip dynamometer was used to estimate muscle strength. Total body composition was assessed by dual-energy x-ray absorptiometry (DEXA). Overall, CRF and body composition improved (time effect: <i>p</i> < 0.05) after 12 weeks. There was no group-by-time interaction for YMCA, 20MSR, muscle strength and body composition variables. Therefore, the present study suggests that individuals with childhood-onset obesity and adult-onset obesity can improve their CRF and body composition similarly after mild weight loss.</p>","PeriodicalId":10399,"journal":{"name":"Clinical Obesity","volume":"14 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cob.12623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41112426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}