David B. Sarwer

Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: Two-year results.

A previous study reported that preoperative binge‐eating disorder (BED) did not attenuate weight loss at 12 months after bariatric surgery. This report extends the authors prior study by examining weight loss at 24 months.

Changes in Fasting and Prandial Gut and Adiposity Hormones Following Vertical Sleeve Gastrectomy or Roux-en-Y-Gastric Bypass: an 18-Month Prospective Study

BackgroundVertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) produce substantial weight loss, both primarily through gastric restriction but with potentially different hormonal signaling. This prospective, observational study compared changes in gut-derived hormones in VSG, RYGB, and weight-stable participants at 6 and 18xa0months post-surgery.MethodsSixty-four obese, non-diabetic women, including 18 VSG, 23 RYGB, and 23 weight-stable controls completed assessments at baseline and 6xa0months, before and after consuming a mixed-nutrient meal; blood sampling occurred for 180xa0min post-meal. Fifty-one participants completed the 18-month outcome. Change from baseline in post-prandial area under the curve (over 180xa0min) for GLP-1, PYY3–36, ghrelin, and leptin was measured at 6 and 18xa0months post-surgery.ResultsAt 18xa0months, VSG and RYGB participants lost a mean (±SEM) of 25.5xa0±xa02.3% and 34.2xa0±xa04.2% of initial weight, respectively (pxa0<xa00.156), which both differed (pxa0<xa00.001) from the +1.7xa0±xa01.0% gain in the control group. Fasting ghrelin declined significantly more in VSG than RYGB participants at both months 6 (pxa0=xa00.0199) and 18 (pxa0=xa00.0003). In response to the mixed-nutrient meal, GLP-1 and PYY3–36 demonstrated an exaggerated post-prandial response that was significantly greater in RYGB than VSG at 6xa0months (pxa0<xa00.0001 and pxa0=xa00.0062, respectively) but not 18xa0months (pxa0=xa00.0296 and pxa0=xa00.1210).ConclusionsVSG and RYGB both produced substantial weight losses at 18xa0months. The data suggest a role of gastrointestinal hormones as mediators of weight loss.

Preoperative Medical Weight Management in Bariatric Surgery: a Review and Reconsideration

Bariatric surgery is the most robust treatment for extreme obesity. The impact ofxa0preoperative 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. We offer a reconsideration of the role of preoperative medical weight management and provide recommendations for future research in this area.

Body Image and Body Contouring Procedures.

Dissatisfaction with physical appearance and body image is a common psychological phenomena in Western society. Body image dissatisfaction is frequently reported by those who have excess body weight, but also is seen in those of normal body weight. For both groups of individuals, this dissatisfaction impacts self-esteem and quality of life. Furthermore, it is believed to be the motivational catalyst to a range of appearance-enhancing behaviors, including weight loss efforts and physical activity. Body image dissatisfaction is also believed to play a role in the decision to seek the wide range of body contouring procedures offered by aesthetic physicians. Individuals who seek these procedures typically report increased body image dissatisfaction, focus on the feature they wish to alter with treatment, and often experience improvement in body image following treatment. At the same time, extreme body image dissatisfaction is a symptom of a number of recognized psychiatric disorders. These include anorexia nervosa, bulimia nervosa, and body dysmorphic disorder (BDD), all of which can contraindicate aesthetic treatment. This special topic review paper provides an overview of the relationship between body image dissatisfaction and aesthetic procedures designed to improve body contouring. The review specifically focuses on the relationship of body image and body weight, as well as the presentation of body image psychopathology that would contraindicate aesthetic surgery. The overall goal of the paper is to highlight the clinical implications of the existing research and provide suggestions for future research on the psychological aspects of body contouring procedures.

Project HELP: a Remotely Delivered Behavioral Intervention for Weight Regain after Bariatric Surgery.

BackgroundWeight regain following bariatric surgery is common and potentially compromises the health benefits initially attained after surgery. Poor compliance to dietary and physical activity prescriptions is believed to be largely responsible for weight regain. Patients may benefit from developing specialized psychological skills necessary to engage in positive health behaviors over the long term. Unfortunately, patients often face challenges to physically returning to the bariatric surgery program for support in developing and maintaining these behaviors. Remotely delivered interventions, in contrast, can be conveniently delivered to the patient and have been found efficacious for a number of health problems, including obesity. To date, they have received little attention with bariatric surgery patients. The study aimed to evaluate a newly developed, remote acceptance-based behavioral intervention for postoperative weight regain.MethodsPatients at least 1.5xa0years out from surgery who experienced postoperative weight regain were recruited to receive the 10-week intervention. Participants were assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up.ResultsSupport for the intervention’s feasibility and acceptability was achieved, with 70xa0% retention among those who started the program and a high mean rating (4.7 out of 5.0) of program satisfaction among study completers. On average, weight regain was reversed with a mean weight loss of 5.1xa0±xa05.5xa0% throughout the intervention. This weight loss was maintained at 3-month follow-up. Significant improvements in eating-related and acceptance-based variables also were observed.ConclusionsThis pilot study provides initial support for the feasibility, acceptability, and preliminary efficacy of a remotely delivered acceptance-based behavioral intervention for postoperative weight regain.

A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery

BackgroundTens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain.MethodsA sample of bariatric surgery patients (nu2009=u200911) who regained at least 10xa0% of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery.ResultsThe intervention was shown to be feasible and acceptable, with 72xa0% retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58u2009±u20093.02xa0% throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables.ConclusionsThese findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.

Sexual functioning of men and women with severe obesity before bariatric surgery

BACKGROUNDnObesity may impair sexual function through multiple mechanisms, but little is known about sexual dysfunction among adults with severe obesity seeking bariatric procedures.nnnOBJECTIVESnTo describe sexual function and associated factors before bariatric surgery.nnnSETTINGnTen U.S. clinical facilities.nnnMETHODSnBefore bariatric surgery, 2225 of 2458 Longitudinal Assessment of Bariatric Surgery-2 study participants (79% female, median age 45 years and median body mass index 46 kg/m2) completed a survey about sexual function over the past month. Mixed effects ordinal logistic regression models were used to identify factors independently related to 4 domains of sexual function.nnnRESULTSnOne third of women (34%) and one quarter of men (25%) were not sexually active, alone or with a partner, in the past month. Twenty-six percent of women and 12% of men reported no sexual desire. Physical health limited sexual activity at least moderately in 38% of women and 44% of men. About one half of the women (49%) and the men (54%) were moderately or very dissatisfied with their sexual life. Among women, older age, being Caucasian, urinary incontinence, depressive symptoms, and antidepressant medication use were associated with poorer sexual function in multiple domains. In men, older age, not being married, depressive symptoms, and antidepressant medication use were associated with poorer sexual function in multiple domains.nnnCONCLUSIONnBefore bariatric surgery, approximately one half of women and men with severe obesity are dissatisfied with their sexual life. Older age, severity of depressive symptoms, and antidepressant medication use are associated with poorer sexual function in both sexes.

Evaluation of a web‐based weight loss intervention in overweight cancer survivors aged 50 years and younger

Half of adult cancer survivors under age 50 years are obese. Excess body weight is associated with cancer recurrence, and effective weight loss interventions for younger cancer survivors are needed. Commercially available, online weight loss programmes are readily accessible, but few have been studied in this population. This study employed a single‐arm, pre‐post intervention (baseline‐6 month/baseline‐12 month comparisons) to preliminarily explore feasibility, efficacy and safety of an online, commercially available weight loss programme in breast (n = 30) and testicular (n = 16) cancer survivors under age 50 years.

Commercially available lifestyle modification program: randomized controlled trial addressing heart and bone health in BRCA1/2+ breast cancer survivors after risk-reducing salpingo-oophorectomy

PurposeThe goal of this RCT was to examine the efficacy and safety of a web-based program to improve cardiovascular and bone health outcomes, among 35 BRCA1/2+ breast cancer survivors who underwent prophylactic oophorectomy and thus experienced premature surgical menopause.MethodsA 12-month commercially available web-based lifestyle modification program (Precision Nutrition Coaching) was utilized. Cardiovascular fitness, dietary intake, leisure time activity, body composition, bone mineral density, bone structure, and muscle strength were assessed.ResultsAverage adherence to all program components was 74.8xa0%. Women in the intervention group maintained their cardiovascular fitness level over the 12xa0months (1.1xa0±xa07.9xa0%), while the control group significantly decreased fitness capacity (−4.0xa0±xa07.5xa0%). There was a significant difference between groups in percent change of whole body bone area (−0.8xa0±xa02.5 control and 0.5xa0±xa01.30 intervention). We also observed decreased BMI (−4.7xa0±xa06.2xa0%) and fat mass (−8.6xa0±xa012.7xa0%) in the intervention group due to significant concomitant decreases in caloric intake and increases in caloric expenditure. The control group demonstrated decreased caloric intake and decreased lean tissue mass.ConclusionsIn this population at high risk for detrimental cardiovascular and bone outcomes, a commercially available lifestyle intervention program mitigated a decline in cardiovascular health, improved bone health, and decreased weight through fat loss.Implications for cancer survivorsPrecision Nutrition Coaching has shown benefit in breast cancer survivors for reduced risk of deleterious cardiovascular and bone outcomes.

The Psychosocial Burden of Obesity.

Obesity is associated with several comorbidities, including cardiovascular disease, type 2 diabetes, sleep apnea, osteoarthritis, and several forms of cancer. Obesity and its comorbidities also come with a significant psychosocial burden, impacting numerous areas of psychosocial functioning. The evaluation of psychosocial functioning is an important part of the assessment and treatment planning for the patient with obesity. This article provides an overview of the psychosocial burden of obesity. The article also describes the psychological changes typically seen with weight loss. A particular focus is on the psychosocial functioning of individuals with extreme obesity who present for and undergo bariatric surgery.