Shushmita Ahmed

Effect of Roux-en-Y gastric bypass on testosterone and prostate-specific antigen

Obese men have lower serum levels of testosterone, dehydroepiandrosterone (DHEA) and prostate‐specific antigen (PSA), but an increased risk of dying from prostate cancer. The aim of this study was to examine the effect of surgically induced weight loss on serum testosterone, DHEA and PSA levels in obese men.

Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005-2007.

Obesity and its consequences are a major health concern. There are conflicting reports regarding utilization of preventive health‐care services among obese patients. Our objective was to determine whether obese patients receive the same preventive care as normal weight patients. Weighted patient clinic visit data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for all adult patient visits with height/weight data (N = 866,415,856) from 2005 to 2007. Preventive care practice patterns were compared among different weight groups of normal, obese, and morbidly obese. Obese patients received the least number of preventive exams with a clear gradient present by weight. Obese patients were significantly less likely to receive cancer screening including breast examination (normal weight, reference, obese, odds ratio (OR), 0.8), mammogram (obese OR, 0.7), pap smear (obese OR, 0.7), pelvic exam (obese OR, 0.8), and rectal exam (obese OR, 0.7). The obese population also received less tobacco (obese OR, 0.7) and injury prevention education (obese OR, 0.7), yet significantly more diet, exercise, and weight reduction education. Significant differences in clinic practice patterns relative to normal weight patients were also evident with more physician referral (obese OR, 1.2) and less likely to see physician at the index clinic visit (obese OR, 0.8) and less likely to receive psychotherapy referral (obese OR, 0.6). Significant gaps in preventive care exist for the obese including cancer screening, tobacco cessation and injury prevention counseling, and psychological referral. Although obese patients received more weight‐related education, this emphasis may have the consequence of de‐emphasizing other needed preventive health measures.

Mo1526 What Motivates Weight Loss Surgery Patients

Background By better understanding patientmotivations, patient education can be individualized for the most effective healthcare possible. The purpose of this study was to evaluate patient motivations for bariatric surgery. Methods Preoperative, three, six and twelve month postoperative data were prospectively obtained for 169 consecutive laparoscopic Roux-en Y gastric bypass surgery patients at a single academic institution. All patients were given a standardized multiple choice questionnaire which asked them about their primary motivations for bariatric surgery preoperatively, then 6 and 12 months postoperatively. Results Better health was the primary motivator preoperatively and at 12 months postoperatively (87, 89%, respectively). A better appearance was a primary motivation for only 15% of patients preoperatively and 20% of patients 12 months postoperative. Within health-related motivations for bariatric surgery, 29% of patients expressed a primary desire to live longer preoperative and, by 12 months postoperatively, this number increased to 38.7% of patients postoperatively. The primary motivation for bariatric surgery from a family perspective was to have more energy with children preoperatively and remained so at 12 months postoperatively (44 to 46%). The second most common familial motivation was to be a healthy role model which did not change from preto post-operatively (29.8 to 29.5%). Preoperatively, 65% of patients thought that diet and exercise would be the most important factor to maintain long-term weight loss; however, by 12 months postoperatively, only 56% of patients thought that diet and exercise would be the most important factor. Patients gave an increasingly greater role to surgery as an important factor for weight loss raising its importance from 45% preop to 58% at one year postoperatively. Observed to patientexpected (O:E) ratios of 12 month percent excess weight loss became more accurate as patients progressed from preop to 6 and 12 months postop (0.60, 0.70, 0.78). Pre-operative O:E Ratios of percent excess weight loss were strongly correlated with 12 postoperative excess weight loss (p<0.001). Conclusions Patients had increasingly, more realistic expectations for surgerys role and ideal weight. Preoperatively, accurate patient expectation of surgical weight loss resulted in better observed post-op weight loss. Patient motivation may be a prime factor for weight loss and should be harnessed for improved outcomes.