Todd A. Kellogg

The relationship among food addiction, negative mood, and eating-disordered behaviors in patients seeking to have bariatric surgery

BACKGROUND Food addiction (FA) may be related to poor weight loss outcomes; however, the literature on food addiction in bariatric surgery-seeking populations is limited. OBJECTIVES The aim of the present study was to identify the prevalence of FA in a bariatric surgery-seeking population and its association with mood, problematic eating behaviors, and substance use. The relationship between prebariatric surgery food addiction screening and postsurgical outcomes was assessed. SETTING Academic medical center. METHODS Adult outpatients (n = 923) seeking bariatric surgery underwent psychological evaluation between January 2012 and May 2014. Patients were administered the Yale Food Addiction Scale (YFAS) to assess FA. Of the original sample, 195 patients underwent Roux-en-Y gastric bypass surgery. Patients returned for medical follow-up at 6 (n = 169) and 12 (n = 113) months postsurgery; 26 (13%) patients at 6 months and 82 (42%) patients at 12 months were lost to follow-up or had not reached 1 year postsurgery. RESULTS Fourteen percent of patients met FA criteria. Patients positive for FA were more likely to endorse greater levels of depression, anxiety, binge eating episodes, nighttime eating syndrome, and low eating self-efficacy. No relationship was observed between FA and current substance use. FA did not predict postoperative outcomes including weight loss, rehospitalization, or attendance at follow-up medical appointments. CONCLUSIONS FA is related to psychological distress and eating disordered behaviors among bariatric patients. However, FA was not predictive of short-term (6-12 mo) bariatric surgery outcomes. Future research should determine how FA affects long-term postoperative outcomes and mood stability.

Bariatric surgery and diabetes: Implications of type 1 versus insulin-requiring type 2

To report the impact of bariatric surgery on metabolic outcomes in patients with type 1 diabetes (DM1) versus insulin‐requiring type 2 diabetes mellitus (IRDM2).

Post-bariatric Complications—Leaks

Laparoscopic bariatric procedures offer effective treatments for medically complicated obesity, and as experience grows in this surgical specialty and also due to the success of the Fellowships overseen by the Fellowship Council, complications are becoming remarkably rare. The vast majority of patients undergoing a bariatric procedure can expect minimal postoperative pain, a hospital stay of less than 48 h, and dramatic weight loss with improvement in obesity-related comorbid diseases within the first year. Despite the complexity of these procedures coupled with the technical challenges inherent to operating on obese patients, perioperative morbidity and mortality are low. The two most important causes of early postoperative morbidity are pulmonary embolism and enteric leak; in this chapter, we will focus on diagnosis and management of the latter, although it is important to realize that these two complications may mimic one another in terms of signs and symptoms. We will present and dissect a case report illustrating the important principles of postoperative management of this complication. Leaks after bariatric operations are potentially life-threatening, and management of leaks depends largely on the timing and severity of illness at presentation. A high index of suspicion is warranted, because a delay in diagnosis and treatment can very realistically be the difference between a favorable outcome and death.

Neural Modulation in the Treatment of Obesity

With the obesity epidemic, multiple efforts have been directed at developing and evaluating new, novel, and innovative therapies to induce clinically relevant weight loss. The majority of bariatric procedures involve anatomic changes designed to restrict oral intake mechanically; these procedures are usually in conjunction with some other influences related to the neurohormonal sequelae of a duodenal bypass (Roux-en-Y gastric bypass) or the removal of the majority of the ghrelin-secreting tissue (sleeve gastrectomy). These procedures, however, require major surgery, and any less invasive, easily reversible intervention would generate tremendous interest if proven effective.

Management of Abdominal Wall Hernias in the Bariatric Patient

Abdominal wall hernia and obesity are associated closely. Many patients being considered for bariatric surgery have an abdominal wall hernia— either a primary umbilical hernia or an incisional hernia after previous abdominal operations. Similarly, many patients with an abdominal wall hernia have concomitant medically complicated obesity and probably should be considered for bariatric surgery. This chapter addresses the controversies of whether the abdominal wall hernia should be repaired before, during, or after the bariatric procedure. Also, should we as physicians (and surgeons) actively suggest bariatric surgery to patients with medically complicated obesity asking only to have their abdominal wall hernia repaired?