CME/CE: Bariatric Surgery & Mental Health

CME/CE: Bariatric Surgery & Mental Health

Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common. To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.   Taking a Closer Look For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27...
Bariatric Surgery & Mental Health

Bariatric Surgery & Mental Health

Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common. To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.   Taking a Closer Look For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27...
Conference Highlights: ACS 2016

Conference Highlights: ACS 2016

Assessing Early Discontinuation of Opiates After Trauma The inappropriate use of prescription opiates  is a significant public health issue throughout the United States, but little is known about patterns of use and factors associated with discontinuation of these drugs after major trauma. For a study, investigators sought to identify predictors of opiate discontinuation in patients who were discharged after experiencing a trauma. At 3 months, more than 90% had discontinued opiate use. Advanced age, marital status, and low socioeconomic status appeared to be significantly associated with a lower likelihood of discontinuation of opiates after a trauma whereas race, injury severity, and comorbid anxiety or depression were not. The findings may help surgeons identify high-risk patients and manage them accordingly. —————————————————————-   Monitoring Functional Recovery at Home Few studied have explored the feasibility of wearable, real-time, wireless monitoring devices and their effect on functional recovery and patient-centered outcomes after surgery. For a study, researchers had major abdominal surgery patients wear wristband pedometers that tracked their steps 3 to 7 days before their operation, during their hospitalization, and for 2 weeks after they were discharged. Web-based, self-reported symptoms and quality of life (QOL) were obtained throughout the study. Adherence rates for wearing the pedometer were above 80% before and after discharge. More than 75% of symptom and QOL assessments were completed by about 63% and 74% of patients, respectively. Patient satisfaction scores were 4 out of 5. —————————————————————-   Predicting ICU Readmission for Surgical Patients ICU readmission within 72 hours is an established quality measure of postoperative care, but research is lacking on predictors of these readmissions following various types of...
Patient Factors in Bariatric Surgery Choices

Patient Factors in Bariatric Surgery Choices

Gastric bypass surgery and laparoscopic adjustable gastric banding are two commonly performed bariatric procedures, but each has different profiles for risk and effectiveness. Few studies have explored the factors that might lead patients to proceed with one procedure over another. In the Journal of the American College of Surgeons, a study was conducted to investigate the reasons why obese patients choose one type of weight loss operation over another. First author Caroline M. Apovian, MD, FACP, FACN, and colleagues studied 536 adults who had either gastric bypass (297 patients) or gastric banding (239 patients). A Deeper Look According to the results, diabetes status played an important role in decision- making for patients who were choosing between gastric bypass and laparoscopic adjustable gastric banding procedures. Those with diabetes were more likely to proceed with gastric bypass surgery. “This could be the result of patients and their physicians understanding that obesity causes type 2 diabetes, and that gastric bypass surgery can be life-saving and restore normal glucose levels,” says Dr. Apovian. Other patients who were more likely to select gastric bypass over the laparoscopic banding procedure included those who wanted greater weight loss and those willing to assume a higher mortality risk to reach their ideal weight. BMI appeared to play a smaller role in the decision-making process for patients choosing between bariatric surgeries. “Psychological and emotional issues appear to influence surgery decisions,” Dr. Apovian says. “It’s important to consider the patient’s individual preferences and what matters most to them.” In addition, the study found that patients reporting more uncontrolled eating were more likely to undergo laparoscopic banding than gastric bypass....
Enhancing Outcomes in Bariatric Surgery

Enhancing Outcomes in Bariatric Surgery

In 2008, the Obesity Society, the American Association of Clinical Endocrinologists, and the American Society for Metabolic & Bariatric Surgery published a joint clinical practice guideline on the perioperative nutritional, metabolic, and non-surgical support of bariatric surgery patients. Since that time, a significant increase in the amount and strength of data has emerged. In 2013, the guidelines were updated to reflect these changes. Key Changes to the Bariatric Surgery Guideline For the 2013 updated guidelines, experts revised 56 of the 72 recommendations that were made in the 2008 document and added just two. These revisions represent such changes as the FDA approval of sleeve gastrectomy, which was considered an investigative procedure in 2008, says Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU, who served as lead author of the updated guideline that was published in Endocrine Practice, Surgery for Obesity and Related Diseases, and Obesity. Over the past 5 years, the role of bariatric surgery in patients with type 2 diabetes has become clearer, says Dr. Mechanick. “We still are not recommending bariatric surgery for patients with diabetes who are not obese. Instead, bariatric surgery should be considered in patients with diabetes who are obese and who have not responded to conventional methods for controlling their disease.” The use of bariatric surgery in patients with mild obesity was a new addition to the guideline. With the FDA approval of the Lap-Band® (Apollo Endosurgery, Inc) device for patients with mild obesity, the expert writing committee made the recommendation for considering gastric banding in select patients with a BMI of 30 kg/m2 to 35 kg/m2 and at least one obesity-related comorbidity....
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