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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....
Clinical Guidelines for Managing Obesity

Clinical Guidelines for Managing Obesity

According to published data, nearly 155 million adults in the United States are classified as being either overweight (having a BMI of 25 to 29.9 kg/m2) or obese (having a BMI of 30 kg/m2 or higher). “Health-care providers are on the front line of the obesity epidemic,” explains Donna H. Ryan, MD. “Greater efforts are needed to identify patients who need to lose weight for cardiovascular reasons. As clinicians, we’re in a prime position to direct successful weight loss efforts.” According to Dr. Ryan, behaviors around food and physical activity and getting patients the help they need to change these behaviors are paramount to weight loss. “Losing weight is a complex issue that goes beyond a person’s willpower,” she says. “We need to do more than simply advise obese and overweight patients to lose weight. We need to be actively involved to help patients reach a healthier body weight, and that’s not necessarily a so-called ‘normal’ body weight.” Helpful Guidance In 2013, the American Heart Association, American College of Cardiology, and Obesity Society released comprehensive treatment recommendations to help healthcare providers tailor weight loss treatments to adults who are overweight or obese. The guidelines address five specific areas of obesity, including:   1)   The identification of who needs to lose weight.   2)   How much weight patients should lose.   3)   Diets to consider for weight loss.   4)   Expected weight loss with lifestyle interventions.   5) Patients who should be considered for bariatric surgery. According to the guidelines, healthcare providers should calculate BMI at annual visits or more frequently and use BMI and waist circumference (WC) cutpoints to identify...
Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...
Innovative Techniques to Address Bariatric Surgery Complications

Innovative Techniques to Address Bariatric Surgery Complications

Millions of patients find it extremely difficult to achieve durable weight loss without medical intervention. Many opt for bariatric surgery to achieve a healthier weight, but up to 30% of patients who undergo these procedures regain weight. There are a variety of reasons for regaining weight after bariatric surgery. In some cases, there may be dysfunction of the stomach pouch that was surgically created. Others may experience dangerous and painful complications, such as fistulas and leaks. Patients who experience these types of post-bariatric surgical problems are reluctant to undergo another invasive procedure to correct the issues. Alternatives to Bariatric Surgery Complications In recent years, an important treatment alternative has emerged for this patient population thanks to advanced endoscopy. Using this approach, we can address post-bariatric surgery problems like fistulas, ulcers, and lap band erosion with less invasive endoscopic surgery techniques. Advanced endoscopy enables clinicians to: Locate and repair defects. Close leaks and fistulas with endoscopic sutures. Reduce patient discomfort. Reduce postoperative recovery time. Help re-establish proper pouch dimensions. Help stop weight gain and aid in weight loss. With advanced endoscopy, we’re able to perform endoscopic pouch reduction surgery to restore the stomach pouch to its original post-surgery dimensions and halt weight gain. These procedures help patients experience less postoperative discomfort, as there is minimal to no blood loss, no external cuts, and no need to re-route the existing anatomy. This results in shorter hospital recovery times, with most patients going home the same day. Advanced endoscopic techniques can be beneficial to manage complications after bariatric surgery. These include repairing and/or addressing gastric pouch dysfunction/defects, esophageal and gastric fistulas, sleeve...
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