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...
CME/CE: Disparities in Older Patients with Diabetes

CME/CE: Disparities in Older Patients with Diabetes

Studies show that the prevalence of type 2 diabetes among adults aged 65 and older in the United States ranges between 20% and 25%. However, controversy has surrounded the most appropriate approaches to treating and managing diabetes in older adults, particularly with regard to identifying therapeutic targets for A1C and the control of other cardiovascular risk factors. In addition, research suggests there are disparities in risk factor control among racial and ethnic minorities with diabetes when compared with whites who have the disease. “Diabetes continues to be a major public health problem among older racial and ethnic minorities,” says Hermes J. Florez, MD, MPH, PhD. There are important factors to consider when managing this older patient group and developing treatment targets. These include the potential for adverse effects when using pharmacologic treatment, risks for hypoglycemia, and individual comorbidities, among other factors.   A Closer Look For a study published in Diabetes Care, investigators assessed data from the Atherosclerosis Risk in Communities (ARIC) study (2011–2013), which involved non-institutionalized, community-dwelling older adults with diabetes. The cross-sectional analysis involved more than 5,000 participants aged 67 to 90 with and without diagnosed diabetes who attended the fifth visit of the ARIC study. The authors evaluated the prevalence of glycemic, lipid, and blood pressure (BP) control overall and by race. The study also investigated correlates of meeting treatment targets and whether or not racial differences in risk factor control could be explained by demographic and clinical characteristics. Stringent risk factor targets were defined as having an A1C of less than 7%, an LDL cholesterol (LDL-C) level of less than 100 mg/dL, and a BP...
Disparities in Older Patients With Diabetes

Disparities in Older Patients With Diabetes

Studies show that the prevalence of type 2 diabetes among adults aged 65 and older in the United States ranges between 20% and 25%. However, controversy has surrounded the most appropriate approaches to treating and managing diabetes in older adults, particularly with regard to identifying therapeutic targets for A1C and the control of other cardiovascular risk factors. In addition, research suggests there are disparities in risk factor control among racial and ethnic minorities with diabetes when compared with whites who have the disease. “Diabetes continues to be a major public health problem among older racial and ethnic minorities,” says Hermes J. Florez, MD, MPH, PhD. There are important factors to consider when managing this older patient group and developing treatment targets. These include the potential for adverse effects when using pharmacologic treatment, risks for hypoglycemia, and individual comorbidities, among other factors.   A Closer Look For a study published in Diabetes Care, investigators assessed data from the Atherosclerosis Risk in Communities (ARIC) study (2011–2013), which involved non-institutionalized, community-dwelling older adults with diabetes. The cross-sectional analysis involved more than 5,000 participants aged 67 to 90 with and without diagnosed diabetes who attended the fifth visit of the ARIC study. The authors evaluated the prevalence of glycemic, lipid, and blood pressure (BP) control overall and by race. The study also investigated correlates of meeting treatment targets and whether or not racial differences in risk factor control could be explained by demographic and clinical characteristics. Stringent risk factor targets were defined as having an A1C of less than 7%, an LDL cholesterol (LDL-C) level of less than 100 mg/dL, and a BP...
Updated Stroke Prevention Guidelines

Updated Stroke Prevention Guidelines

The American Heart Association and American Stroke Association (AHA/ASA) have updated guidelines on primary stroke prevention based on comprehensive and timely evidence from clinical investigations and research trials. Recommendations are included for controlling risk factors, using interventional approaches to atherosclerotic disease, and antithrombotic treatments for preventing stroke. The guidelines were published in Stroke and are available for free online at http://stroke.ahajournals.org. “One of the most important changes in the AHA/ASA guidelines is that newer anticoagulants can be used as alternatives to warfarin to prevent stroke in patients with atrial fibrillation (AF),” says James F. Meschia, MD, FAHA, who chaired the AHA/ASA committee that developed the recommendations. The guidelines note that although some of the new AF drugs are more expensive, they require less ongoing monitoring and therefore represent reasonable options for patients. Another key recommendation from the guidelines is that clinicians are urged to use of statins, along with diet and exercise, to help lower the stroke risk in patients at high risk for experiencing a stroke within the next 10 years. “In addition, the CHA2DS2-VASc is recommended for stratifying the risk for stroke,” says Dr. Meschia. “Patients with a score of 0 on the CHA2DS2-VASc do not require anticoagulants, but those with a score of 2 or higher should receive these therapies.” He adds that patients with a score of 1 on CHA2DS2-VASc can be considered for anticoagulants.   Women & Stroke According to the AHA/ASA, women have higher stroke risks if they are pregnant, use oral contraceptives, use hormone replacement therapy, have migraines, and/or have depression. The guidelines recognize the different risk factors women face throughout their...
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