Search Results for "bariatric surgery"
Effectiveness of Exercise Interventions After Bariatric Surgery
There is no doubt that exercise is good for you and that individuals with obesity, both before and after bariatric surgery (like everyone else), would stand to benefit from increasing their levels of physical activity. Following bariatric surgery, exercise may be particularly important not just to increase physical fitness, but also to limit the obligatory loss in muscle mass that generally accompanies weight loss. Now, a study by David Creel and colleagues, published in OBESITY, compares three levels of exercise intervention in patients following bariatric surgery in terms of effectiveness and adherence. A total of 150 patients undergoing bariatric surgery were randomised to either standard care (SC), pedometer use (P), or exercise counseling group (C). The standard care group (SC) received no exercise support by the bariatric center beyond a simple educational pamphlet. Participants in the pedometer group (P) were given a pedometer and a one-page information sheet on using the device to increase physical activity. This handout promoted the progressive attainment of 10,000 steps/day. Individuals were asked to wear their device daily and record date, steps achieved, and whether they wore the device the entire day, part of the day, or not at all. Journals were collected, but no feedback was provided. Participants in the exercise counselling group (C) were regularly seen at the bariatric centre and counselled by a certified exercise professional using motivational intervention techniques with individual goal setting. Based on physical activity measurements using an accelerometer over two weeks before and 2, 4, and 6 months postoperatively, there was no difference between the SC and P groups, with a statistically significant but modest increase in daily steps in the C group that emerged at 4 months and was maintained at 6 months (about 1,000 extra steps per day compared to SC). There was no notable difference in exercise tolerance, which increased in all three groups post surgery. No group reached the 10,000 steps/day or 150 bout-minutes/week recommended for general health As may be expected from these rather modest results, no significant differences in weight or weight change were found between groups at any time point. Thus, these findings suggest that handing out a pedometer and asking patients to journal their activity is no more effective in promoting physical activity, than simply handing out a pamphlet; moreover, even adding in counselling by an exercise professional adds little (if anything) to the outcome. Although the researchers discuss the possibility that an even more intense intervention may provide… Read More »
What Behaviours Are Important For Optimal Outcomes With Bariatric Surgery?
Bariatric surgery is by far the most effective treatment for severe obesity but outcomes vary from one patient to the next. Now a paper by James Mitchell and colleagues, published in JAMA Surgery, reports on the postoperative eating behaviors and weight control strategies that are associated with differences in body weight seen at 3 years after bariatric surgery. The study looks at self-reported data from over 2000 participants in the The Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study, a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers in the USA. Participants completed detailed surveys regarding eating and weight control behaviors prior to surgery and then annually after surgery for 3 years. The researchers assessed 25 postoperative behaviors related to eating, weight control practices, and the use of alcohol, smoking, and illegal drugs. The three key behaviours associated with poor outcomes were lack of weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day. Thus, a participant who postoperatively started to self-weigh regularly, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose almost 40% of their baseline weight compared to only 24% weight loss in participants who did not adopt these behaviours. Other behaviours that had negative influences on outcomes included problematic use of alcohol, smoking and illegal drugs. Thus, as one may have suspected all along, helping patients adopt and adhere to behavioural changes that include self-montioring and mindful eating behaviours can be expected to substantially affect the success of bariatric surgery. @DrSharmma Seoul, South Korea
The Edmonton Obesity Staging System Predicts Early Complications After Bariatric Surgery
Regular readers will be well aware of the Edmonton Obesity Staging System (EOSS), which classifies individuals living with obesity according to the presence and severity of medical, mental and functional complications on a 5-point ordinal scale. We have previously shown that EOSS provides a better assessment of mortality risk than BMI, waist circumference, or the presence of metabolic syndrome. Now, a paper by Sonja Chiappetta and colleagues from Offenbach, Germany, published in SOARD, shows that EOSS strongly predicts early surgical complications and mortality in patients undergoing bariatric surgery. The authors analysed data from 534 patients, collected prospectively, for patients undergoing laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), or laparoscopic omega-loop gastric bypass (LOLGB). As typical for a bariatric surgery population, the mean BMI was around 50 kg/m2. While the total postoperative complication rate for the entire patient sample was 9%, the complications rates were 0% for patients with EOSS Stage 0 (5% of patients), 1.6% for Stage 1 ( (12%), 8% for Stage 2 (71%), 22% for Stage 3 (13%) and 100% for Stage 4 (0.2%). There was no significant difference in BMI levels across EOSS stages and not consistent association of EOSS stage with age. From these findings the authors conclude that, “Patients with EOSS≥3 have a higher risk of postoperative complications. Our data confirm that the EOSS is useful as a scoring system for the selection of obese patients before surgery and suggest that it may also be useful for presurgical stratification and risk assessment in clinical practice. Patients should be recommended for obesity surgery when their EOSS stage is 2 to prevent impairments associated with metabolic disease and to reduce the risk of postoperative complications.” @DrSharma Edmonton, AB
Bariatric Surgery Improves Mitochondrial Efficiency
One of the more frustrating aspects of weight loss, is that it is often associated with decreased metabolic rate and increased ‘fuel efficiency’. Thus, following weight loss, not only does the body need fewer calories, doing the same amount of physical work uses fewer calories than before (the joke is that, if you ran 5K a day to lose weight, you have to run 10K a day to keep it off). Now, a study by Maria Fernström and colleagues, published in Obesity Surgery, shows increased mitochondrial efficiency following bariatric surgery. The researchers performed skeletal muscle biopsies in 11 women before and at 6 months after gastric bypass surgery. Measurements in isolated mitochondria showed a marked increase in coupled respiration (state 3) and overall mitochondrial capacity (P/O ratio) with a non-significant increase in uncoupled (state 4) respiration. Thus, at 6 months following gastric bypass surgery, both the mitochondrial capacity for coupled, i.e., ATP-generating, respiration increased as well as the P/O ratio improved. As the authors note, not only would this increased “fuel efficiency” in part explain the decreased basal metabolism often associated with weight loss but also the propensity for weight regain that often follows weight-loss interventions. Obviously, due to lack of a control group, this study does not demonstrate that these changes are in any way specific to weight-loss following bariatric surgery. Also, given that the nadir of weight loss is generally not achieved until about 18 months following surgery, the changes observed in this study may not represent the maximum increase in mitochondrial efficiency to be achieved with further weight loss. @DrSharma Edmonton, AB
Bariatric Surgery In The Elderly
While the often impressive benefits of bariatric surgery on health and quality of life in younger patients with severe obesity are well documented, the safety and benefits of bariatric surgery in older patients remains largely unclear. Now, a systematic review by my colleague Alexandra Chow from the University of Alberta, Edmonton, Canada, published in Obesity Surgery looks at outcomes in patients older than 65 years of age. The review includes data from 8 studies (1835 patients) of roux-en-Y gastric bypass surgery, all of which were case series. Overall mean excess weight loss was about 70%, which is only marginally less than generally seen in younger patients with this procedure. Mean 30-day mortality was 0.14 % with a post-operative complication rate of around 20%, with wound infections being the most common (8 %) followed by cardiorespiratory complications (3 %). Thus, it appears that bariatric surgery is reasonably safe and produces meaningful clinical outcomes in patients beyond 65 years of age. Obviously, I would assume that these numbers are better than expected as centres (including ours) are rather selective about patients as they get older. Thus, these outcomes may not be applicable to every patient above the age of 65. Nevertheless, it appears that for selected elderly patients, bariatric surgery may well be considered an effective treatment for severe obesity despite a reasonable measure of risk. @DrSharma Edmonton, AB
