Bariatric surgery in patients with psychiatric comorbidity: Significant weight loss and improvement of physical quality of life

Background: Patients that have psychiatric comorbidity are thought to lose less weight than the general bariatric population and are therefore sometimes denied surgery. However, there is no scientific evidence for this assumption. The aim of this study is to evaluate the weight loss and health-related quality of life (HRQoL) in patients with psychiatric disorders who undergo bariatric surgery and compare these patients with a general bariatric population. Method: Patients who underwent bariatric surgery in 2015 were included. Patients who received individual counselling and had a current DSM IV axis 1 or 2 diagnosis were included in the psychiatric group (n = 163), all other patients in the generic group (n = 2362).Weight and HRQoL were assessed before and 12-, 24-, 36- and 48-months after surgery. Data was analysed using regression analyses. Results: The maximum total weight loss (TWL) was 27.4% in the psychiatric group vs 31.0% in the generic group. Difference in %TWL between the psychiatric and generic group was significant from baseline to all follow-up moments (P <.001). Improvement of PHS was significantly higher in the generic group from baseline to 12-month (P =.002), 24-month (P =.0018), 36-month (P =.025) and 48-monthfollow-up (P =.003). Change in mental HRQoL was only different comparing baseline to 48-monthfollow-up (P =.014). Conclusion: Although weight loss and change in physical HRQoL was lower in patients with pre-operative psychiatric disorders, results of this group were still excellent. Thus, patients with psychiatric diagnoses benefit greatly from bariatric surgery and these patients should not be denied weight loss surgery

Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer

Background: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients included in the COlon cancer Laparoscopic or Open Resection (COLOR) trial at 10-year follow-up. Methods: Between March 1997 and March 2003, patients with non-metastatic colon cancer were recruited by 29 hospitals in eight countries and randomised to either laparoscopic or open surgery. Main inclusion criterion for the COLOR trial was solitary adenocarcinoma of the left or right colon. The primary outcome was disease-free survival at 3 years, and secondary outcomes included overall survival and recurrence. The 10-year follow-up data of all Dutch patients were collected. Analysis was by intention-to-treat. The trial was registered at ClinicalTrials.gov (NCT00387842). Results: In total, 1248 patients were randomised, of which 329 were Dutch. Fifty-eight Dutch patients were excluded and 15 were lost to follow-up, leaving 256 patients for 10-year analysis. Median follow-up was 112 months. Disease-free survival rates were 45.2 % in the laparoscopic group and 43.2 % in the open group (difference 2.0 %; 95 % confidence interval (CI) −10.3 to 14.3; p = 0.96). Overall survival rates were 48.4 and 46.7 %, respectively (difference 1.7 %; 95 % CI −10.6 to 14.0; p = 0.83). Stage-specific analysis revealed similar survival rates for both groups. Sixty-two patients were diagnosed with recurrent disease, accounting for 29.4 % in the laparoscopic group and 28.2 % in the open group (difference 1.2 %; 95 % CI −11.1 to 13.5; p = 0.73). Seven patients had port- or wound-site recurrences (laparoscopic n

Determinants of Physical Activity among Patients with Colorectal Cancer: From Diagnosis to 5 Years after Diagnosis

Introduction  Physical activity (PA) is associated with higher quality of life and probably better prognosis among colorectal cancer (CRC) patients. This study focuses on determinants of PA among CRC patients from diagnosis until 5 yr postdiagnosis. Methods  Sociodemographic and disease-related factors of participants of two large CRC cohort studies were combined. Moderate-to-vigorous PA during sport and leisure time (MVPA-SL) was measured at diagnosis (T0) and 6, 12, 24, and 60 months (T6 to T60) postdiagnosis, using the SQUASH questionnaire. Mixed-effects models were performed to identify sociodemographic and disease-related determinants of MVPA-SL, separately for stage I–III colon (CC), stage I–III rectal cancer (RC), and stage IV CRC (T0 and T6 only). Associations were defined as consistently present when significant at ≥4 timepoints for the stage I–III subsets. MVPA-SL levels were compared with an age- and sex-matched sample of the general Dutch population. Results  In total, 2905 CC, 1459 RC and 436 stage IV CRC patients were included. Patients with higher fatigue scores, and women compared with men had consistently lower MVPA-SL levels over time, regardless of tumor type and stage. At T6, having a stoma was significantly associated with lower MVPA-SL among stage I-III RC patients. Systemic therapy and radiotherapy were not significantly associated with MVPA-SL changes at T6. Compared with the general population, MVPA-SL levels of CRC patients were lower at all timepoints, most notably at T6. Conclusions  Female sex and higher fatigue scores were consistent determinants of lower MVPA-SL levels among all CRC patients, and MVPA-SL levels were lowest at 6 months postdiagnosis. Our results can inform the design of intervention studies aimed at improving PA, and guide healthcare professionals in optimizing individualized support

Increase in Physical Activity After Bariatric Surgery Demonstrates Improvement in Weight Loss and Cardiorespiratory Fitness

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Improvement of health-related quality of life after Roux-en-Y gastric bypass related to weight loss

INTRODUCTION: Effect of bariatric surgery on health-related quality of life (HRQOL) varies greatly. This might be caused by the diversity in questionnaires used to assess HRQOL and the weight loss of the studied population. This study assesses the relationship between weight loss and HRQOL in primary Roux-en-Y gastric bypass (RYGB) patients by using an obesity-specific (impact of weight on quality of life-lite, IWQOL-lite) and a generic (RAND-36) questionnaire. METHODS: HRQOL and weight parameters were assessed before and 15 and 24 months after RYGB surgery. HRQOL was assessed by using IWQOL-lite (an obesity-specific questionnaire consisting of one total score and five domains) and RAND-36 (a generic questionnaire consisting of two subtotal scores, the physical health summary (PHS) and mental health summary (MHS), and nine scales). RESULTS: Two thousand one hundred thirty-seven patients were included. HRQOL improved significantly after RYGB. Preoperative BMI was negatively related to baseline PHS (p < 0.001) and IWQOL-lite total (p < 0.001). Percentage total weight loss (%TWL) was positively related to HRQOL score at both follow-up moments. Change in HRQOL from baseline to 24 months was related to %TWL at 24 months in both subtotals of RAND-36 and IWQOL-lite total score (p ≤ 0.001 in all). CONCLUSION: HRQOL improves after RYGB. Higher %TWL is related to greater improvement in HRQOL and better HRQOL 15 and 24 months after RYGB. The variance in the effect of RYGB surgery on HRQOL can be explained by the questionnaire used and weight loss of the population

Genetic analysis in the bariatric clinic; impact of a PTEN gene mutation

Background: Pathogenic PTEN gene mutations are known to cause PTEN tumor hamartoma syndrome. Recent studies also suggest a role for PTEN mutations in the pathogenesis of obesity. No PTEN mutations have been reported among bariatric surgery patients and obesity treatment results are unknown. Since preventive screening for associated tumors is offered to patients with molecular proven PTEN hamartoma tumor syndrome, recognition of this condition in the bariatric surgery clinic is important. Method: We present a patient with morbid obesity who carries a known pathogenic PTEN mutation, identified at the bariatric surgery clinic using an obesity gene panel consisting of 52 obesity–associated genes. We analyzed the weight loss response during the first 3 years after Sleeve Gastrectomy. Results: At 1, 2 and 3 years after surgery, the patient achieved a Total Body Weight Loss of 39.4%, 48.8% and 44.9%, respectively. This corresponds to the results of a control group of 18 female patients with normal genetic test results. Conclusion: Our patient illustrates the importance of recognizing this serious genetic condition for which preventive cancer screening options are available. The positive weight loss results after Sleeve Gastrectomy suggest that this could be a successful treatment option for obesity patients with PTEN mutations

Body image dissatisfaction and depression in postbariatric patients is associated with less weight loss and a desire for body contouring surgery

BACKGROUND: Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results. OBJECTIVES: To evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS. SETTING: Outpatient clinic. METHODS: One thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model. RESULTS: There was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n = 157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction. CONCLUSIONS: There are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients

Body Contouring Surgery after Massive Weight Loss: Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post-Bariatric Surgery Population : Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post-Bariatric Surgery Population

Background: Body contouring surgery improves quality of life, weight loss, and body image after bariatric surgery. It is unclear why only a minority of the post-bariatric surgery population undergoes body contouring surgery. This study assesses overhanging skin, body satisfaction, and qualification for reimbursement of body contouring surgery in a Dutch post-bariatric surgery population. Methods: Post-bariatric patients were selected from a prospective database. Electronic questionnaires evaluated demographics, desire for body contouring surgery, excess skin, and satisfaction with their body. Results: A total of 590 patients were included: 368 patients (62.4 percent) desired body contouring surgery, 157 (26.6 percent) did not and 65 (11.0 percent) had undergone body contouring surgery. There were no significant differences between the groups regarding the percentage of patients who met the qualifications for reimbursement. Patients who desired body contouring surgery had more body parts affected by overhanging skin and more often rated the overhanging skin with a Pittsburgh Rating Scale grade 3 compared with patients without a desire to undergo body contouring surgery. The plastic surgeon was never consulted by 39.1 percent of the "desire" population; 44.1 percent of these patients met the weight criteria. Conclusions: Post-bariatric patients who desired body contouring surgery had more excess skin than patients without a desire and were less satisfied with their body. Almost half of these patients never consulted a plastic surgeon, partly because of incorrect assumptions regarding reimbursement. Plastic surgeons (together with bariatric teams) should better inform these patients about body contouring surgery possibilities

Barriers and facilitators of participation in weight loss intervention for patients with suboptimal weight loss after bariatric surgery; a qualitative study among patients, physicians, and therapists

INTRODUCTION: Not all patients with suboptimal weight loss after bariatric surgery are willing to participate in postoperative behavioral intervention to improve their weight loss. The objective of this study was to explore barriers to and facilitators of participation in postoperative behavioral intervention. METHODS: Thirty semi-structured interviews were conducted with patients (18), physicians (6), and therapists (6) (i.e., psychologists, dieticians, or physiotherapists). A thematic analysis approach was used. RESULTS: Emotional responses caused by confrontation with suboptimal weight loss hampered patients' deliberation about participation; insufficient exploration of their need for help limited patients' ability to make informed decisions; patients were receptive to their physician's advice when their physician respected their autonomy; using visual weight loss graphs helped to explain suboptimal weight loss to patients; and financial costs and time constraints obstructed participation. CONCLUSIONS: To improve adequate intervention participation, health care providers should focus on emotion regulation, support patients in exploring their own need for help, and respect patients' autonomy