Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

PURPOSE OF REVIEW: Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.RECENT FINDINGS: Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity

Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

Melanie McGrice, Kathlene Don Paul Nutrition Plus Enterprises, Melbourne, VIC, Australia Abstract: Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.Keywords: weight, bariatric, surger

The micronutrient intake profile of a multicentre cohort of australian LAGB patients

Background Patients who have undergone bariatric surgery have increased risks of developing micronutrient deficiencies. Translational research investigating the actual micronutrient intake of bariatric patients is limited. We examined the micronutrient intake of a multicentre cohort of laparoscopic adjustable gastric banding patients 1 year post-surgery. These data were compared to micronutrient recommendations for the general population. Methods Consecutive patients from three bariatric surgery facilities in Melbourne, Australia, were invited to participate 12 months post-operatively. A validated food frequency questionnaire was posted to 215 prospective participants. Results Of the 52 participants, micronutrient intakes from food and fluids alone were below population recommendations for calcium, folate, magnesium, potassium, retinol equivalents, thiamin and vitamin E. Males did not meet the recommended intakes for zinc, and iron intakes in pre-menopausal women were insufficient. Intakes lower than recommended levels for these micronutrients suggest inadequate intake of foods from vegetable, dairy, lean meat (or alternatives) and wholegrains. Micronutrient intakes below recommended levels in this patient group can be further explained by their macronutrient intakes that suggested diets of poor nutrient density. Recommendations for supplementation in this group have wide variations, usually having been developed through the presence of clinical and biochemical deficiencies. Conclusions Nutritional supplementation should be more extensive in scope and dosage than is currently recommended by some professional guidelines. Further long-termstudies are needed to explore both macro- and micronutrient intakes on the morbidity and mortality of this patient population. © Springer Science+Business Media New York 2013

What are gastric banding patients eating one year post-surgery?

Background: There is a paucity of evidence-based dietary management guidelines for patients post-laparoscopic adjustable gastric banding, including no consensus recommendations for macronutrient intake. We examined the macronutrient intake across a multi-centre cohort of post-bariatric surgery patients and compared these intakes to post-bariatric surgery and population-based dietary guidelines. Methods: Two hundred and fifteen patients from three bariatric surgery centres in Melbourne, Australia were invited to complete a validated Food Frequency Questionnaire 12 months post-operatively. Results: Energy intakes of the 52 participants ranged from 1,140 to 13,200 kJ/day, with an average of 4,890 kJ/day (±2,360 kJ/day). Many patients did not meet minimum population recommendations for macronutrients. The average fibre intake was only 14 g/day (compared to the recommendations of 25 g for women and 30 g for men). The average diet 1 year post-operatively was 36 % total fat compared to the recommendations of 20-25 %, with 14 % of intake from saturated fat. Conclusions: Patients' dietary intakes vary significantly 1 year post-laparoscopic adjustable band surgery, with many patients not meeting recommendations. These results suggest that patients decrease their total energy intake; however, eating habits may not improve as they consume a diet high in saturated fat. It is recommended that all patients receive dietary education about diet quality post-laparoscopic adjustable gastric band surgery to assist them in improving their diet quality as well as quantity for optimal health and weight loss. Specific international guidelines for nutrient intakes for people undergoing bariatric surgery are needed. © 2012 Springer Science + Business Media, LLC

Activin A and Follistatin influence hair follicle development in mice

Poster session abstract: P-168McDowall, Melanie L., McGrice, Hayley, Penno, Natasha M., Nattrass, Greg, Hebart, Michelle L., Hynd, Philiphttp://nahrs.org/MeetingsCalendar/ArchiveofNAHRSEvents.asp

Weighted co-expression networks shed light on the molecular mechanism of action of metyrapone on wool follicle development

The density of Merino wool follicles is established early in fetal development. This commercially important trait dictates wool fibre diameter which is the key driver of the price paid for wool. Merino lambs exposed to metyrapone (an inhibitor of cortisol synthesis) in utero show a lifetime alteration in wool growth parameters. Microarray data from a metyrapone treatment experiment were analysed within a systems biology framework using Weighted Gene Co-expression Network Analysis (WGCNA). Four networks were created to determine those genes involved in metyrapone mediated improvement of wool growth parameters. Using the WGCNA approach, we were able to detect co-expressed gene modules associated with metyrapone treatment. Gene ontology enrichment analysis of the genes comprising these modules identified a Bone Morphogenetic Protein (BMP4), a ligand known to be involved in hair/wool follicle development and expressed at the time of branching of secondary-derived follicles in Merino sheep.N. S. Watson-Haigh, H. N. Kadarmideen, M. McDowall, G. S. Nattrass, H. A. McGrice and P. I. Hyndhttp://www.aaabg.org/proceedings18/index.htmlhttp://trove.nla.gov.au/work/3642077

Transient treatment of pregnant Merino ewes with modulators of cortisol biosynthesis coinciding with primary wool follicle initiation alters lifetime wool growth

The economically important characteristics of the adult fleece of Merino sheep, such as increases in clean fleece weight, fibre length, fibre diameter and crimp characteristics are determined during critical phases of fetal development of the skin and its appendages. Genetics plays a major role in the development of traits, but the maternal uterine environment could also influence development. Treatment of pregnant ewes with cortisol and its analogues has previously been shown to produce changes in wool follicle morphology. The aim of this study was to determine the effect of transient manipulation of maternal cortisol status during critical phases of wool follicle initiation and development in utero. From Days 55–65 post-conception, singleton-bearing Merino ewes were treated with metyrapone (cortisol inhibitor) or betamethasone (cortisol analogue). Lambs exposed to metyrapone in utero were born with hairier birthcoats than the control or betamethasone treatment groups (P < 0.05), displayed a 10% increase in staple length and a reduction in crimp frequency for the first three shearings (P < 0.05). Co-expression network analysis of microarray data revealed up-regulation of members of the transforming growth factor-β and chemokine receptor superfamilies, gene families known to influence hair and skin development. These experiments demonstrate that presumptive transient manipulation of maternal cortisol status coinciding with the initiation of fetal wool follicle development results in long-term alteration in fleece characteristics, namely fibre length and fibre crimp frequency. These results indicate it is possible to alter the lifetime wool production of Merino sheep with therapeutics targeted to gene expression during key windows of development in utero.M. L. McDowall, N. S. Watson-Haigh, N. M. Edwards, H. N. Kadarmideen, G. S. Nattrass, H. A. McGrice and P. I. Hyn

Mucin Gene mRNA Levels in Broilers Challenged with 'Eimeria' and/or 'Clostridium perfringens'

The effects of 'Eimeria' (EM) and 'Clostridium perfringens' (CP) challenges on the mRNA levels of genes involved in mucin (Muc) synthesis (Muc2, Muc5ac, Muc13, and trefoil family factor-2 [TFF2]), inflammation (tumor necrosis factor alpha [TNF-α] and interleukin-18 [IL-18]), and metabolic processes (cluster of differentiation [CD]36) in the jejunum of broilers were investigated. Two parallel experiments involving 1) EM challenge and 2) EM and CP challenges were conducted. The first experiment was a 2 x 2 study with 12 birds per treatment (N 5 48) involving fishmeal substitution (25%) in the diet (FM) and EM challenge. The treatments were: Control (FM2, EM2), Fishmeal (FM+, EM2), EM challenge (FM2, EM+), and fishmeal substitution and EM challenge (FM+, EM+). The second experiment was a 2 x 2 x 2 experiment with six birds per treatment (N = 5 48) involving fishmeal (FM2, FM+), 'Eimeria' (EM2, EM+), and 'C. perfringens' (CP2, CP+). In both arms of the study, male broilers were given a starter diet for the whole period of 16 days, except those assigned to FM+, where 25% of the starter ration was replaced with fishmeal from days 8 to 14. EM inoculation was performed on day 9 and CP inoculation on days 14 and 15. The EM challenge birds were euthanatized for sampling on day 13; postmortem examination and sampling for the 'Eimeria' plus 'C. perfringens' challenge arm of the study were on day 16. In the 'Eimeria' challenge arm of the study, fishmeal supplementation significantly suppressed the mRNA levels of TNF-α, TFF2, and IL-18 pre-CP inoculation but simultaneously increased the levels of Muc13 and CD36 mRNAs. Birds challenged with Eimeria exhibited increased mRNA levels of Muc13, Muc5ac, TNF-a, and IL-18. In the 'Eimeria' and 'C. perfringens' challenge arm, birds exposed to EM challenge exhibited significantly lower mRNA levels of Muc2 and CD36. The mRNA levels of CD36 were also significantly suppressed by CP challenge. Our results showed that the transcription of mucin synthesis genes in the jejunum of broilers is modulated by fishmeal inclusion in the diet. Furthermore, we show for the first time suppression of CD36 mRNA levels in the intestine of broilers challenged with 'Eimeria' or 'C. perfringens'