A pilot study of implementation of endoscopic sleeve gastroplasty (ESG) in Norway

Background and aim - Bariatric surgery is the most effective treatment for obesity but is invasive and associated with serious complications. Endoscopic sleeve gastroplasty (ESG) is a less invasive weight loss procedure to reduce the stomach volume by full-thickness sutures. ESG has been adopted in many countries, but implementation at Scandinavian centres has not yet been documented. We performed a clinical pilot trial at a Norwegian centre with the primary objective to assess the feasibility of the ESG procedure. Patients and methods - We included the first 10 patients treated with ESG at a Norwegian centre in a single-arm pilot study. The eligibility criteria were either a body mass index (BMI) of 40–49.9 kg/m2, BMI 35–39.9 kg/m2 and at least one obesity-related comorbidity, or BMI 30–34.9 kg/m2 and type 2 diabetes. Patient follow-up resembled the scheme used for bariatric surgery at the center, including dietary plans and outpatient visits. Results - All procedures were technically successful except for one patient who had adhesions between the stomach and anterior abdominal wall, related to a prior hernia repair, resulting in less-than-intended stomach volume reduction. Mean total body weight loss (TBWL) after 26 and 52 weeks was 12.2% (95% CI 8.1–16.2) and 9.1% (95% CI 3.3 − 15.0). One patient experienced a minor suture-induced diaphragmatic injury, which was successfully managed conservatively. Conclusions - This first Scandinavian clinical trial of ESG, documenting the implementation of the procedure at a Norwegian center, demonstrated acceptable feasibility and safety, with large variations in individual weight loss during the 52-week follow-up period

Employment Is Associated with the Health-Related Quality of Life of Morbidly Obese Persons

Published version of an article in the journal: Obesity Surgery. The original publication is available at Springerlink. http://dx.doi.org/10.1007/s11695-010-0289-6. Open AccessBackground  We aimed to investigate whether employment status was associated with health-related quality of life (HRQoL) in a population of morbidly obese subjects. Methods  A total of 143 treatment-seeking morbidly obese patients completed the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) and the Obesity and Weight-Loss Quality of Life (OWLQOL) questionnaires. The former (SF-36) is a generic measure of physical and mental health status and the latter (OWLQOL) an obesity-specific measure of emotional status. Multiple linear regression analyses included various measures of the HRQoL as dependent variables and employment status, education, marital status, gender, age, body mass index (BMI), type 2 diabetes, hypertension, obstructive sleep apnea, and treatment choice as independent variables. Results  The patients (74% women, 56% employed) had a mean (SD, range) age of 44 (11, 19–66) years and a mean BMI of 44.3 (5.4) kg/m2. The employed patients reported significantly higher HRQoL scores within all eight subscales of SF-36, while the OWLQOL scores were comparable between the two groups. Multiple linear regression confirmed that employment was a strong independent predictor of HRQoL according to the SF-36. Based on part correlation coefficients, employment explained 16% of the variation in the physical and 9% in the mental component summaries of SF-36, while gender explained 22% of the variation in the OWLQOL scores. Conclusion  Employment is associated with the physical and mental HRQoL of morbidly obese subjects, but is not associated with the emotional aspects of quality of life

Patient complaints following bariatric surgery 2012-18

BAKGRUNN Vi undersøkte saker fremmet for Norsk pasientskadeerstatning (NPE) etter vektreduserende kirurgi, inkludert bakgrunnen for klagen, andel pasienter som fikk medhold, og kjennetegn ved saker der klager fikk medhold. MATERIALE OG METODE Samtlige klagesaker knyttet til vektreduserende kirurgisk behandling i perioden 2012–18 ble gjennomgått og kategorisert med henblikk på symptomer, funn og hendelser med relevans for utfallet av klagesaken. Anonyme resyméer fra de sakkyndiges uttalelser ble gjennomgått og kategorisert etter årstall for vedtak, kjønn, alder, grunnlag for medhold eller avslag på erstatning samt hvorvidt behandlingen var utført i offentlig eller privat regi. RESULTATER Det ble gitt medhold i 44 (26 %) av totalt 171 søknader om pasientskadeerstatning. Disse søknadene kom fra 25 pasienter som var operert i det offentlige (19 % medhold) og 19 pasienter operert i det private helsevesenet (51 % medhold). Den hyppigste enkeltårsaken til medhold (n = 18) var manglende indikasjon for vektreduserende operasjon. FORTOLKNING Manglende indikasjon utløste medhold i flere klagesaker etter vektreduserende kirurgi enn kirurgtekniske feil. Riktig pasientutvelgelse, god preoperativ forberedelse, god informasjon og samvalg er viktig for best mulig resultat av vektreduserende kirurgi. Et tverrfaglig team som følger pasientene over tid, kan bidra til å kvalitetssikre hele behandlingskjeden

Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study

Background: There is little robust evidence relating to changes in health related quality of life (HRQL) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass (RYGB). The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects. In addition, we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year. We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program (ILI) with morbidly obese subjects.Methods: A total of 139 morbidly obese patients chose treatment with RYGB (n=76) or ILI (n=63). The ILI comprised four stays (seven weeks) at a specialized rehabilitation center over one year. The daily schedule was divided between physical activity, psychosocially-oriented interventions, and motivational approaches. No special diet or weight-loss drugs were prescribed. The participants completed three HRQL-questionnaires before treatment and 1 year thereafter. Both linear regression and ANCOVA were used to analyze differences between weight loss and treatment for five dimensions of HRQL (physical, mental, emotional, symptoms and symptom distress) controlling for baseline HRQL, age, age of onset of obesity, BMI, and physical activity. Clinical relevance was assessed by effect size (ES) where ES.80 as large. Results: The adjusted between group mean difference (95% CI) was 8.6 (4.6,12.6) points (ES=.83) for the physical dimension, 5.4 (1.5–9.3) points (ES=.50) for the mental dimension, 25.2 (15.0–35.4) points (ES=1.06) for the emotional dimension, 8.7 (1.8–15.4) points (ES=.37) for the measured symptom distress, and 2.5 for (.6,4.5) fewer symptoms (ES=.56), all in favor of RYGB. Within-group changes in HRQOL in the RYGB group were large for all dimensions of HRQL. Within the ILI group, changes in the emotional dimension, symptom reduction and symptom distress were moderate. Linear regression analyses of weight loss on HRQL change showed a standardized beta-coefficient of –.430 (p<.001) on the physical dimension, –.288 (p=.004) on the mental dimension, –.432 (p<.001) on the emotional dimension, .287 (p=.008) on number of symptoms, and .274 (p=.009) on reduction of symptom pressure. Conclusions: Morbidly obese participants undergoing RYGB and ILI had improved HRQL after 1 year. The weaker response of ILI on HRQL, compared to RYGB, may be explained by the difference in weight loss following the two treatments

Association of time of obesity onset with comorbidities in treatment-seeking men and women with severe obesity.

Objectives: Early obesity onset is a risk factor for specific comorbidities in adulthood, but whether this relationship is present in men and women with severe obesity is unknown. This study aimed to examine whether obesity onset in childhood or adolescence, as compared with adulthood, is associated with higher odds of comorbidities in men and women with severe obesity. Methods: A cross-sectional study of treatment-seeking men and women with severe obesity attending a tertiary care centre in Norway, from 2006 to 2017, was performed. Results: A total of 4,583 participants (69.13% women) were included. Almost all men (99.69%) and women (99.18%) suffered from ≥1 comorbidities. Compared with women, men were older (mean [SD]) (45.54 [12.14] vs. 42.56 [12.00] years, p 20 years), was associated with lower odds (OR [95% CI]) of obstructive sleep apnoea (OSA) in men (0.69 [0.53, 0.91], p < 0.01) and higher odds of OSA (1.49 [1.16, 1.91], p < 0.01) in women, and the interaction was significant (p < 0.01). Childhood onset of obesity was also associated with higher odds of coronary heart disease in men (1.82 [1.15, 2.89], p = 0.01) and type 2 diabetes in women (1.25 [1.01, 1.54], p = 0.04). Conclusion: Childhood onset of obesity was associated with higher odds of coronary heart disease in men and OSA and type 2 diabetes in women, but with lower odds of OSA in men