Patients seeking metabolic and bariatric surgery (MBS) are treated by an interdisciplinary team of surgeons and integrated health professionals before and after their surgery. Support groups are required as part of safet...Patients seeking metabolic and bariatric surgery (MBS) are treated by an interdisciplinary team of surgeons and integrated health professionals before and after their surgery. Support groups are required as part of safety and quality of care programs seeking and maintaining accreditation; nevertheless, the research is limited regarding the efficacy and outcomes related to support group attendance. The intention of this systematic review is to summarize current literature surrounding MBS support groups, to identify gaps in the literature, and to provide recommendations for future research regarding support groups, as well as guidance for support group facilitators. Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines platform and database searches were conducted for MBS support groups from 1998 to present using PubMed (Medline); Ovid (Medline); APA PsycNet (PsychINFO). Inclusion criteria were English language, adults of any age and adolescents (ages 14-18), and private, hospital, or academic medical center live support groups that follow American Society for Metabolic and Bariatric Surgery standards. Eighteen studies were included in our review. Authors sought to examine the relationship between attendance at facilitator-led, in person or virtual and hybrid support groups and outcomes of weight loss, self-management, and barriers to attendance. Results showed that support group attendance was associated with better weight loss, self-management, and adherence following surgery. This review supports the ongoing need for support group to be part of the interdisciplinary care of patients undergoing MBS. Additional research is needed to address cited gaps in the literature surrounding selection bias, lack of comparison groups, and to determine the impact of hybrid and virtual support groups on patient outcomes.
BACKGROUND: Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD...BACKGROUND: Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD was added as a new variable for the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, allowing for analysis of this variable on perioperative and postoperative outcomes. OBJECTIVE: To examine the impact of preoperative LD diagnosis on 30-day outcomes following MBS and quantify intraoperative liver biopsy frequency. SETTING: MBSAQIP, 2023. METHODS: A total of 217,952 cases (24,240 with LD; 193,712 without LD) were analyzed to compare operative length, length of stay (LOS), infectious complications, serious complications, major adverse cardiovascular events (MACE), and mortality. Chi-square and Wilcoxon rank-sum tests were used, and propensity matching was performed based on age, sex, race, body mass index, and preoperative comorbidities. RESULTS: Patients with LD had a slight increase in operative length (99.6 vs. 92.0 min; P < .0001) and were more likely to experience prolonged LOS (>5 days: .84% vs. .67%; P < .05). Rates of infectious complications (1.86% vs. 1.40%; P < .0001) and serious complications (1.65% vs. 1.31%; P < .01) were higher among those with LD. There were no differences in 30-day mortality (.08% vs. .11%; p = NS) or MACE (MACE: .10% vs. .07%; p = NS) between groups. Only 3.5% of cases included intraoperative liver biopsy. CONCLUSION: Patients with LD experienced higher rates of postoperative infections and serious complications, as well as prolonged LOS, than those without LD. These findings highlight the importance of preoperative LD screening in bariatric surgery patients.
BACKGROUND: Obesity is increasingly linked to chronic kidney disease, and most patients with end-stage renal disease would benefit from kidney transplantation. Bariatric surgery is the most effective treatment for obesit...BACKGROUND: Obesity is increasingly linked to chronic kidney disease, and most patients with end-stage renal disease would benefit from kidney transplantation. Bariatric surgery is the most effective treatment for obesity and possibly improves postrenal transplant outcomes in patients with obesity. OBJECTIVE: To determine if a history of bariatric surgery is predictive of length of stay (LOS) after kidney transplantation. SETTING: National inpatient stays in the United States. METHODS: The National Inpatient Sample (NIS) from 2016 to 2021 was combined, and patients undergoing kidney transplantation were identified with relevant health factors recorded. Cohorts stratified by prior bariatric surgery were identified. Characteristics and outcomes were compared with Welsh t-tests and chi-squared tests. A multivariable linear regression model was created against LOS. Five groups by LOS time were formed and rates of mortality, organ rejection or failure, sepsis, adverse reaction to immunosuppressant therapy, and urinary tract infection (UTI) compared. RESULTS: Twenty-four thousand seven hundred eighty-seven patients were identified with admission for kidney transplantation and 654 (2.6%) had undergone previous bariatric surgery. Patients with a history of bariatric surgery were more frequently female, had obesity, and had diabetes, anticoagulant therapy, sleep apnea, and anxiety or depression. The linear regression modeling showed that patients with history of bariatric surgery had decreased LOS (5.6 versus 6.4 days, P < .001). Patients with increased LOS were associated with greater morbidity (P < .05). CONCLUSION: Previous bariatric surgery is associated with decreased LOS in patients undergoing kidney transplantation. Care teams should be aware of predictors of LOS, as longer LOS is associated with increased postoperative complications and hospital costs.
BACKGROUND: There is a need for an instrument that efficiently identifies heart failure (HF) symptoms in patients with obesity. OBJECTIVES: To determine the spectrum of HF symptoms in patients with severe obesity who los...BACKGROUND: There is a need for an instrument that efficiently identifies heart failure (HF) symptoms in patients with obesity. OBJECTIVES: To determine the spectrum of HF symptoms in patients with severe obesity who lose weight following bariatric surgery using a new, validated HF health-related quality of life (HRQOL) instrument, Patient-Reported Outcomes Measurement Information System (PROMIS) + HF-27. SETTING: Health academic quaternary care center in the United States. METHODS: Prospective longitudinal 12-month cohort study. PROMIS + HF-27 HRQOL surveys were administered before and 1 year after sleeve gastrectomy. T-scores anchoring HRQOL domain scores to the U.S. general population were calculated. Dyspnea T-scores were centered on a chronic obstructive pulmonary disease reference population. RESULTS: Of 40 patients at baseline, 33 (83%) reported some degree of dyspnea: mild n = 18 (55%), moderate n = 12 (36%), and severe n = 3 (9%) on the PROMIS + HF-27 survey. Only 1 patient had been given a clinical diagnosis of dyspnea during routine primary care visits. Dyspnea, physical function, fatigue, sleep disorders, and pain T-scores were significantly improved (dyspnea: preoperative: 45.3 ± 8.2, postoperative: 35.6 ± 4.9, P < .0001; physical function: preoperative: 47.7 ± 7.6, postoperative: 52.3 ± 5.3, P = .001; fatigue: preoperative: 54.5 ± 8.6, postoperative: 45.7 ± 8.1, P < .000; sleep disorders: preoperative: 52.1 ± 8.5, postoperative: 46.6 ± 7.8, P = .002; pain: preoperative: 55.1 ± 9.4, postoperative: 47.3 ± 6.2, P < .0001; n = 40). Depression and cognitive disturbances T-scores did not significantly change after surgery (P > .05 for all). Summary scores for physical function, social roles, mental function, and the overall HRQOL total score were significantly improved 1 year after bariatric surgery (P < .05). None of the summary scores or the domain T-scores, including dyspnea, were significantly associated with weight loss adjusted for sex, age, and preoperative weight. CONCLUSIONS: PROMIS + HF-27 efficiently measured and detected improvements in multiple obesity-relevant HRQOL domains following sleeve gastrectomy. Of these, dyspnea was the most prominent and showed the largest improvement after bariatric surgery.
BACKGROUND: Neurological impairment has been recognized in up to 70% of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, which can lead to poor quality of life (QoL). OBJECTIVES...BACKGROUND: Neurological impairment has been recognized in up to 70% of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity, which can lead to poor quality of life (QoL). OBJECTIVES: To evaluate the impact of bariatric surgery on neurological alterations, QoL, and factors associated with neurological response. SETTING: Tertiary University Hospital, Spain METHODS: A prospective, longitudinal study was conducted in 53 patients undergoing bariatric surgery between 2021 and 2023. Psychometric tests and the SF-12 questionnaire were performed 1-month before and 3- and 6-months after surgery. Liver biopsy was performed during the intervention. A group of healthy controls was included at a 2:1 ratio, as a reference. RESULTS: Mean age was 49 (SD 9) years, 68% were female and median body mass index was 45 (interquartile range [IQR] 39-49) kg/m. No patients presented advanced fibrosis (F3-F4) and only 14% showed a nonalcoholic fatty liver disease (NAFLD) score >3 in liver biopsy. A total of 63% exhibited alterations in verbal fluency (Animal Naming Test -ANT-), with a significant improvement at 3- (36%; P = .035) and 6-months (35%; P < .001). Psychomotor speed and selective attention (75% versus 48%; P = .004) as well as bimanual and visuomotor coordination (90% vs. 74%; P = .021) showed a significant improvement after surgery. QoL increased globally, mainly in the physical sphere (P < .001). Older age, diabetes and IL-6 levels were associated with an altered ANT after surgery. CONCLUSIONS: Neurological impairment is common in patients with MASLD and severe obesity. Cognitive, motor performance, and QoL improve after bariatric surgery. Age, diabetes, and inflammatory markers are predictors of poor response.
Docimo S, Oviedo RJ, Afaneh C
… +6 more, Schirmer B, Moustarah F, Grothe K, Vosburg RW, Carter J, Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery
BACKGROUND: Endoscopic bariatrics is a growing area of interest in the battle against obesity. This systematic review provides a review of the pertinent endoluminal approaches to bariatrics. The purpose of this review is...BACKGROUND: Endoscopic bariatrics is a growing area of interest in the battle against obesity. This systematic review provides a review of the pertinent endoluminal approaches to bariatrics. The purpose of this review is to describe the current indications, clinical outcomes, safety profile, and the progress of endoluminal bariatric therapies for both primary and revisional indications. METHODS: We conducted a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A review of databases were performed and all studies were then evaluated based on inclusion and exclusion criteria: all studies with participants over the age of 18 years, a meta-analysis design, a randomized trial design, or a cohort study design were included. All case reports, letters, comments, and animal and in vitro studies were excluded. RESULTS: A total of 9586 articles were retrieved from our search. After removing duplicates, 7778 studies remained. After applying inclusion and exclusion criteria, and adding one study from our review of citations, a total of 46 studies were included in our study (Fig. 1). DISCUSSION: This review was conducted utilizing all aspects of the PRISMA model for systematic review. The 46 studies included summaries the various approaches to endoluminal bariatrics and provides a thorough overview of outcomes and complications.
BACKGROUND: There is considerable variability in both the timing of weight change and changes in psychological difficulties functioning following metabolic bariatric surgery (MBS). Empirical studies appear to show that l...BACKGROUND: There is considerable variability in both the timing of weight change and changes in psychological difficulties functioning following metabolic bariatric surgery (MBS). Empirical studies appear to show that levels of depressive symptoms decrease with weight loss and increase due to weight recurrence. Yet, this research has not included sufficient repeated measurements to account for individual differences in the timing of when weight nadir is achieved and weight recurrence begins post-MBS. OBJECTIVES: Examine how trait-like measures of mood and momentary measures of affect change over time relative to when an individual reach their nadir weight following MBS. SETTING: A health care facility in Sanford Research, Fargo, ND and a university health care facility in Stanford University, Stanford, CA. METHODS: Participants provided data from before surgery until 3 years after surgery. Depressive symptoms (as measured by the Beck Depressive symptoms Inventory) and weight were collected during in-person visits at 6-, 12-, 15-, 18-, 21-, 24-, 30-, and 36-months postsurgery. Momentary mood was assessed via ecologic momentary assessment at 1, 2, and 3 years after surgery. RESULTS: No difference in BDI scores emerged relative to weight nadir (both before and after nadir). However, there was a statistically-significant positive association between time in months relative to weight nadir and momentary negative affect, but this effect was quite small. CONCLUSIONS: The current study suggests that depressive symptoms does not improve in the time between MBS and weight nadir (i.e., weight loss phase) and also does not deteriorate meaningfully after patients reach their weight nadir (i.e., weight recurrence phase). While momentary negative affect was related to weight change after surgery, this small effect is not likely clinically meaningful.
BACKGROUND: Obesity is associated with impaired left ventricular myocardial function. Metabolic and bariatric surgery (MBS) is a potential intervention to improve cardiac function in individuals with obesity. OBJECTIVES:...BACKGROUND: Obesity is associated with impaired left ventricular myocardial function. Metabolic and bariatric surgery (MBS) is a potential intervention to improve cardiac function in individuals with obesity. OBJECTIVES: This study aimed to assess changes in left ventricular myocardial work in individuals with obesity following MBS using the pressure-strain loop method, providing a foundation for guiding clinical interventions. SETTING: The study was conducted at a medical facility specializing in MBS and cardiovascular assessments. METHODS: A total of 68 individuals with obesity (mean age 32.9 ± 6.0 years; 32 males) scheduled for MBS were prospectively enrolled, along with 48 healthy volunteers matched for age and sex (mean age 31.6 ± 5.6 years; 22 males) as the control group. Conventional echocardiographic parameters, global longitudinal strain (GLS), and myocardial work (MW) parameters were assessed for all participants both prior to MBS and 12 months postoperatively. MW parameters included global constructive work (GCW), global work index (GWI), global wasted work (GWW), and global work efficiency (GWE). RESULTS: Twelve months postsurgery, reductions were observed in body mass index (BMI), blood pressure, blood glucose, blood lipids, and left ventricular mass index in the obesity group, although these remained higher than the control group. Improvements were noted in GLS, GCW, GWI, and GWE within the obesity group but remained lower than those of the control group. Conversely, GWW decreased but was still higher than that of the control group. CONCLUSIONS: MBS led to improvements in left ventricular systolic function due to weight reduction and metabolic enhancements; however, these improvements did not fully restore normal levels within 12 months postsurgery.
BACKGROUND: Obesity and rheumatoid arthritis (RA) are chronic, often coexisting conditions that compound clinical complexity. Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, but its lo...BACKGROUND: Obesity and rheumatoid arthritis (RA) are chronic, often coexisting conditions that compound clinical complexity. Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, but its long-term safety and impact on RA disease control are not well defined. OBJECTIVES: To evaluate the long-term safety (≤5 years) and potential disease-modifying effects of MBS in patients with RA. SETTING: Multicenter, retrospective cohort study using the TriNetX global federated health research network across multiple healthcare institutions worldwide. METHODS: Adults (≥18 years) who underwent MBS between 2010 and 2024 were identified. Three cohorts were created: RA with MBS, RA without MBS, and MBS without RA. Propensity score matching was performed using demographic and comorbidities. Primary outcomes included long-term safety, nutritional complications, and RA disease-modifying indicators such as medication use and inflammatory markers. RESULTS: One thousand nine-hundred thirty-one patients with RA who underwent MBS were matched 1:1 with controls. Patients with RA experienced higher nutritional complications including vitamin D (52.4% versus 42.7%), B12 (18.0% versus 14.0%), and iron deficiency (11.5% versus 8.5%). Sleeve gastrectomy was associated with fewer complications than Roux-en-Y gastric bypass. Postoperatively, patients with RA showed significant reductions in use of corticosteroids (34.3% versus 53.6%), tumor necrosis factor inhibitors (6.3% versus 14.5%), and disease-modifying antirheumatic drugs (9.7% versus 31.6%), along with lower inflammatory makers levels. Five-year mortality was lower in the RA surgical group (1.8% versus 3.8%). CONCLUSIONS: MBS in patients with RA is associated with improved disease control and reduced mortality, though higher nutritional risks warrant careful postoperative monitoring and multidisciplinary care.
BACKGROUND: Elderly patients undergo bariatric surgery less frequently than younger patients due to several factors such as increased complication risk. Obesity exacerbates frailty among elderly patients through sarcopen...BACKGROUND: Elderly patients undergo bariatric surgery less frequently than younger patients due to several factors such as increased complication risk. Obesity exacerbates frailty among elderly patients through sarcopenia and metabolic dysfunction. Therefore, specific preoperative risk assessment in elderly patients is crucial. OBJECTIVES: We created the modified Bariatric Frailty Score (mBFS) and compared the 30-day outcomes between low versus high mBFS in elderly patients after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). SETTING: 2015-2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. METHODS: Patients aged ≥ 60 years who underwent SG and RYGB were included. 14 variables of the Canadian Study of Health and Aging-Frailty Index were mapped onto 9 variables of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (each component equals 1 point). Correlations and multivariate logistical regression analysis were performed between mBFS and 7 postoperative outcomes (nonhome discharge, mortality, prolonged hospital stay, intensive care unit admissions, cardiac complications, pulmonary complications, and renal complications). Finally, a propensity score matching between low mBFS (0-4) and high mBFS (5-9) was performed for SG and RYGB. RESULTS: A total of 90,239 and 40,272 patients were included for SG and RYGB, respectively. The increasing mBFS was strongly correlated with linear regression. In the multivariate analysis, scores of 5, 6, 7, and 8 strongly predicted the 7 postoperative outcomes of interest. After the propensity score matching, the matched cohorts for SG and RYGB were 3337 and 1655, respectively. A high mBFS (5-9) was associated with an increased rate of postoperative complications in the SG and RYGB groups. CONCLUSIONS: Our mBFS is a better predictor of nonhome discharge, prolonged hospital stays, 30-day mortality, unplanned intensive care unit admissions, and cardiac, pulmonary, and renal complications than the American Society of Anesthesiologists score of III, American Society of Anesthesiologists score of IV-V, renal insufficiency, or smoker status. Our study validated the cumulative deficit theory in elderly bariatric surgery patients.
Dougherty EN, Murray MF, Laam LA
… +9 more, Kerver GA, Stanley TB, Koball AM, Steffen KJ, Heinberg LJ, Safer DL, Bond DS, Wonderlich SA, Engel SG
Surg Obes Relat Dis
· 2026 Jan · PMID 41176457
·
Full text
BACKGROUND: Loss of control eating (LOCE) is associated with adverse clinical outcomes after metabolic and bariatric surgery (MBS); however, current understanding of factors that predict LOCE is incomplete. This study is...BACKGROUND: Loss of control eating (LOCE) is associated with adverse clinical outcomes after metabolic and bariatric surgery (MBS); however, current understanding of factors that predict LOCE is incomplete. This study is the first to investigate boredom and stress as predictors of LOCE following MBS. OBJECTIVES: To use ecological momentary assessment (EMA) to evaluate boredom and stress as predictors of LOCE over 3 years following MBS. SETTING: University hospitals; United States. METHODS: Adults (N = 150) who underwent MBS completed a study visit followed by a 1-week EMA protocol at 1-year, 2-year, and 3-years post-MBS (with 143 participants contributing data at year 1, 110 at year 2, and 91 at year 3). During the EMA protocol, participants provided ratings of boredom, stress, and LOCE five times per day. RESULTS: Stress and boredom were associated with LOCE when controlling for year since surgery. Regarding variability in associations over time, at the within-person level, momentary boredom predicted more severe LOCE, but only at 2 years post-MBS. Momentary stress predicted more severe LOCE at 2- and 3-years post-MBS, with no change between these years. At the between-person level, participants with higher boredom reported more severe LOCE during the EMA protocol at 2- and 3-years post-MBS, with the strongest association 3-years post-MBS. Participants with higher stress reported more severe LOCE during the EMA protocol each year following MBS, with the strongest association at 2-years post-MBS. CONCLUSIONS: Boredom and stress predict more severe LOCE, particularly 2-3 years post-MBS, highlighting this period as an opportunity for intervention.
BACKGROUND: Research indicates the prevalence of alcohol use disorder (AUD) increases following bariatric surgery. However, the evolution of alcohol drinking motives over time and the predictors of increased alcohol use...BACKGROUND: Research indicates the prevalence of alcohol use disorder (AUD) increases following bariatric surgery. However, the evolution of alcohol drinking motives over time and the predictors of increased alcohol use postsurgery remain unclear. OBJECTIVES: This study examined changes in alcohol consumption and drinking motives during the first 6 months after bariatric surgery, as well as psychological factors associated with increased postoperative alcohol use. SETTING: The research was conducted across four Belgian hospitals. METHODS: A prospective cohort study was carried out. Of the 298 participants who completed baseline questionnaires, 252 (84.6%) completed them 6 months postsurgery. RESULTS: Six months postsurgery, the prevalence of probable AUD (7.9% versus 3.2%, P < .01), and the total Alcohol Use Disorders Identification Test scores declined (z = -6.28; P < .001) in the full sample. However, a subgroup (9.1%) reported increased alcohol intake (z = -4.23; P < .001) and heightened coping-related drinking motives (z = -2.82; P < .01), a pattern not observed in the overall sample. Preoperative psychological factors (i.e., emotional regulation, experiential avoidance, emotional eating) were not significantly associated with postoperative alcohol use. However, the group with increased intake showed higher postoperative anxiety than others (H(2) = 7.12; P = .03), and was the only one in which anxiety scores did not decrease postoperatively (z = -.89, P = .37). CONCLUSIONS: By 6 months postsurgery, a subset of individuals demonstrated increased alcohol use, coping drinking motives, and persistent high anxiety. The 6-month postoperative period may represent a key window for implementing interventions to prevent AUD development.