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Erschienen in: Obesity Surgery 2/2012

01.02.2012 | Clinical Research

Medical and Psychosocial Outcomes of Laparoscopic Roux-en-Y Gastric Bypass: Cross-sectional Findings at 4-Year Follow-up

verfasst von: Valerie H. Myers, Claire E. Adams, Brooke L. Barbera, Phillip J. Brantley

Erschienen in: Obesity Surgery | Ausgabe 2/2012

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Abstract

Background

In conjunction with the Louisiana Office of Group Benefits, the Louisiana State University School of Medicine conducted a study to examine 4-year medical and psychosocial outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in patients insured by a state-run managed care program.

Methods

Forty severely obese participants (body mass index >40 and <60 kg/m2) underwent LRYGB surgery. Four years later, self-reported data on weight, blood pressure, blood glucose, and cholesterol were collected from the participants via telephone, and chart reviews for most recent weight and laboratory measures available were requested from physicians of record. Participants also completed self-report measures of quality of life, depressive symptoms, binge eating, quality of eating style, and overall satisfaction with the surgery via telephone.

Results

Patients lost an average of 62% of excess weight. In addition, the sample showed favorable medical outcomes in terms of blood pressure, lipid profiles, and blood glucose. Patients reported low depression, good quality of life, high satisfaction with surgery, and no binge eating 4 years post-surgery. However, many participants reported concerns about eating habits as well as excessive intake of high-fat, high-calorie foods.

Conclusions

Overall, these results suggest healthy levels of psychosocial and medical functioning 4 years after LRYGB and highlight the need for long-term dietary counseling and support post-surgery.
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Literatur
1.
Zurück zum Zitat Center for Disease Control and Prevention. The burden of chronic diseases and their risk factors: national and state perspectives. Atlanta: US Department of Health and Human Services; 2002. Center for Disease Control and Prevention. The burden of chronic diseases and their risk factors: national and state perspectives. Atlanta: US Department of Health and Human Services; 2002.
2.
Zurück zum Zitat Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–44.PubMedCrossRef Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–44.PubMedCrossRef
4.
Zurück zum Zitat Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22:2554–63.PubMedCrossRef Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22:2554–63.PubMedCrossRef
5.
6.
Zurück zum Zitat Christiansen T, Bruun JM, Madsen EL, et al. Weight loss maintenance in severely obese adults after an intensive lifestyle intervention: 2- to 4-year follow-up. Obesity. 2007;15:413–20.PubMedCrossRef Christiansen T, Bruun JM, Madsen EL, et al. Weight loss maintenance in severely obese adults after an intensive lifestyle intervention: 2- to 4-year follow-up. Obesity. 2007;15:413–20.PubMedCrossRef
7.
Zurück zum Zitat Ryan DH, Johnson WD, Myers VH, et al. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. Arch Intern Med. 2010;170:146–54.PubMedCrossRef Ryan DH, Johnson WD, Myers VH, et al. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. Arch Intern Med. 2010;170:146–54.PubMedCrossRef
8.
Zurück zum Zitat MacLean LD, Rhode BM, Nohr C. Late outcome of isolated gastric bypass. Ann Surg. 2000;231:524–8.PubMedCrossRef MacLean LD, Rhode BM, Nohr C. Late outcome of isolated gastric bypass. Ann Surg. 2000;231:524–8.PubMedCrossRef
9.
Zurück zum Zitat Pories WJ, MacDonald Jr KG, Morgan EJ, Sinha MK, et al. Surgical treatment of obesity and its effects on diabetes: 10-y follow-up. Am J Clin Nutr. 1992;55:582S–5.PubMed Pories WJ, MacDonald Jr KG, Morgan EJ, Sinha MK, et al. Surgical treatment of obesity and its effects on diabetes: 10-y follow-up. Am J Clin Nutr. 1992;55:582S–5.PubMed
10.
Zurück zum Zitat Sugerman HJ. The epidemic of severe obesity: the value of surgical treatment. Mayo Clin Proc. 2000;75:669–72.PubMed Sugerman HJ. The epidemic of severe obesity: the value of surgical treatment. Mayo Clin Proc. 2000;75:669–72.PubMed
11.
Zurück zum Zitat Garb J, Welch G, Zagarins S, et al. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009;19:1447–55.PubMedCrossRef Garb J, Welch G, Zagarins S, et al. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009;19:1447–55.PubMedCrossRef
12.
Zurück zum Zitat Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–205.PubMedCrossRef Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–205.PubMedCrossRef
13.
Zurück zum Zitat Czupryniak L, Wiszniewski M, Szymański D, et al. Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg. 2010;20:506–8.PubMedCrossRef Czupryniak L, Wiszniewski M, Szymański D, et al. Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients. Obes Surg. 2010;20:506–8.PubMedCrossRef
14.
Zurück zum Zitat Pories WJ, Swanson MS, McDonald KG, et al. Who would have thought it? An operation proved to be the most effective therapy for adult onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRef Pories WJ, Swanson MS, McDonald KG, et al. Who would have thought it? An operation proved to be the most effective therapy for adult onset diabetes mellitus. Ann Surg. 1995;222:339–50.PubMedCrossRef
15.
Zurück zum Zitat Sjöström N. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32:S93–7.CrossRef Sjöström N. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32:S93–7.CrossRef
16.
Zurück zum Zitat Schauer P, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.PubMedCrossRef Schauer P, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–29.PubMedCrossRef
17.
Zurück zum Zitat Schernthaner G, Morton JM. Bariatric surgery in patients with morbid obesity and type 2 diabetes. Diab Care. 2008;31:S297–302.CrossRef Schernthaner G, Morton JM. Bariatric surgery in patients with morbid obesity and type 2 diabetes. Diab Care. 2008;31:S297–302.CrossRef
18.
Zurück zum Zitat Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus. Ann Intern Med. 2009;150:94–103.PubMed Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus. Ann Intern Med. 2009;150:94–103.PubMed
19.
Zurück zum Zitat Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:184–9.PubMedCrossRef Arterburn D, Schauer DP, Wise RE, et al. Change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:184–9.PubMedCrossRef
20.
Zurück zum Zitat Jones Jr KB. Roux-en-Y gastric bypass: an effective anti-reflux procedure in the less than morbidly obese. Obes Surg. 1998;8:35–8.PubMedCrossRef Jones Jr KB. Roux-en-Y gastric bypass: an effective anti-reflux procedure in the less than morbidly obese. Obes Surg. 1998;8:35–8.PubMedCrossRef
21.
Zurück zum Zitat Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997;7:479–84.PubMedCrossRef Smith SC, Edwards CB, Goodman GN. Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg. 1997;7:479–84.PubMedCrossRef
22.
Zurück zum Zitat Charuzi I, Lavie P, Peiser J. Bariatric surgery in morbidly obese sleep-apnea patients: short and long-term follow-up. Am J Clin Nutr. 1992;55:594S–6.PubMed Charuzi I, Lavie P, Peiser J. Bariatric surgery in morbidly obese sleep-apnea patients: short and long-term follow-up. Am J Clin Nutr. 1992;55:594S–6.PubMed
23.
Zurück zum Zitat Macgregor AMC, Greenberg RA. Effect of surgically induced weight loss on asthma in the morbidly obese. Obes Surg. 1993;3:15–21.PubMedCrossRef Macgregor AMC, Greenberg RA. Effect of surgically induced weight loss on asthma in the morbidly obese. Obes Surg. 1993;3:15–21.PubMedCrossRef
24.
Zurück zum Zitat Klem ML, Wing RR, Ho Chang CC, et al. A case–control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means. Int J Obes. 2000;24:573–9.CrossRef Klem ML, Wing RR, Ho Chang CC, et al. A case–control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means. Int J Obes. 2000;24:573–9.CrossRef
25.
Zurück zum Zitat Karlsson J, Taft C, Sjostrom L, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61.CrossRef Karlsson J, Taft C, Sjostrom L, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61.CrossRef
26.
Zurück zum Zitat Kinzl JF, Schrattenecker M, Traweger C, et al. Quality of life in morbidly obese patients after surgical weight loss. Obes Surg. 2007;17:229–35.PubMedCrossRef Kinzl JF, Schrattenecker M, Traweger C, et al. Quality of life in morbidly obese patients after surgical weight loss. Obes Surg. 2007;17:229–35.PubMedCrossRef
27.
Zurück zum Zitat Craig J. Bariatric surgery: an option for long-term weight loss. Diabetes Self Manag 2002;9:14, 17–8, 20–11. Craig J. Bariatric surgery: an option for long-term weight loss. Diabetes Self Manag 2002;9:14, 17–8, 20–11.
28.
Zurück zum Zitat Frezza EE. Knowing your bariatric practice: what’s your insurance fee? What’s your leverage? Obes Surg. 2006;16:942–4.PubMedCrossRef Frezza EE. Knowing your bariatric practice: what’s your insurance fee? What’s your leverage? Obes Surg. 2006;16:942–4.PubMedCrossRef
29.
Zurück zum Zitat Frezza EE. Six steps to fast-track insurance approval for bariatric surgery. Obes Surg. 2006;16:659–63.PubMedCrossRef Frezza EE. Six steps to fast-track insurance approval for bariatric surgery. Obes Surg. 2006;16:659–63.PubMedCrossRef
30.
Zurück zum Zitat Encinosa WE, Bernard DM, Du D, et al. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47:531–5.PubMedCrossRef Encinosa WE, Bernard DM, Du D, et al. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47:531–5.PubMedCrossRef
31.
Zurück zum Zitat Hawkins SC, Osborne A, Finlay IG, et al. Paid work increases and state benefit claims decrease after bariatric surgery. Obes Surg. 2007;17:434–7.PubMedCrossRef Hawkins SC, Osborne A, Finlay IG, et al. Paid work increases and state benefit claims decrease after bariatric surgery. Obes Surg. 2007;17:434–7.PubMedCrossRef
32.
Zurück zum Zitat Martin LF, Lundberg AP, Juneau F, et al. A description of morbidly obese state employees requesting a bariatric operation. Surgery. 2005;138:690–700.PubMedCrossRef Martin LF, Lundberg AP, Juneau F, et al. A description of morbidly obese state employees requesting a bariatric operation. Surgery. 2005;138:690–700.PubMedCrossRef
33.
Zurück zum Zitat Hunter SM, Larrieu JA, Ayad FM, et al. Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity. South Med J. 1997;90:578–86.PubMedCrossRef Hunter SM, Larrieu JA, Ayad FM, et al. Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity. South Med J. 1997;90:578–86.PubMedCrossRef
34.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.PubMedCrossRef Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.PubMedCrossRef
35.
Zurück zum Zitat National Institute of Diabetes and Digestive and Kidney Diseases (2008b). High blood cholesterol. National institute of diabetes and digestive and kidney diseases. 2008. Available at http://www.nhlbi.nih.gov/health/dci/ Diseases/ Hbc/HBCWhatIs.html. Accessed 7 Mar 2009. National Institute of Diabetes and Digestive and Kidney Diseases (2008b). High blood cholesterol. National institute of diabetes and digestive and kidney diseases. 2008. Available at http://​www.​nhlbi.​nih.​gov/​health/​dci/​ Diseases/ Hbc/HBCWhatIs.html. Accessed 7 Mar 2009.
36.
Zurück zum Zitat Ware JE. SF-36 Health Survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993. Ware JE. SF-36 Health Survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.
37.
Zurück zum Zitat Arnau RC, Meagher MW, Norris MP, et al. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol. 2001;20:112–9.PubMedCrossRef Arnau RC, Meagher MW, Norris MP, et al. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol. 2001;20:112–9.PubMedCrossRef
38.
Zurück zum Zitat Beck AT, Steer RA, Ball R, et al. Comparison of Beck Depression Inventories-1A and II in psychiatric outpatients. J Pers Assess. 1996;67:588–97.PubMedCrossRef Beck AT, Steer RA, Ball R, et al. Comparison of Beck Depression Inventories-1A and II in psychiatric outpatients. J Pers Assess. 1996;67:588–97.PubMedCrossRef
39.
Zurück zum Zitat Spitzer RL, Yanovski S, Wadden T, et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord. 1993;13:137–53.PubMedCrossRef Spitzer RL, Yanovski S, Wadden T, et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord. 1993;13:137–53.PubMedCrossRef
40.
Zurück zum Zitat Canetti L, Berry EM, Elizur Y. Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight loss program: the mediating role of emotional eating. Int J Eat Disord. 2009;42:109–17.PubMedCrossRef Canetti L, Berry EM, Elizur Y. Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight loss program: the mediating role of emotional eating. Int J Eat Disord. 2009;42:109–17.PubMedCrossRef
41.
Zurück zum Zitat Thorp AA, Healy GN, Owen N, et al. Deleterious associations of sitting time and television viewing time with cardiometabolic risk biomarkers. Diab Care. 2010;33:327–34.CrossRef Thorp AA, Healy GN, Owen N, et al. Deleterious associations of sitting time and television viewing time with cardiometabolic risk biomarkers. Diab Care. 2010;33:327–34.CrossRef
42.
Zurück zum Zitat Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13:159–60.PubMedCrossRef Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13:159–60.PubMedCrossRef
43.
Zurück zum Zitat Kolotkin RL, Crosby RD, Gress RE, et al. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surge Obes Relat Dis. 2009;5:250–6.CrossRef Kolotkin RL, Crosby RD, Gress RE, et al. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Surge Obes Relat Dis. 2009;5:250–6.CrossRef
45.
Zurück zum Zitat Hall JC, Watts JM, O’Brien PE, et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg. 1990;211:419–27.PubMedCrossRef Hall JC, Watts JM, O’Brien PE, et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg. 1990;211:419–27.PubMedCrossRef
46.
Zurück zum Zitat Yale CE. Gastric surgery for morbid obesity: complications and long-term weight control. Arch Surg. 1989;124:941–6.PubMedCrossRef Yale CE. Gastric surgery for morbid obesity: complications and long-term weight control. Arch Surg. 1989;124:941–6.PubMedCrossRef
47.
Zurück zum Zitat Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6.PubMed Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6.PubMed
49.
Zurück zum Zitat National Institutes of Health Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61. National Institutes of Health Consensus Development Conference Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.
50.
Zurück zum Zitat Saber AA, Elgamal MH, McLeod MK. Bariatric surgery: the past, present, and future. Obes Surg. 2008;18:121–8.PubMedCrossRef Saber AA, Elgamal MH, McLeod MK. Bariatric surgery: the past, present, and future. Obes Surg. 2008;18:121–8.PubMedCrossRef
51.
Zurück zum Zitat Strain GW, Gagner M, Pomp A, et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009;5:582–7.PubMedCrossRef Strain GW, Gagner M, Pomp A, et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009;5:582–7.PubMedCrossRef
52.
Zurück zum Zitat Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up. Obes Surg. 2009;19:3–12.PubMedCrossRef Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up. Obes Surg. 2009;19:3–12.PubMedCrossRef
53.
Zurück zum Zitat National Institute of Diabetes and Digestive and Kidney Diseases. Bariatric surgery clinical research consortium. Bethesda: National Institutes of Diabetes and Digestive and Kidney Diseases; November 1, 2002. RFA DK-03-006. National Institute of Diabetes and Digestive and Kidney Diseases. Bariatric surgery clinical research consortium. Bethesda: National Institutes of Diabetes and Digestive and Kidney Diseases; November 1, 2002. RFA DK-03-006.
Metadaten
Titel
Medical and Psychosocial Outcomes of Laparoscopic Roux-en-Y Gastric Bypass: Cross-sectional Findings at 4-Year Follow-up
verfasst von
Valerie H. Myers
Claire E. Adams
Brooke L. Barbera
Phillip J. Brantley
Publikationsdatum
01.02.2012
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 2/2012
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-010-0324-7

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