5-Year Results of Banded One-Anastomosis Gastric Bypass: a Pilot Study in Super-Obese Patients.

BACKGROUND: The novel banded one-anastomosis gastric bypass (B-OAGB) procedure has not previously been reported in super-obese patients over the long term. In this pilot study, outcomes in patients with a mean baseline body mass index (BMI, kg/m2) of ≥ 50 who underwent B-OAGB were evaluated through 5-year follow-up. PATIENTS AND METHODS: Total weight loss (TWL), excess weight loss (EWL), BMI evolution, and changes in type 2 diabetes biomarkers were analyzed prospectively in super-obese patients who underwent B-OAGB. Paired samples t tests were used to assess weight outcome change from baseline through 5-year follow-up and 95% CIs were calculated. The Bariatric Outcomes and Reporting System (BAROS) was used to assess surgical success at 3 time points. RESULTS: Between October 2013 and February 2014, a 12-patient pilot cohort (mean baseline BMI 57.5 ± 6.3) underwent B-OAGB. No perioperative complications were observed within 30 days. Five-year mean BMI was 31.2 ± 5.4, a BMI loss of 25.9 (TWL 45.3 ± 7.5%; EWL 72.2 ± 12.8%). Between 11 and 24 months following surgery, 3 patients required band removal; each had one complication (1 stasis esophagitis and recurrent vomiting; 1 hypoalbuminemia; 1 anemia). There was no mortality. Long-term B-OAGB BAROS subscale and composite scores were comparable to other major bariatric procedures. CONCLUSIONS: In a pilot study of super-obese patients who underwent B-OAGB, excellent durable BMI loss of 25.9 kg/m2 (EWL 72.2%) at 5 years was achieved with an acceptable level of reoperation. More B-OAGB long-term follow-up studies are necessary to provide definitive conclusions regarding this combination bariatric procedure.

SALTO - Study Protocol and Rationale of a Community-Oriented Obesity Prevention Program in the Kindergarten.

BACKGROUND: The prevalence of early childhood overweight and obesity in Austria has reached average European levels of 20% in boys and 18% in girls. The rationale and study protocol of SALTO, Salzburg Together against Obesity will be presented, which is aimed to assist adults in increasing the rate of 4- to 6-year-old children with a healthy body weight. METHODS: A controlled longitudinal sequential study design consisting of 14 intervention (IK) and 8 control (CK) kindergarten was used to investigate the effect of actions tailored for teachers and parents on BMI among 4- to 6-year-old children. The study launched in November 2014 was approved by the ethics committee of the University of Salzburg. RESULTS: 681 children, 181 parents (119 mothers, 62 fathers) and 30 teachers were investigated until October 2016. Preliminary analyses revealed that more boys (19%) and fathers (60% IK, 43% CK) were overweight and obese than girls (16%) and mothers (19% IK, 20% CK). CONCLUSION: The challenges faced by the SALTO staff in the implementation of health-promoting actions in the kindergarten are manifold. The Community-Oriented Core Setting (COCS) intervention approach will show whether the actions will reduce the percentage of obesity and be sustainable in the long term.

Crave, Like, Eat: Determinants of Food Intake in a Sample of Children and Adolescents with a Wide Range in Body Mass.

Obesity is a heterogeneous condition with obese individuals displaying different eating patterns. Growing evidence suggests that there is a subgroup of obese adults that is marked by frequent and intense food cravings and addiction-like consumption of high-calorie foods. Little is known, however, about such a subgroup of obese individuals in childhood and adolescence. In the present study, a sample of children and adolescents with a wide range in body mass was investigated and trait food craving, liking for and intake of high- and low-calorie foods was measured. One-hundred and forty-two children and adolescents (51.4% female, n = 73; Mage = 13.7 years, SD = 2.25; MBMI-SDS = 1.26, SD = 1.50) completed the Food Cravings Questionnaire-Trait, then viewed pictures of high- and low-calorie foods and rated their liking for them, and subsequently consumed some of these foods in a bogus taste test. Contrary to expectations, higher body mass was associated with lower consumption of high-calorie foods. However, there was an interaction between body mass and trait food craving when predicting food consumption: in obese participants, higher trait food craving was associated with higher consumption of high-calorie foods and this association was not found in normal-weight participants. The relationship between trait food craving and high-calorie food consumption within obese individuals was mediated by higher liking for high-calorie foods (but not by liking for low-calorie foods). Thus, similar to adults, a subgroup of obese children and adolescents - characterized by high trait food craving - seems to exist, calling for specific targeted treatment strategies.

[Gender differences of psychological, nutritional, and physical fitness variables influencing obesity/overweight in Austrian children and adolescents]. / Geschlechtsunterschiede bei psychologischen, ernährungs- und sportwissenschaftlichen Einflussfaktoren auf Adipositas/Übergewicht bei Kindern und Jugendlichen in Österreich.

Eating behavior and physical activity behavior are under the control of certain cognitive patterns. 6600 adults and 4400 children/adolescents (8-18 years) were tested with the Obesity Diagnostics and Evaluation System (AD-EVA). Potentially significant gender differences will be detailed for the entire juvenile cohort, the subgroup of obese children/adolescents as compared to the adult cohort in this article.Among all the subscales tested, obese girls primarily showed significantly higher values of (preclinical) eating disorders than boys. These data are relevant for both prevention and health promotion.No significant differences were found in regard to sports motivation. This warrants facilitation of physical activity for both genders. Further, a male predilection for "Snacks" and "High-fat food" that could be found in the total representative study group, could not be verified in the subgroup of obese girls and boys, thus suggesting a similarily unhealthy eating behavior in both genders of juvenility.

Dietary restraint and impulsivity modulate neural responses to food in adolescents with obesity and healthy adolescents.

OBJECTIVE: Despite alarming prevalence rates, surprisingly little is known about neural mechanisms underlying eating behavior in juveniles with obesity. To simulate reactivity to modern food environments, event-related potentials (ERP) to appetizing food images (relative to control images) were recorded in adolescents with obesity and healthy adolescents. METHODS: Thirty-four adolescents with obesity (patients) and 24 matched healthy control adolescents watched and rated standardized food and object images during ERP recording. Personality (impulsivity) and eating styles (trait craving and dietary restraint) were assessed as potential moderators. RESULTS: Food relative to object images triggered larger early (P100) and late (P300) ERPs. More impulsive individuals had considerably larger food-specific P100 amplitudes in both groups. Controls with higher restraint scores showed reduced food-specific P300 amplitudes and subjective palatability ratings whereas patients with higher restraint scores showed increased P300 and palatability ratings. CONCLUSIONS: This first ERP study in adolescents with obesity and controls revealed impulsivity as a general risk factor in the current obesogenic environment by increasing food-cue salience. Dietary restraint showed paradoxical effects in patients, making them more vulnerable to visual food-cues. Salutogenic therapeutic approaches that deemphasize strict dietary restraint and foster healthy food choice might reduce such paradoxical effects.

The assessment of eating behaviour in children who are obese: a psychological approach. A position paper from the European childhood obesity group.

OBJECTIVE: This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice. METHODS: Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors' combined clinical experience, a three-staged approach to assessment was agreed by consensus. RESULTS: Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three-staged approach to assessing eating behaviours in the absence of hunger is described. CONCLUSIONS: This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

[The self-report version of the Strengths and Difficulties Questionnaire in an Austrian field sample]. / Der Selbstbeurteilungsbogen des SDQ anhand einer österreichischen Feldstichprobe.

OBJECTIVE: To assess the validity and the reliability of the self-report version of the Strength and Difficulties Questionnaire in an Austrian sample. METHODS: The questionnaire was given to 2529 healthy children and adolescents aged 11-18 years (mean age 12.71 +/- 1.4). Evaluation was performed according to given criteria, yielding a Total Problem Score, scores on four clinical subscales, and on one scale for pro-social behaviour. Descriptive statistics, Cronbach's alpha, and a varimax rotated factorial analysis were calculated. RESULTS: Cronbach's Alpha was > 0.63 for the Total Problem Scale, the Pro-Social Behaviour Scale and Emotional Problems Subscale. Factorial analysis revealed five independent factors explaining 41.8% of the variance. The analysis revealed good item-subscale correlations, but could not replicate the original factorial structure completely. Normative data for the SDQ-Self for Austria are provided. CONCLUSION: The German self-report version of the SDQ should, at the moment, only be used with extended analysis of multi-informant information.

The validation of the Moorehead-Ardelt Quality of Life Questionnaire II.

BACKGROUND: The Moorehead-Ardelt Quality of Life Questionnaire was originally developed as a disease-specific instrument to measure postoperative outcomes of self-perceived quality of life (QoL) in obese patients. 5 key areas were examined: self-esteem, physical well-being, social relationships, work, and sexuality. Each of these questions offered 5 possible answers, which were given + or - points according to a scoring key. The questionnaire was used independently or incorporated into the Bariatric Analysis and Reporting System (BAROS). The instrument is simple, unbiased, user-friendly and can be completed in <1 minute. It has been found useful, reliable and reproducible in numerous clinical trials in different countries. Further research and feedback from some of its users prompted refinements, now included in the Moorehead-Ardelt Quality of Life Questionnaire II (M-A QoLQII). This study tested the validity of the improved instrument. METHODS: The wording of the questions was changed, to make them less suggestive and allow for the use of the survey before and after medical intervention, and with control groups. A 6th question, analyzing eating behavior, was added. The +/-1 point given to the evaluation of self-esteem was split with this new question, thus maintaining the consistency of the scores. The drawings were simplified. Finally, the scoring key was changed to a 10-point Likert scale, to improve response-differentiation. To validate the M-A QoLQII, we examined its concordance with other health and well-being indicators, specifically the MOS 36-Item Short-Form Health Survey (SF-36), the Beck Depression Inventory-II (BDI-II) and the Stunkard and Messick Eating Inventory. The study population included 110 morbidly obese patients (20 males, 90 females, mean BMI=50), participants of gastric bypass support groups. Reliability of the M-A QoLQII was determined using Cronbach's alpha coefficient. Construct validity was measured by conducting a series of Spearman rank correlations. RESULTS: A Cronbach's alpha coefficient of 0.84 indicated satisfactory internal consistency. The M-A QoLQII was found to be significantly correlated (P <0.01) to 7 of the 8 SF-36 scales: Physical Role (r=0.357), Bodily Pain (r=-0.486), General Health (r=0.413), Vitality (r=0.588), Social Functioning (r=0.517), Emotional Role (r=0.480), and Mental Health (r=0.489). The questionnaire also significantly correlated (P <0.01) to the Beck Depression Inventory-II (r=0.317), as well as to the 'Disinhibition' (r=-0.307) and 'Hunger' (r=-0.254) factors of the Stunkard and Messick Eating Inventory. CONCLUSIONS: The M-A QoLQII correlates well with other widely used health and well-being indicators such as the SF-36, Beck Depression Inventory II and the Stunkard and Messick Eating Inventory. The study established the validity and reliability of this improved disease-specific instrument for QoL measurement in the obese population.