Unrealistic weight loss expectations in candidates for bariatric surgery.

BACKGROUND: Unrealistic expectations of weight loss are prevalent in obese patients and can negatively affect their adherence to dietary and health goals. We sought to examine the expectations and perceived notions about weight loss in candidates for bariatric surgery. METHODS: A total of 284 consecutive and prospective bariatric patients were surveyed using a validated Goals and Relative Weights questionnaire before an educational seminar. The participants categorized their weight loss expectations as "dream," "happy," "acceptable," and "disappointed" and rated the effect of surgically-induced weight loss on 21 indicators of health, quality of life, social functioning, and self-image on a 1-10 scale. The data are presented as the mean +/- standard deviation. RESULTS: Of the 284 patients, 230 were women and 54 were men (age 45 +/- 10 years; body mass index 50 +/- 8 kg/m(2)). These patients stated that their "dream" weight would be 89% +/- 8% excess body weight loss and that 77% +/- 9%, 67% +/- 10%, 49% +/- 14% excess body weight loss would be their "happy," "acceptable," and "disappointed" weight, respectively. Participants ranked health, fitness, body image, work performance, and self-confidence as the most important benefits of bariatric surgery. Women had greater "happy" and "acceptable" weight loss expectations and put more emphasis on physical presence (r = .17-.33, P <.01). Younger patients put more emphasis on attractiveness and improvements in social and sex life after bariatric surgery (r = .15-.19, P <.01). CONCLUSION: The results of our study have shown that although the candidates for bariatric surgery understand its benefits, they have unrealistic expectations of weight loss. In our study, the patients' most modest weight loss expectation, the "disappointed" weight, was equivalent to what providers would consider a successful weight loss outcome after bariatric surgery. Setting realistic expectations is an important aspect of the preoperative evaluation and education, especially for younger women.

Bariatric surgery improves urinary incontinence in morbidly obese individuals.

BACKGROUND: Urinary incontinence is common in obese individuals. We report on the prevalence of urinary incontinence in patients undergoing bariatric surgery and the effect of surgically induced weight loss on urinary incontinence. METHODS: The prospectively collected data from 201 consecutive candidates for bariatric surgery were evaluated. The patients were surveyed using a questionnaire regarding the duration of incontinence, stress/urge incontinence symptoms, and incontinence severity before and after undergoing bariatric surgery. Severity was quantified using a validated index developed Data are presented as the mean +/- standard deviation. RESULTS: Of 201 patients, 65 (32%) reported urinary incontinence. Of the 65 patients, 44 women and 1 man (age 49 +/- 11 years, body mass index 48 +/- 7 kg/m(2)) underwent Roux-en-Y gastric bypass (n = 42) or laparoscopic-assisted gastric banding (n = 3). Of the 38 patients who reported mild (2%), moderate (48%), and severe (50%) urinary incontinence preoperatively who had complete follow-up at > or = 6 months postoperatively, 19 (50%) had demonstrated resolution of urinary incontinence and 19 had reported residual slight-moderate (37%) or severe (13%) urinary incontinence. The overall severity score improved from 5.4 +/- 2.3 to 2.3 +/- 2.8 postoperatively (P <.001); the percentage of excess body weight loss was 61% +/- 19%. The patients reported subjective improvement within 4 months postoperatively or after a 50-lb weight loss. CONCLUSION: Urinary incontinence is prevalent in bariatric surgery patients. Surgically induced weight loss results in improvement or resolution of urinary incontinence in 82% of patients. The findings from this large cohort warrant additional investigation with urodynamic studies.

A state-wide review of contemporary outcomes of gastric bypass in Florida: does provider volume impact outcomes?

OBJECTIVES: To report contemporary outcomes of gastric bypass for obesity and to assess the relationship between provider volume and outcomes. BACKGROUND: Certain Florida-based insurers are denying patients access to bariatric surgery because of alleged high morbidity and mortality. SETTINGS AND PATIENTS: The prospectively collected and mandatory-reported Florida-wide hospital discharge database was analyzed. Restrictive procedures such as adjustable gastric banding and gastroplasty were excluded. RESULTS: The overall complication and in-hospital mortality rates in 19,174 patients who underwent gastric bypass from 1999 to 2003 were 9.3% (8.9-9.7) and 0.28% (0.21-0.36), respectively. Age and male gender were associated with increased duration of hospital stay (P < 0.001), increased in-hospital complications [age: odds ratio (OR) = 1.11, CI: 1.08-1.13; male: OR = 1.53, CI: 0.36-1.72] and increased in-hospital mortality (age: OR = 1.51, CI: 1.32-1.73; male: CI = 2.66, CI: 1.53-4.63), all P < 0.001. The odds of in-hospital complications significantly increased with diminishing surgeon or hospital procedure volume (surgeon: OR = 2.0, CI: 1.3-3.1; P < 0.001, 1-5 procedures relative to >500 procedures; hospital volume: OR = 2.1, CI: 1.2-3.5; P < 0.001, 1-9 procedures relative to >500 procedures). The percent change of in-hospital mortality in later years of the study was lowest, indicating higher mortality rates, for surgeons or hospitals with fewer (< or =100) compared with higher (> or =500) procedures. CONCLUSION: Increased utilization of bariatric surgery in Florida is associated with overall favorable short-term outcomes. Older age and male gender were associated with increased morbidity and mortality. Surgeon and hospital procedure volume have an inverse relationship with in-hospital complications and mortality.

Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with obesity. Our aim in this study is to report objective improvement of obesity-related OSA and sleep quality after bariatric surgery. METHODS: Prospective bariatric patients were referred for polysomnography if they scored >or=6 on the Epworth Sleepiness Scale. The severity of OSA was categorized by the respiratory disturbance index (RDI) as follows: absent, 0 to 5; mild, 6 to 20; moderate, 21 to 40; and severe, <40. Patients were referred for repeat polysomnography 6 to 12 months after bariatric surgery or when weight loss exceeded 75 lbs. Means were compared using paired t tests. Chi-square tests and linear regression models were used to assess associations between clinical parameters and RDI; P<.05 was considered statistically significant. RESULTS: Of 349 patients referred for polysomnography, 289 patients had severe (33%), moderate (18%), and mild (32%) OSA; 17% had no OSA. At a median of 11 months (6 to 42 months) after bariatric surgery, mean body mass index (BMI) was 38 +/- 1 kg/m2 (P<.01 vs 56 +/- 1 kg/m2 preoperatively) and the mean RDI decreased to 15 +/- 2 (P<.01 vs 51 +/- 4 preoperatively) in 101 patients who underwent postoperative polysomnography. In addition, minimum oxygen saturation, sleep efficiency, and rapid eye movement latency improved, and the requirement for continuous positive airway pressure was reduced (P

Developmental differences in nicotine place conditioning.

To understand the motivations and implications of the prevalence of smoking, studies have compared the behavioral effects of nicotine, the psychoactive drug in tobacco, in adolescent and adult animals. The present study used a biased three-chambered conditioned-place preference procedure without prior habituation to examine the potential rewarding and anxiolytic effects of nicotine across adolescence and adulthood to assess the presence of age-dependent differences in response to nicotine.