A randomized clinical trial evaluating eHealth in bariatric surgery.

BACKGROUND: Supporting patients before, and long after, their bariatric treatment contributes a lot to successful outcome. eHealth interventions have a hypothetical benefit in addition to standard care. This could lead to increased weight loss, reduction of obesity-related diseases, patient adherence, and quality of life. This randomized controlled trial aims to evaluate the value of an eHealth platform and self-monitoring devices as additions to standard bariatric care. MATERIALS AND METHODS: Two-hundred-and-five patients who underwent primary bariatric surgery were randomized (2:1:1) to receive standard care (control group), additional access to an educational patient eHealth platform (online group), or additional access to eHealth platform as well as self-monitoring devices (device group). The platform consisted of an interactive educational environment with informational videos, dietary advice, news, and more. The self-monitoring devices used were a weight scale, blood pressure monitor, pulse oximeter, and activity bracelet. The primary endpoint was weight loss and secondary outcomes included reduction of obesity-related diseases, quality of life, and eHealth use. RESULTS: Postoperative weight loss, reduction of obesity-related diseases, frequency of consultations, and quality of life were similar between groups. Participation to the eHealth platform was high (online group 90%, device group 98%). Most frequently accessed contents were informational messages, videos, and the treatment preparation modules. The percentage of active users of the self-monitoring devices dropped from 62% in the first postoperative month to 19% after 2 years. Thirteen patients in the device group withdrew due to unwillingness to use self-monitoring devices. CONCLUSION: Participation to the eHealth intervention in addition to the standard post-bariatric guidance program was high, however, had no significant impact on clinical outcomes such as weight loss, reduction of obesity-related diseases, and quality of life. Trial registration ClinicalTrials.gov (identifier number NL56992.100.16) https://clinicaltrials.gov/ct2/show/NCT03394638.

The Value of an e-Health Platform in Bariatric Surgery: A Retrospective Study on the Impact on Weight Loss.

Background: In this time, where health care is getting more digitalized, opportunities open up to provide patients with additional information using e-Health. An e-Health platform was developed to increase knowledge about obesity in general, bariatric procedures, and follow-up program to achieve more weight loss. It was hypothesized that a higher e-Health usage, defined as page views per patient, leads to a higher percentage total weight loss (%TWL) at 2 years postoperatively. Materials and Methods: Accounts with available follow-up data between January 2015 and April 2018 were retrospectively reviewed. Three groups were formed based on number of page views. Results: In total, 1,098 subjects were analyzed. On average, a patient connected 12 times with an average of 51-page views per patient. At 1 year postoperatively, the %TWL was 30.7 versus 30.9 versus 31.9 (p = 0.126), and at 2 years 29.4 versus 29.8 versus 30.5 (p = 0.350) in low-active, medium-active, and high-active group, respectively. Analysis whether patients accessed the preoperative content did not show significant differences. However, patients who accessed content after surgery lost more weight than those who did not, being 30.1%TWL versus 31.7%TWL at 1 year (p = 0.006) and 28.9%TWL versus 30.4%TWL at 2 years postoperatively (p = 0.034). Pre- and postoperative quality of life did not differ between groups. Conclusion: e-Health might be a beneficial tool for weight reduction after bariatric surgery. The current platform reached a large portion of patients. Patients accessing postoperative content lost more weight at 1 and 2 years postoperatively than those who did not. Quality of life was comparable.

Assessing the value of eHealth for bariatric surgery (BePatient trial): study protocol for a randomized controlled trial.

BACKGROUND: The expansion of digital devices and widespread access to the Internet has opened up opportunities to provide patients with more personal information. It can be hypothesized that eHealth in addition to standard care could enhance clinical outcomes such as increased weight loss, co-morbidity reduction, and commitment to the program. The beneficial value of incorporating eHealth applications as standard postoperative care is yet to be established. In this trial, the value of different levels of eHealth are assessed. METHODS/DESIGN: Two hundred adult patients with a body mass index (BMI) ≥ 40 kg/m2, or ≥ 35 kg/m2 with obesity-related co-morbidity, undergoing sleeve gastrectomy or gastric bypass will be enrolled in this randomized controlled trial. Patients will be randomly assigned to one of the groups: receiving standard care (control group, n = 100); have access to an online eHealth platform in addition to the previous group (online group, n = 50); or receive wireless monitoring devices in addition to previous groups (device group, n = 50). The total follow-up period is two years postoperatively. Primary outcome is weight loss in terms of BMI. Secondary outcomes include: quality of life; return-to-work time; co-morbidity reduction; additional contacts; and ease of use of devices. DISCUSSION: In this trial, the value of different levels of eHealth will be assessed. This addresses an important aspect of a changing healthcare environment. TRIAL REGISTRATION: Trialregister.nl, NTR6827. Retrospectively registered on 19 November 2017. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6827 .

Improvement in quality of life after bariatric surgery: sleeve versus bypass.

BACKGROUND: Obesity is steadily growing to be the largest threat to human health in this century, not only increasing prevalence of obesity-related co-morbidity but also impairing health-related quality of life (QoL). Bariatric surgery has shown to improve co-morbidity as well as QoL. OBJECTIVES: To assess the differences in improvement in QoL for the 2 most performed procedures: laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB). SETTING: Obesity center, the Netherlands. METHODS: All patients who underwent either SG or RYGB as a primary operation from January 2012 until January 2017 were eligible. Included, were only those who completed preoperatively and 1-year postoperatively the QoL questionnaire. The RAND 36-item Health Survey was used to assess QoL. RESULTS: A total of 1184 cases were included in analysis of which 666 patients underwent SG and 518 patients underwent RYGB. Groups significantly differed in body mass index, weight, waist circumference, prevalence of gastroesophageal reflux disease, obstructive sleep apnea syndrome, and hypertension. All QoL domains greatly improved after bariatric surgery. Physical functioning increased more in patients who underwent gastric bypass. This remained significant after correcting for differences between groups. Other domains were not significantly different. CONCLUSION: QoL is greatly improved at 1 year after bariatric surgery. The improvement was comparable after SG and RYGB, expect for more increase in physical functioning after RYGB. QoL could influence decision-making between SG and RYGB. So far, no clinically relevant differences were found. Future research should focus on both longer follow-up and more specific questionnaires.