Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up.

OBJECTIVE: Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV). METHOD: Participants (N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3. RESULTS: The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) (P for all <0.01), and regular evening hyperphagia (16.5-5.0%, P = 0.01), but not cravings (P = 0.93). Mean EDE global score, and hunger and enjoyment scores, also declined (P for all <0.01). These metrics remained lower than baseline through year-3 (P for all <0.01). Presurgery eating variables were not related to weight loss (P for all ≥0.05). However, postsurgery higher EDE global score and greater hunger were independently associated with less weight loss postsurgery (P for both ≤0.01), while cravings were associated with greater weight loss (P = 0.03). DISCUSSION: Pathological eating behaviors and experiences are common presurgery and improve markedly following surgery. Postsurgery pathological eating-related experiences and attitudes and hunger may contribute to suboptimal weight loss. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1058-1067).

Homozygous leptin receptor mutation due to uniparental disomy of chromosome 1: response to bariatric surgery.

CONTEXT: Severe early-onset obesity with major hyperphagia associated with hypogonadotropic hypogonadism is recognized as the main clinical presentation of leptin (LEP) or LEP receptor (LEPR) gene complete deficiency. In a few reported cases, homozygous mutations have been found in patients from consanguineous families. Care of LEPR-deficient patients is complicated because they cannot benefit from LEP treatment. Furthermore, gastric surgery may not be recommended in such genetic hypothalamic obesity. OBJECTIVE: We investigated in a morbidly obese patient the genetic origin of his obesity and evaluated the benefit of bariatric surgery in this case. SUBJECT AND METHODS: The patient exhibited severe early-onset obesity with hyperphagia and delayed puberty in a nonobese family. He had clinical and hormonal follow-up from 3 to 26 years of age. Gastroplasty procedures were undertaken when he was 16 and 18 years old. LEPR genetic analysis of the patient and his relatives was performed. RESULTS: A new homozygous LEPR sequence frameshift, predicted to generate a truncated protein from a premature stop codon in exon 14, was identified in the proband inherited from two paternal copies of chromosome 1 (isodisomy). Vertical ring gastroplasty was sufficient to induce and maintain a 40-kg weight loss into adulthood. CONCLUSION: We described the first case of a patient with chromosome 1 uniparental isodisomy revealed by molecular analysis of LEPR. In this case, gastroplasty may be partially effective for weight control as illustrated.

Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity.

BACKGROUND: Repeat sleeve gastrectomy (re-SG) and the addition of the duodenal switch (DS) are possible options to increase weight loss after isolated SG (ISG). We report the feasibility, safety, and outcomes of laparoscopic re-SG versus DS in patients presenting with insufficient weight loss or weight regain after ISG. METHODS: From November 2003 to December 2009, 7 and 19 patients underwent laparoscopic re-SG and DS, respectively, mainly because of the patients' dietary habits: volume eating (hyperphagia) was treated by re-SG and eating meals too frequently (polyphagia) by DS. RESULTS: At ISG, the mean weight and BMI was 127.7 ± 31.4 kg, and 45.1 ± 11.8 kg/m(2) for the re-SG group and 119.8 ± 20.9 kg and 41.2 ± 5.5 kg/m(2) for the DS group, respectively. The mean interval between ISG and reoperation was 37.1 ± 20.3 months for the re-SG group and 29.8 ± 24.9 months for the DS group. At reoperation, the mean weight, BMI, and percentage of excess weight loss (%EWL) was 109.7 ± 21 kg, 38.9 ± 8.7 kg/m(2), 24.3 ± 16.6% for the re-SG group and 107.6 ± 19.6 kg, 36.9 ± 4.2 kg/m(2), and 19.5 ± 19.9% for the DS group, respectively. The mean operative time was 137.5 ± 75.5 minutes for the re-SG group and 152.6 ± 54.3 minutes for the DS group. No conversion to open surgery was required, and no mortality occurred. One patient in the re-SG group developed a leak at the angle of His. In the DS group, 1 patient presented with bleeding, 1 patient with a duodenoileostomy leak, and 1 patient with a duodenoileostomy stenosis. The mean hospital stay was 11.5 ± 20.5 days for the re-SG group and 4.7 ± 2.7 days for the DS group. The mean follow-up was 23.2 ± 11.1 months for the re-SG group and 24.9 ± 20.1 months for the DS group. The mean weight, BMI, and %EWL was 100 ± 21.1 kg, 35.3 ± 8.3 kg/m(2), 43.7 ± 24.9% for the re-SG group and 80.7 ± 22.5 kg, 27.3 ± 5.2 kg/m(2), 73.7 ± 27.7% for the DS group, respectively. During follow-up, 3 patients in the DS group required corrective surgery for late complications. CONCLUSION: The results of the present study have shown that laparoscopic re-SG is feasible but carries the risk of fistula development, which is difficult to treat. Laparoscopic DS was also shown to be feasible at a cost of not negligible complications, which are easier to manage than with re-SG. The efficacy seemed greater after DS than after re-SG.

Laparoscopic placement of non-adjustable silicone ring for weight regain after Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular surgical procedures for obesity. One of the possible long-term problems is weight regain, usually after a period of successful weight loss. Weight regain after RYGBP can be due to new eating habits, like sweet-eating or grazing, or volume eating because of impaired restriction. This paper reports our experience in patients who presented weight regain after laparoscopic RYGBP, because of new appearance of volume eating or hyperphagia, treated by the laparoscopic placement of a non-adjustable silicone ring around the gastric pouch. METHODS: From July 2004 to November 2007, six patients affected by weight regain due to hyperphagic behavior, benefited from revision of RYGBP consisting of the placement of a non-adjustable silicone ring loosely encircling the stomach part. Mean weight and body mass index (BMI) at the time of RYGBP were 105.0 kg +/- 12.3 and 36.3 +/- 3.0 kg/m(2), respectively, and all patients suffered from obesity-related co-morbidities. After a mean time from RYGBP of 26.0 +/- 14.2 months, patients presented a weight regain of 4.7 +/- 3.4 kg compared with their minimal weight, with a final mean weight, BMI, and percentage of excess weight loss (%EWL) at the time of the silicone ring of 86.0 +/- 13.1 kg, 29.5 +/- 3.9 kg/m(2), and 47.0 +/- 24.7%, respectively. Preoperative evaluation for each patient included history and physical examination, nutritional and psychiatric evaluation, laboratory tests, and barium swallow check. Outcome measures included evaluation of the Roux-en-Y construction, operative time, postoperative morbidity and mortality, and weight loss in terms of absolute weight loss, BMI, and %EWL. RESULTS: Any modification of the digestive circuit was evidenced. Mean operative time was 82.5 +/- 18.3 min. No operative mortality and no conversion to open surgery were achieved. No postoperative complications were achieved. Mean hospital stay was 2.6 +/- 1.5 days. After a mean follow-up of 14.0 +/- 9.2 months, the six patients presented a mean weight loss of 9.1 +/- 2.4 kg, with a final mean weight, BMI, and %EWL of 76.8 +/- 13.7 kg, 26.4 +/- 4.2 kg/m(2), and 70.4 +/- 30.4%, respectively. Difference in term of %EWL before and after revision (23.4 +/- 5.7) is statistically significant (p < 0.05). There have been no erosions or slippage of the ring during this follow-up. CONCLUSION: One of the possible causes of weight regain after RYGBP is the new eating behavior of the patient, one of which is hyperphagia. Treatment of this condition can be the placement of a non-adjustable silicone ring loosely fitted around the gastric pouch which contributes to improved weight loss.

Night eating syndrome and binge eating disorder among persons seeking bariatric surgery: prevalence and related features.

OBJECTIVE: To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES: A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS: Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION: The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.