Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study.

Among a US cohort followed 5 years after Roux-en-Y gastric bypass or sleeve gastrectomy, cumulative incidence of marriage and separation/divorce were 18% among unmarried (N=614) and 13% among married (N=827) participants, respectively. Preoperative predictors of marriage included younger age, college degree, lower BMI and cohabitating or being separated (versus single). Objectives: To describe changes in marital status following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Background: Spousal encouragement and finding a life partner are self-reported motivators for undergoing bariatric surgery. Methods: This study included 1441 US adults enrolled in a 6-center prospective cohort study who underwent RYGB or SG (2006-2009) and self-reported marital status preoperatively and annually postoperatively for ≤5 years. Time to change in marital status was analyzed with Kaplan-Meier estimates of cumulative incidence and Cox proportional-hazard models. Results: Preoperative, 57% of participants (79% female, median age 47 years, median body mass index [BMI] 47 kg/m2) were married, 5% cohabitating, 4% separated, 15% divorced, 2% widowed, and 17% always single. The 5-year cumulative incidence of marriage among unmarried participants (N = 614) was 18%. Cohabitating (hazard ratios [HR] = 5.25) or being separated (HR = 3.03) versus always single, younger age (HR = 1.69/10 years), having a college degree versus ≤high school (HR = 2.36), lower BMI (HR = 1.54/10kg/m2), and fewer depressive symptoms (HR = 1.47/10 Beck Depression Inventory points) preoperative independently predicted (P < 0.05) higher chance of marriage. The 5-year cumulative incidence of separation/divorce among married participants (N = 827) was 13%. Female sex (HR = 2.08), younger age (HR = 1.84/10 years), household income <$25,000 versus ≥$100,000 (HR = 2.48), smoking (HR = 1.76), and sexual desire ≥once/week versus never (HR = 2.12) preoperative independently predicted (P ≤ 0.05) separation/divorce. Conclusions: Among a cohort of US adults, the majority did not change marital status within 5 years following RYGB or SG. Cumulative incidence of marriage and separation/divorce was 18% among unmarried and 13% among married participants, respectively. Several preoperative predictors of marriage and separation/divorce were identified.

Long-term Satisfaction with Roux-en-Y Gastric Bypass Surgery: Results From a Multicenter Prospective Cohort Study.

OBJECTIVE: The aim of this study was to examine change in overall satisfaction with Roux-en-Y gastric bypass (RYGB) surgery over 3 to 7 years post-surgery and identify pre-surgery predictors and post-surgery factors associated with not being satisfied. BACKGROUND: It is unclear how satisfaction with RYGB surgery changes over time following surgery and factors associated with not being satisfied are not well understood. METHODS: Participants of a multicenter prospective cohort study of bariatric surgery were followed annually < 7 years. A total of 1423 participants of the 1770 who underwent RYGB had data on satisfaction with surgery (81% female; median age 47 years; median body mass index 46 kg/m 2 ). RESULTS: The percentage of participants who were not satisfied with RYGB surgery significantly increased from 15.4% 3 years post-surgery to 23.0% 7 years post-surgery ( P = 0.01). Pre-surgery younger age, lower BMI, higher percent weight loss needed to reach dream weight, poorer physical and mental health, and less social support independently predicted higher risk of not being satisfied with surgery. When examining pre- to post-surgery changes, less post-surgery weight loss, worsening physical and mental health status, less social support, and greater depressive symptomology were associated with higher risk of not being satisfied with surgery. CONCLUSIONS: Level of satisfaction with RYGB surgery significantly decreased 3 to 7 years following surgery. Several pre- and post-surgery characteristics were associated with not being satisfied with surgery and provide potentially useful insight into individual patient experiences following RYGB. Knowledge of these characteristics may be useful in communication between surgeons and patients regarding post-surgical expectations and the impact of surgery on patients' lives.

Proximal Roux-en-Y gastric bypass: Addressing the myth of limb length.

BACKGROUND: Some studies suggest that changes in weight or metabolic outcomes are affected by the lengths of the gastrointestinal limbs in the Roux-en-Y gastric bypass. METHODS: Participants (N = 1,770) underwent primary Roux-en-Y gastric bypass and were followed ≤7 years in the Longitudinal Assessment of Bariatric Surgery-2, a multicenter US cohort study. Alimentary limb and biliopancreatic limb lengths were measured according to research protocol; common channel was measured in a subsample (N = 547). Aimentary limb, biliopancreatic limb, and common channel ratio to total small bowel length were calculated. RESULTS: Median presurgery body mass index was 46 (25th-75th percentile: 43-51) kg/m2. Medians (25th-75th percentiles) for alimentary limb length were 125 cm (100-150), for biliopancreatic limb length were 50 cm (50-60), and common channel length were 410 cm (322-520). Statistics for ratios to the small bowel length were 0.23 (0.18-0.27) for alimentary limb, 0.09 (0.07-0.10) for biliopancreatic limb, and 0.69 (0.63-0.73) for common length. There were no significant associations between alimentary limb, biliopancreatic limb, common channel, alimentary limb ratio, biliopancreatic limb ratio or common channel ratio, and either weight loss or improvement in cardiometabolic outcomes. CONCLUSION: The common channel length in Roux-en-Y gastric bypass is highly variable between individuals. None of the limb lengths in this study, nor alimentary limb, biliopancreatic limb, or common channel ratios, seem to be related to weight loss or metabolic improvements >7 years.

Alcohol Use Thresholds for Identifying Alcohol-related Problems Before and Following Roux-en-Y Gastric Bypass.

OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of potential thresholds of alcohol use for identifying alcohol-related problems in women post-Roux-en-Y gastric bypass (RYGB). BACKGROUND: Despite evidence that RYGB alters alcohol pharmacokinetics and is associated with an increased risk for alcohol-related problems, the level of alcohol use that should prompt further screening for alcohol-related problems following RYGB is unclear. METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Before surgery and annually for ≤7 years following surgery, participants completed the 10-item Alcohol Use Disorder Identification Test (AUDIT), which assesses past-year frequency and quantity of alcohol, frequency of consuming ≥6 drinks, and alcohol-related problems (ie, symptoms of alcohol dependence and/or alcohol-related harm). The AUDIT-Consumption (AUDIT-C) score was determined from the first 3 AUDIT items. RESULTS: Post-RYGB, 835 women reported current drinking at 1 or more annual assessment(s). Compared with higher frequency thresholds, drinking ≥2 times/month had the highest combined sensitivity (85.3%) and specificity (61.4%) for identifying alcohol-related problems. Compared with higher quantity thresholds, drinking ≥3 drinks/drinking day had the highest combined sensitivity (64.2%) and specificity (87.2%). An AUDIT-C score ≥3, versus other thresholds, had the highest combined sensitivity (76.4%) and specificity (81.6%). CONCLUSION: The sensitivity and specificity of these thresholds indicate assessment of alcohol consumption alone may be inadequate for identifying women at risk for alcohol-related problems post-RYGB. Additional screening tools for alcohol-related problems, which assess symptoms of alcohol-related problems, should be conducted in this population.

Objective vs. Self-report Sedentary Behavior in Overweight and Obese Young Adults.

BACKGROUND: Sedentary behavior (SED) has been measured almost exclusively by self-reported total SED or television time in longitudinal studies. This manuscript aimed to compare self-reported vs. objectively measured SED. METHODS: Among overweight and obese young adults enrolled in a weight loss trial, baseline SED was assessed by 3 methods: 1) a questionnaire assessing 8 common SEDs (SEDQ), 2) 1 question assessing SED from the Global Physical Activity Questionnaire (SEDGPAQ), and 3) a monitor worn on the arm (SEDOBJ). In addition, television time (SEDTV) was isolated from the SEDQ. SED measures were compared using Spearman's correlations, signed-rank tests, and Bland-Altman plots. RESULTS: In 448 participants, SEDQ and SEDGPAQ were only weakly associated with SEDOBJ (rs = 0.21; P < .001, rs = 0.32; P < .001, respectively). Compared with SEDOBJ, SEDQ more often overestimated SEDOBJ (median difference: 1.1 hours/day; P < .001), while SEDGPAQ more often underestimated SEDOBJ (median difference: -0.7 hours/day; P < .001). The correlation between SEDTV and SEDOBJ was not significantly different from 0 (rs = 0.08; P = .08). CONCLUSIONS: SEDQ and SEDGPAQ were weakly correlated with, and significantly different from, SEDOBJ in overweight and obese young adults. SEDTV was not related to SEDOBJ. The poor associations of self-reported and objectively measured SED could affect interpretation and comparison across studies relating SED to adverse health outcomes.

Objective Versus Self-Reported Physical Activity in Overweight and Obese Young Adults.

BACKGROUND: To compare moderate-to-vigorous intensity physical activity (MVPA) assessed via questionnaires to an objective measure of MVPA in overweight or obese young adults. METHODS: MVPA was assessed in 448 [median BMI = 31.2 (Interquartile Range: 28.5-34.3) kg/m2] young adults [median age: 30.9 (Interquartile Range: 27.8-33.7) years]. Measures included the SenseWear Armband (MVPAOBJ), the Paffenbarger Questionnaire (MVPAPAFF), and the Global Physical Activity Questionnaire (GPAQ). The GPAQ was used to compute total MVPA (MVPAGPAQ-TOTAL) and MVPA from transportation and recreation (MVPAGPAQ-REC). RESULTS: The association between MVPAOBJ and MVPAPAFF was rs = 0.40 (P < .0001). Associations between MVPAOBJ and MVPAGPAQ-TOTAL and MVPAGPAQ-REC were rs = 0.19 and rs = 0.32, respectively (P < .0001). MVPAGPAQ-TOTAL was significantly greater than MVPAOBJ (P < .0001). Median differences in MET-min/week between MVPAOBJ and MVPAPAFF or MVPAGPAQ-REC were not significantly different from zero. There was proportional bias between each self-reported measure of MVPA and MVPAOBJ. There were significant associations between all measures of MVPA and fitness. MVPAOBJ was significantly associated with BMI and percent body fat. CONCLUSIONS: Objective and self-reported measures of MVPA are weakly to moderately correlated, with substantial differences between measures. MVPAOBJ provided predictive validity with fitness, BMI, and percent body fat. Thus, an objective measure of MVPA may be preferred to self-report in young adults.