Core Set of Patient-Reported Outcome Measures for Measuring Quality of Life in Clinical Obesity Care.

PURPOSE: The focus of measuring success in obesity treatment is shifting from weight loss to patients' health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care. MATERIALS AND METHODS: The Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review. RESULTS: The meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma. CONCLUSION: A core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients' and experts' opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.

Outcomes of the first global multidisciplinary consensus meeting including persons living with obesity to standardize patient-reported outcome measurement in obesity treatment research.

Quality of life is a key outcome that is not rigorously measured in obesity treatment research due to the lack of standardization of patient-reported outcomes (PROs) and PRO measures (PROMs). The S.Q.O.T. initiative was founded to Standardize Quality of life measurement in Obesity Treatment. A first face-to-face, international, multidisciplinary consensus meeting was conducted to identify the key PROs and preferred PROMs for obesity treatment research. It comprised of 35 people living with obesity (PLWO) and healthcare providers (HCPs). Formal presentations, nominal group techniques, and modified Delphi exercises were used to develop consensus-based recommendations. The following eight PROs were considered important: self-esteem, physical health/functioning, mental/psychological health, social health, eating, stigma, body image, and excess skin. Self-esteem was considered the most important PRO, particularly for PLWO, while physical health was perceived to be the most important among HCPs. For each PRO, one or more PROMs were selected, except for stigma. This consensus meeting was a first step toward standardizing PROs (what to measure) and PROMs (how to measure) in obesity treatment research. It provides an overview of the key PROs and a first selection of the PROMs that can be used to evaluate these PROs.

Early COVID-19 Vaccine Hesitancy Characteristics in Mothers Following Bariatric Surgery.

BACKGROUND: Obesity has played a central role in heightened coronavirus disease 2019 (COVID-19) risk and vaccine response. COVID-19 vaccine intention among those with a history of severe obesity, specifically those who have undergone bariatric surgery, has not been described. This study aims to examine early COVID-19 vaccine intention among mothers with a history of severe obesity who underwent bariatric surgery. METHODS: Sixty-four mothers (Mage = 39.3 years) who underwent bariatric surgery (Mtime since surgery = 19.6 months) completed surveys online (November 2020-February 2021). Information obtained included their COVID-19 vaccine intention (vaccine ready, undecided, vaccine opposed). Analyses examined group differences in demographics, body mass index (BMI = kg/m2), knowledge of obesity-related COVID-19 risk, flu vaccination history, general beliefs about vaccine safety/effectiveness, and factors increasing confidence/motivation to obtain a COVID-19 vaccine. RESULTS: Thirty-six (56.3%) mothers had severe obesity (≥ Class II [BMI = ≥ 35 kg/m2]). The majority were vaccine hesitant (undecided [n = 28; 43.8%]; vaccine opposed [n = 15; 23.4%]). Compared to the vaccine-ready group, vaccine-hesitant groups were younger (p < .05). For the vaccine opposed, recent flu vaccination rates (p = .012) and general belief that vaccines are safe (p = .028) were lower than expected. Among hesitant participants, no reported side effects and the health of self and others were endorsed as top factors increasing vaccine confidence and motivation respectively. CONCLUSIONS: While preliminary, the prominence of early vaccine hesitancy in this sample of mothers who have undergone bariatric surgery, with most persisting with severe obesity, indicates a subgroup at high risk. Factors to address through targeted messaging and intervention were identified.

A cross-sectional examination of the home food environments of mothers who have undergone metabolic and bariatric surgery: a pilot study.

BACKGROUND: Healthful dietary changes after metabolic and bariatric surgery (MBS) may benefit not only patients, but the type and/or availability of foods/beverages in the family home food environment (HFE) overall, thereby reducing obesogenic environmental risks to child offspring in the home. Few studies have investigated the family HFE after MBS. OBJECTIVES: To examine whether the HFE of mothers post-MBS differed from the HFE of mothers of normal weight, overweight, and with obesity using an open home food inventory. SETTING: Cincinnati, Ohio and Newark, Delaware. METHODS: Thirty-two mothers with a child (6-12 yr) participated (8 post-MBS, 8 normal weight, 8 overweight, 8 with obesity) in a pilot study. Research personnel recorded all foods and beverages in the home. Per person total energy and servings of fruits, vegetables, sugar-sweetened beverages, and energy-dense snack foods in the HFE were examined using 1-way analyses of variance and Cohen's d effect sizes. RESULTS: Mothers in the post-MBS group had significantly fewer servings of sugar-sweetened beverages available per person compared with mothers with obesity (P = .01). Effect sizes for group differences indicated total energy, sugar-sweetened beverages, and servings of fruits and vegetables were generally medium to large, most with lower mean values for the post-MBS group relative to comparator groups. CONCLUSION: These findings, while preliminary, highlight areas for future research and add to an emerging literature on obesogenic risks to offspring in the post-MBS home, a known subgroup at high risk for severe obesity.

Halo or horn? A qualitative study of mothers' experiences with feeding children during the first year following bariatric surgery.

BACKGROUND: Obesity is a chronic condition that has an intergenerational effect. The aims of the study were to better understand the impact of maternal bariatric surgery on obesogenic risks to child offspring in the home via documenting mothers' thoughts, behaviors, and experiences around child feeding, family meals, and the home food environment during her first year postsurgery. METHOD: Utilizing a mixed-method cross-sectional design, 20 mothers (Mage = 39.6 ±â€¯5.7 years, 75% White, MBMI = 33.6 ±â€¯4.3 kg/m2, Mtime = 7.7 ±â€¯3.1 months post-surgery) of children ages 6-12 years completed validated self-report measures and participated in a focus group. Mother and child heights/weights were measured. RESULTS: The majority of children (N = 20; Mage = 9.2 ±â€¯2.3 years, 65% White, 60% female) were overweight (N = 12; BMI≥85th percentile) and were not meeting the American Academy of Pediatrics healthy eating and activity recommendations to treat/reduce obesity risk. As child zBMI increased, mothers expressed significantly more weight concern (r = 0.59, p = 0.01) and lower obesity-specific quality of life (r = -0.56, p = 0.01), yet assumed less responsibility for child eating choices (r = -0.47, p = 0.04). Qualitative data demonstrated disconnects between mothers' changes to achieve her own healthier weight and applying this knowledge to feeding her child/family. CONCLUSIONS: While bariatric surgery and requisite lifestyle change are effective tools for weight loss at the individual level, there is a great need for innovative family-based solutions. Pediatric obesity is preventable or risk-diminished if addressed early. Maternal bariatric surgery may be a unique (yet missed) opportunity to intervene.

Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.

Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.

Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success.

During the past decade, bariatric surgery has become an increasingly popular treatment option for the growing number of individuals with extreme obesity. For most individuals, the size and durability of the weight loss and improvements in co-morbidity and mortality have far surpassed those typically seen with behavioral modification and pharmacotherapy. A significant minority of patients, however, will experience suboptimal outcomes, including less than expected weight loss, premature weight regain, and frequent vomiting and/or gastric dumping. The reasons for these outcomes are not well understood, but likely involve both behavioral and physiologic processes. The present review highlights current knowledge on the changes in dietary intake and eating behavior that occur after bariatric surgery in terms of the potential threats these changes might pose to long-term postoperative success. The paper also identifies several strategies from the nonsurgical weight loss literature that might help optimize long-term weight maintenance after surgery.

Creating a credential for bariatric behavioral health professionals: potential benefits, pitfalls, and provider opinion.

BACKGROUND: Since the 1991 recommendation by the National Institutes of Health-sponsored consensus development conference, preoperative psychosocial evaluation of weight loss surgery patients has been adopted by >80% of weight loss surgery programs. Although some published suggestions for conducting evaluations exist, no formal guidelines have been published specifying the qualifications, content knowledge, or clinical experience for the behavioral health professionals who conduct them. As a result, the backgrounds of behavioral health professionals working with bariatric surgery patients are varied, and no mechanism exists to ensure consistent quality of care. To obtain expert opinion on this issue, a survey of the American Society for Metabolic and Bariatric Surgery membership was conducted using an Internet-based survey. METHODS: American Society for Metabolic and Bariatric Surgery members of all disciplines were invited by electronic mail to complete an Internet-based survey. Separate forms were created for behavioral health providers and for members of other disciplines. RESULTS: A total of 409 American Society for Metabolic and Bariatric Surgery members responded (60 behavioral health and 349 nonbehavioral health). Of the 409 respondents, 95% indicated a belief that it is important for behavioral health providers to have specialty knowledge; 87% indicated a belief that specialty experience is important; and 70.6% favored the development of a specialty credential for bariatric behavioral health providers to regulate the quality of patient care. However, the respondents also reported concerns about creating such a credential. CONCLUSION: Our results reflect widespread opinion that the provision of bariatric behavioral health services requires specialty knowledge and experience and that a credentialing system would help regulate the standard of care in the field. However, some concerns about credential development remain.

Emotional eating and emotional eating alternatives in subjects undergoing bariatric surgery.

BACKGROUND: The purpose of this study was to characterize emotional eating and its alternatives in obese patients undergoing bariatric surgery. METHODS: The medical charts of 178 consecutive patients who had laparoscopic Roux-en-Y gastric bypass provided by a multidisciplinary bariatric program were reviewed. Data from patients who had emotional eating, reported strategies to overcome their urges to emotionally eat, and had their 6 months follow-up after surgery (N=50) were further analyzed in terms of weight history, medical co-morbidity prior to surgery, weight loss after surgery, and lifetime psychiatric status. RESULTS: 38.7% of the 178 bariatric surgery patients reported emotional eating. Patients reported using three main types of behaviors (oral, sedentary and physical activity) to overcome urges to eat emotionally. Most patients (42%) experiencing emotional eating chose sedentary behaviors to overcome urges to eat in response to emotion. The three groups did not differ in any of the examined variables. CONCLUSIONS: While patients using different coping mechanisms to overcome urges to eat emotionally did not differ before and 6 months after surgery, further research is needed to examine the frequency and long-term effects of emotional eating in bariatric surgery patients.