BACKGROUND: Bariatric surgery is effective for weight loss, but is associated with deficiencies of several micronutrients. Among these, deficiencies in iron and vitamin B12 have been well-described in the literature. While it is known that blood levels of several micronutrients differ between racial groups, it is currently unknown whether the impact of bariatric surgery on micronutrient levels is also race-specific. We addressed this question in reference to vitamin B12 and iron because of the known racial differences in these micronutrients and their impact on red blood cell indices. The aim of our study was to determine whether there are differences in levels of ferritin and vitamin B12, as well as in hemoglobin (HGB) and hematocrit (HCT) levels, between African-Americans (AA), Hispanic-Americans (HA), and Caucasian-Americans (CA) after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective medical record review of 1,046 (201 AA, 106 HA, and 344 CA), who underwent bariatric surgery at Boston Medical Center (BMC) between 2004 and 2015 was conducted. Analysis of variance and linear mixed modeling was used to compare adjusted mean changes in biomarkers of anemia, vitamin B12, and ferritin between racial groups before RYGB and up to a period of 4+ years after the surgery. RESULTS: There were significant decreases in all racial/ethnic groups in mean HCT and HGB within the first year following surgery. Mean HCT from baseline to time point 1 (6months-1 year post-operatively) decreased by 3.3% for AA’s (p<0.001), 3.2% for HA’s (p<0.001), and 5% (p<0.001) for CA’s. Mean HCT and mean HGB for the entire sample decreased from baseline to the end of the observation period by 4.4% and 1.45 g/L, respectively. AA's had lower levels of HCT and HGB throughout the observation period compared to HA's and CA's in both the unadjusted and adjusted models. CA's had the highest levels of these blood markers. Decreases in ferritin were also significant, with a decrease from baseline to the end of the observation period of 27.8 μg/L for AA's (p=0.004), a decrease of 49.6 μg/L for HA's (p<0.001), and 54.5 μg/L (p<0.001) for CA's. In comparison with HA's and AA's, CA's had a higher ferritin level at baseline (p=0.715 and p=0.028, respectively). However, when adjusted for age, sex, and initial BMI, CA's had lower ferritin levels throughout much of the observation period compared to HA's and AA's. After an initial increase at 6 months- 1 year post-operatively (time point 1), mean B12 levels remained fairly stable throughout the observation period with levels only slightly declining for AA’s and HA’s over the observation period. Levels remained higher than baseline for all racial/ethnic groups with mean B12 levels at the end increasing by 144.6 ng/L for AA’s (p<0.001), 70.4 ng/L for HA’s (p=0.186), and 182.2 ng/L for CA’s (p<0.001). Though CA’s saw the greatest increase in mean B12 levels from baseline, AA’s had the highest mean B12 levels over the entire observation period, with significantly different levels compared to HA’s and CA’s at time points 1 (p=0.003 and p=0.028, respectively) and 3 (p=0.050 and p=0.042, respectively). Additionally, when other factors significantly affecting mean HCT, HGB, ferritin, and B12 were analyzed and adjusted for in the mixed model, AA’s continued to have the lowest HCT and HGB levels throughout much of the observation period, with CA's having the highest mean levels. For mean B12, even after adjusting for pre-BMI and sex, levels remained highest in AA’s compared to HA’ and CA’s. CONCLUSIONS: Our data demonstrate that ferritin levels, as well as red blood cell indices, decrease after RYGB and blood markers of anemia occur despite supplementation and post-operative follow-up care. We also show that ethnic minorities exhibit more exaggerated decreases in HCT and HGB, suggesting greater risk of anemia after RYGB in these groups. Thus, it is critical to consider race/ethnicity when providing treatment for patients undergoing gastric bypass surgery. However, future prospective studies are needed to further the preliminary results of this study.

No description available.

Background: Overweight and obesity has increased worldwide and is a leading cause of preventable death. This has led to the quantity of bariatric surgical procedures in Sweden increasing.  Research has identified significant medical benefits such as long-term weight loss, improved risk factors and significant reduction of mortality resulting from the surgery, however research focusing on the experiences of patients has not been undertaken to the same degree. The increasing incidence of overweight and obesity suggest that this patient group will continue to increase each year. Knowledge about the experience of bariatric surgery, including the challenges it represents from the patients’ perspective, is essential for nurses in order to provide the best possible care.                                                           Aim: The aim of the study was to investigate the patient’s experiences after undergoing bariatric surgery beyond the initial post-operative period of 6 months.                       Method: This study has been conducted as a literature review of nine qualitative scientific nursing articles. The data was analysed by conducting a manifest content analysis.        Result: The results found that experiences after bariatric surgery beyond the initial post-operative period were both positive and negative. How the individuals adapted to the changes the surgery entailed was found to be a strong factor in determining the nature of the experience. Two main categories emerged from the data; ‘Enforced Structure’ and ‘A Complete Transformation’.                                                                                   Conclusion: Undergoing bariatric surgery results in extensive and complex changes for this patient group to adapt to. Exploring their experiences has allowed factors for successful and challenging adaption to these changes to be identified. Nursing professionals can use this knowledge to help guide bariatric patients towards a successful adaption to the multitude of changes that surgery encompasses.

Undergraduate honors paper--Mount Holyoke College, 2007. Dept. of Mathematics and Statistics. / Includes bibliographical references (leaves 81-82).

Worldwide obesity has increased at an alarming rate since the 1970’s. It has become a considerable health issue in the United States. A third of the population currently qualifies as obese. These numbers strain the healthcare system and result in higher health care costs related to comorbidities such as type 2 diabetes mellitus, hypertension, and hyperlipidemia. Many individuals attempt to lose weight with dietary changes, physical activity, or medications. These strategies can be effective and assist with modest weight loss but they often fail to meet a patient’s expectations or achieve desired weight loss. Therefore, bariatric surgery becomes an attractive option for many people. There are several types available and significant weight loss is seen with some losing over one hundred pounds in the course of year. These dramatic weight losses improve quality of life and improve or eliminate some comorbid diseases. Unfortunately, research shows that about 1.5 to 2 years post operatively, a large proportion of these people experience a weight regain and results are usually not sustained. Seemingly, this weight regain starts to occur due to a lack of structure and support. Prior to bariatric surgery, there are requirements that one must complete including demonstrating weight loss on their own, attending sessions with a nutritionist, and undergoing a psychological evaluation. In contrast, few surgical programs provide patients with this type of structure post-surgically. Thus, this proposed study aims to incorporate a standardized online multi-disciplinary intervention to prevent weight regain after bariatric surgery. Information on weight trends will be recorded at regular follow up appointments and health related quality of life determined by surveys. After completing this intervention, it is predicted that patients will experience fewer weight fluctuations, limited to no recurrence of comorbidities and an improved quality of life.

No description available.

Introduction: The incidence of endometrial cancer is rising steeply, with the obesity epidemic believed to be the cause. Women with a BMI > 42kg/m2 have a 9-fold increase in their relative risk of endometrial cancer. Few studies have investigated the endometrial effects of obesity or weight loss. I hypothesised that morbidly obese women had a high prevalence of undiagnosed endometrial cancer and pre-cancer, and that major weight loss would result in measurable systemic and endometrial effects. Methods: 118 morbidly obese women undergoing weight loss surgery or non-surgical weight management were recruited into a prospective cohort study. Blood and endometrial samples were taken at baseline, 2 and 12 months. Results: 80 women have undergone baseline assessment (mean age 44 years, median BMI 52kg/m2). Menstrual and reproductive dysfunction was common (15% pre-menopausal amenorrhoea, 31% oligomenorrhoea) and less than one third reported regular menstrual cycles. Four cases of endometrial cancer and six of atypical endometrial hyperplasia were detected at baseline (prevalence 12.5%, 95% CI 6.2-21.8), and women with abnormal endometrium had significantly higher HbA1c and pAKT levels. Undiagnosed diabetes was found in 6%, and overall more than 38% were diabetic and up to 40% more had raised HOMA-IR levels. Significant serial improvements were seen in insulin resistance, adipokines, inflammation and androgens after bariatric surgery. In endometrium significant reductions were seen in Ki-67, pAKT, ER and PR expression. In samples matched for cycle timing and not affected by exogenous hormone treatment Ki-67 reduced by 11% and 17% at 2 and 12 months post-surgery. AEH resolved with weight loss alone in 3/6 patients and with weight loss and LNG-IUS in 2/6 women. Ki-67 expression correlated weakly with pAKT, serum oestradiol, HOMA-IR, FAI and adipokines. Conclusions: Such a high prevalence of endometrial cancer and pre-cancer in morbidly obese women supports targeted screening in this high-risk group and highlights the importance of diagnosing and managing insulin resistance. Reduction in proliferation appears to be mediated by the PI3K/AKT pathway and through changes in insulin resistance, reproductive hormones and inflammation. Ki-67 may have a use as a marker of the 'high-risk' endometrium or in the future surveillance of endometrial abnormality being managed by fertility-sparing means.

BACKGROUND: Over two-thirds of the United States population is considered overweight or obese. Bariatric surgery is often used when conservative weight loss measures fail. The majority of bariatric surgeries are performed on women of childbearing age. Women who become pregnant following bariatric surgery have a decreased occurrence of gestational diabetes, hypertensive disorders and macrosomia, but they also have an increased risk of small for gestational age infants (SGA), with the greatest risk of SGA infants following malabsorptive and mixed bariatric surgery procedures. STUDY: A gap in the literature exists regarding the risks of SGA and intrauterine growth restriction (IUGR) following Roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy (SG), the two most common procedures in the United States in 2014. This study will be a multi-center retrospective cohort study that will identify the risk of IUGR following RYGB and SG. CONCLUSION: This study will improve our understanding of the effects on pregnancy following RYGB and SG. The most innovative, and hardest, part of this study will be the collection of data on as many SG women as possible. This will be the biggest hurdle because SG is a relatively new procedure, so the prevalence of pregnancy following SG is low. PUBLIC HEALTH SIGNIFICANCE: A better understanding of the effects of the most common bariatric procedural types on pregnancy is important given the prevalence of bariatric surgery among women of childbearing age. It will allow bariatric surgeons to better council their patients on a surgery type for those that may be considering pregnancy afterwards, and enable obstetricians to have a better understanding of the risks associated with their patient’s pregnancy.

No description available.

Bariatric surgery is becoming a more common solution for weight loss in individuals with severe obesity. Much attention has been placed on negative surgery outcomes, specifically on psychosocial predictors of post-surgical weight regain and development of psychopathology. Literature on obesity suggests that eating in response to emotional cues is related to the obesity epidemic. The current review identifies all research in the literature that focuses on emotionality and emotional characteristics in bariatric surgery patients and the predicted negative impact on the surgery process from pre-surgical evaluation to post-surgical follow-up. The review was conducted following PRISMA guidelines for systematic reviews. Six articles were identified in the literature meeting all review criteria, specifically focusing on emotionality in bariatric surgery patients. Results suggest high rates of emotional instability, impulsivity, and difficulty in identifying emotions in bariatric surgery patients, which could have adverse effects on the bariatric surgery process. Authors suggest that these components of emotionality may lead to negative effects following surgery, specifically concerning post-surgical dietary restrictions and weight regain. These findings suggest that further research needs to be done in the area of emotionality and bariatric surgery. Authors infer that high rates of emotional instability, impulsivity, and inability to identify emotions may have significant implications for screening and intervention; however, limitations in these studies indicate a need for further research on emotionality in bariatric surgery patients, particularly the impact of emotionality on surgery outcomes.