Title: The effect of movement program on static postural stability in individuals after bariatric surgery Aims: The aim of this diploma thesis was to find out whether a three-month regular exercise program including strenght and aerobic training has an impact on static postural stability in obese individuals who underwent bariatric surgery. Methodology: The special part was written on the basis of data obtained from posturographic measurement of obese patients who underwent bariatric surgery. The static postural stability was measured using pressure plate a MobileMat from Tekscan. Participants were measured before surgery and approximately 4 months after surgery. A total of 30 subjects aged 31-65 years with BMI values between 35-55 kg/m2 (obesity class II and III) who underwent initial and exit examination including stabilometry, were included in this diploma thesis. They were divided into 2 groups, first group participating in a three-month exercise program (n = 10; age 51 ± 7.3 years; BMI 41.7 ± 6.4 kg/m2 ) and a group undergoing bariatric surgery only (n = 20; age 48 ± 9, 4 years; BMI 43.6 ± 6.5 kg/m2 ). The exercise program included exercise three times a week: once a week one-hour strength training and one-hour aerobic group training, and at least once a week home intervention. Results: In...

Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery.

Purpose: To investigate the effects of eccentric exercise on lower body skeletal muscle mass during rapid body mass loss induced by bariatric surgery. Methods: All participants began 6 to 8 weeks after undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Skeletal muscle mass (SMM) in the lower body was measured via magnetic resonance imaging (MRI); additional exercise measurements included muscular strength and functional capacity. Quality of life was measured using Short Form 36 (SF-36). Nineteen females (age = 37.6 ± 9.8 yr, height = 164.4 ± 7.2 cm, mass = 106.9 ± 15.6 kg) were randomly assigned to 1 of 3 groups: eccentric exercise (EEX; n = 6), concentric exercise (CEX; n = 7), or standard-of-care control (CON; n = 6). Exercise groups performed 30-minute lower-body exercise sessions 3 times per week for 16 weeks. Each month the exercise tests were evaluated. At the end of 16 weeks, all participants performed the final exercise tests, received a final MRI scan, and completed the SF-36 questionnaire. Results: Thirteen individuals completed the study. All groups lost mass: CON: 21.4 ± 3.7 kg (p < 0.001), CEX: 19.9 ± 4.0 kg (p = 0.001), and EEX: 21.8 ± 3.3 kg (p < 0.001). SMM decreased in all groups: CON: 0.77 ± 0.5 kg (p = 0.18), CEX: 1.19 ± 0.6 kg (p = 0.06), and EEX: 0.90 ± 0.5 kg (p = 0.09). The skeletal muscle loss in percent of total mass loss was 3.7 ± 4.1%. All measures of muscular strength showed no difference, except for a small decrease in dynamic (60°·sec-1) strength in the eccentric group. Functional capacity and physical quality of life increased significantly in all groups (p < 0.05). Conclusion: SMM loss still occurred in the lower body regardless of resistance training, but the loss was less than what was previously documented. Improved postsurgical functional capacity and physical quality of life may be due to a reduction in fat mass and maintenance of muscular strength during the period of rapid mass loss.

Übergewicht und Diabetes werden zunehmend zum globalen Gesundheitsproblem, eine vielversprechende Behandlungsmöglichkeit der therapieresistenten Adipositas stellen bariatrische Eingriffe dar. Ein positiver Effekt bariatrischer Chirurgie auf die Herzfunktion und das kardiovaskuläre Risiko wurde beobachtet, molekularbiologische Erklärungen dieses Zusammenhanges fehlen bislang. Material und Methoden. Es wurden zwei verschiedene Tiermodelle genutzt, um den Auswirkungen von Übergewicht und bariatrischer Chirurgie auf das Herz nachzugehen: ein HFD-Mausmodell und ein HFD-Rattenmodell mit duodenojejunalem Bypass (DJB). Linksventrikuläres Gewebe beider Modelle wurde mittels quantitativer Real-Time-PCR und Western Blot auf Expression der Zielgene und -proteine untersucht. Aus dem linksventrikulären Gewebe des DJB-Rattenmodells wurde RNA für eine differentielle Genexpressionsanalyse gewonnen. Die Genexpressionsanalyse wurde von der Deep Sequencing Group am CRTD Dresden durchgeführt. Die Analyse der Sequenzierungsdaten erfolgte mittels Ingenuity Pathway Analyse. Ergebnisse. Die zwölfwöchige Hochfettfütterung führte bei den Mäusen zu keiner echokardiographisch darstellbaren Einschränkung des Herzens. Die Tiere wiesen allerdings eine prä- bzw. diabetische Stoffwechsellage auf. Das linksventrikuläre Gewebe der HFD- Mäuse zeigte eine Herabregulation der Glukosetransporter Glut1 und Glut4. Die bariatrische Intervention führte im linksventrikulären Gewebe der Ratten zu einer Heraufregulation des Glukosetransporters Glut1, die Proteinexpression war unverändert. Die Expression des β1-, des β2-Rezeptors und ausgewählter Calcium-handling Proteine war zwischen den beiden Gruppen ebenfalls nicht verschieden. Repräsentative Gene des kardialen Fettsäurestoffwechsels zeigten keine Beeinflussung durch die bariatrische Intervention. Die Analyse der differentiellen Genexpressionsanalyse zeigte für die DJB-Gruppe Veränderungen innerhalb der oxidativen Phosphorylierung und innerhalb adrenerger Signalwege. Zusammenfassung. Es konnte gezeigt werden, dass es durch Übergewicht und eine (prä-) diabetische Stoffwechsellage im linken Ventrikel zur Herabregulation der Glut1- und Glut4- Expression kommt. Nach bariatrischer Chirurgie zeigten Herzen der Interventionsgruppe eine vermehrte Glut1-Expression. Ausgewählte Gene und Proteine der adrenergen Signalkaskade zeigten keine Veränderung innerhalb der DJB-Gruppe, die Pathway-Analyse lässt allerdings vermuten, dass andere Proteine innerhalb dieses Signalweges durchaus differentiell exprimiert vorliegen. Die Überrepräsentation von Genen der oxidativen Phosphorylierung und die protektive Heraufregulation von Glut1 könnten neue Ansatzpunkte für die Therapie kardiovaskulärer Erkrankungen liefern.

Purpose: Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. Methods: In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T. Results: Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses. Conclusions: Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.

Title: Psychological Factors of Weight Loss in Patients after Bariatric Surgery Author: PhDr. Markéta Zajícová Department: Department of Psychology, Charles University in Prague, Faculty of Arts Supervisor: PhDr. Tamara Hrachovinová, PhD. Abstract: Obesity with its comorbidities has enormous impacts on the life of the individual as well as the whole society. Therefore, the attention is paid to the treatment of obesity, where bariatric surgery appears to be one of the most effective. The surgical solution offers excellent results in terms of weight reduction in the short- and medium-term period, but the increased number of weigh gain cases appears in long-term perspective. The aim of this thesis is to find out whether any of the psychological factors that are included in the psychological assessment prior to the bariatric surgery, can predict the development of weight after the surgical procedure. The research is retrospective and quantitative; it focuses on monitoring variables from psychological assessment as well as weight development from the time of the surgery to 4 years after the surgery with intervals of 3, 6, 9 months and 1, 2, 3, 4 years. Attention is focused not only on the weight itself, but also on the weight change (compared to the initial weight and the comparison between consecutive...

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Background: Bariatric surgery is the most effective treatment for severe obesity, resulting in much larger and longer-lasting weight loss compared with those seen with other treatment options. It also results in significant improvements in several weight-related comorbidities. Despite these favorable outcomes, bariatric surgery remains underused in the United States. Objective: The goal of this dissertation was to investigate the impact of insurance-related factors on the access and utilization of bariatric procedures. The goal was achieved via three studies. The first study examined temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in Southeastern Pennsylvania, as well as the associations between payer type, insurance plan type, cost-sharing arrangements (among traditional Medicare beneficiaries), and bariatric surgery utilization. The second study investigated whether there is an association between precertification criteria, such as 3-6 months preoperative supervised medical weight management (MWM), and documented 2-year weight history and the likelihood of undergoing bariatric surgery. The third study examined whether there is an association between insurance-mandated MWM requirement, as well as cardiology and pulmonology evaluations and short-term inpatient healthcare utilization. Data Source: Pennsylvania Health Care Cost Containment Council’s (PHC4) databases in Southeastern Pennsylvania during 2014-2018. Study Population: In Study 1, all adult patients in the PHC4 dataset who underwent the most common types of bariatric surgery during 2014-2018 (N = 14,348) and a 1:1 matched sample of surgery patients and those who were eligible for surgery but did not undergo surgery were identified. In Study 2, privately insured patients within the PHC4 dataset who underwent bariatric surgery in 2016 and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched (N = 1,054). The population of Study 3 consisted of all adult patients within the PHC4 dataset with a diagnosis of severe obesity who underwent the most common bariatric surgical procedures in 2016 and for whom the insurance-mandated precertification requirements were known (N = 2,717). Results: Over the five years, there was an increase in the proportion of Black individuals (37.1% in 2014 vs 43.0% in 2018), Hispanics (5.4% vs 8.0%), and Medicaid beneficiaries (18.5% in 2014 vs 26.9% in 2018) who underwent surgery. The odds of undergoing bariatric surgery based on payer type were statistically different (22% smaller odds) only between Medicare beneficiaries compared to privately insured individuals. There were significantly different odds of undergoing surgery based on insurance plan type within Medicare and private insurance payer categories. Individuals with traditional Medicare plans with no supplementary insurance and those with dual eligibility had smaller odds of undergoing surgery (42% and 32%, respectively) compared to those with private secondary insurance. The insurance requirement for 3-6 months MWM was associated with smaller odds of undergoing surgery (odds ratio [OR] = 0.459, 95% confidence interval [CI] 0.253 to 0.832, P = 0.010), after controlling for insurance plan type and the requirement for documented weight history. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P = 0.132). The requirement for MWM, as well as pulmonology and cardiology examinations, were not associated with the patient length of stay, the number of all-cause rehospitalizations, and the number of all-cause rehospitalization days, after adjusting for patient age, sex, race, ethnicity, the Elixhauser Comorbidity Score, type of the surgery, facility where the surgery was performed, primary payer type, and the estimated median household income. The absence of the precertification requirement for pulmonology and cardiology evaluations was associated with smaller odds of rehospitalizations with common cardiac and pulmonary conditions during the study period, (OR = 0.43, 95% CI 0.23 to 0.80, P = 0.008), after controlling for patient age, sex, race, ethnicity, estimated median household income, and the Elixhauser Comorbidity Score. Conclusions and Significance: Medicaid expansion in Pennsylvania appears to have improved access to bariatric surgery among Black and Hispanic individuals. Nevertheless, insurance plan type, cost-sharing arrangements, and precertification requirements, such as insurance-mandated 3-6 months of MWM requirement, remain key determinants for the access and utilization of bariatric surgery. Additionally, the MWM requirement, as well as the preoperative cardiology and pulmonology evaluations, were not associated with a reduction in inpatient healthcare utilization during the first postoperative year. Careful examination of the bariatric surgery benefit design and application of value-based insurance design to bariatric surgery may improve the access to this potentially life-saving surgery for many Americans. / Public Health

Bakgrund: Idag lider nästan hälften av alla vuxna män och kvinnor i Sverige av övervikt eller fetma. Bariatrisk kirurgi blir en allt vanligare metod för viktreducering och minskning av de fetmarelaterade komorbiditeterna. De vanligaste operationerna resulterar i kraftig viktreducering, men forskning visar att en del av patienterna går upp kilona senare. Syfte: Syftet med denna litteraturstudie är att belysa patienters upplevelser av sin livssituation efter bariatrisk kirurgi. Metod: En litteraturstudie med kvalitativ metod. Studien sammanställer 15 vetenskapliga artiklars resultat. Resultat: Studiens resultat visar på att det vardagliga livet påverkas av den minskade vikten och att en känsla av självständighet infinner sig i samband med att patientens mobilitet ökar. En stor andel patienter upplever sig hämmade av en extrem trötthet efter att ha genomgått kirurgin. Fysiska biverkningar har negativ inverkan på livskvalitén. Resultatet visar på att många upplever sig mer respekterade och uppmärksammade efter viktnedgången. Relationer till familj och vänner visar sig kunna påverkas både positivt och negativt efter ingreppet. Ökat självförtroende och bättre självkänsla är ett av resultaten av viktnedgången. Men att förändra bilden av sig själv tar för många lång tid. Relationen till mat är en central del i behandlingen. Många av patienterna har tidigare använt mat för att hantera känslor. Efter ingreppet finns känslorna kvar och nya sätt för att hantera dem arbetas fram. Det kan i en del fall resultera i att personen utvecklar exempelvis ett spelberoende eller alkoholmissbruk. Konklusion: Ett önskat resultat kräver stöd från sjukvården. Stöd i att orka med vardagen efter ingreppet, hantera det nya sociala livet, acceptera och se sitt nya jag samt bearbeta sin relation till mat upplevs som mest centralt. / Background: Currently almost half of the adult Swedish population struggle with overweight or obesity. Bariatric surgery is becoming a commonly used method for weight loss and reduction of obesity-related comorbidities. The most common procedures often lead to great weight loss, but research shows that postoperative weight gain is common. Aim: The aim of this literature review is to illustrate patient perception and experience of their life situation after going through bariatric surgery. Method: This is a literature review performed with a qualitative approach. The review is based on the result of 15 scientific articles. Results: The study shows that everyday life is affected by the weight loss after bariatric surgery, and that the patients gain independence and greater mobility. Many patients experience that they are inhibited by enormous fatigue after their surgery. Physical side effects have a negative impact on their quality of life. The results show that many feel that they receive greater respect and positive attention after weight loss. Relationships with family and friends are affected in both positive and negative ways. Confidence and self-esteem are affected positively by weight loss, but a change of body image doesn’t always come naturally and takes a long time for many. The relationship with food is a central part of the treatment as a whole considering that emotional eating is common with obese patients. The emotional issues are left unresolved after surgery and patients find new ways of coping with them that don’t include food. In some cases patients fall into new addictions like gambling addiction or drug abuse. Conclusion: To achieve successful results after bariatric surgery, one must get sufficient support from health care providers. Support in handling everyday life, social aspects and accepting the new self. Support in coping with the issue of emotional eating is considered to be essential for successful outcome.

This thesis focuse on bariatric-metabolic surgery and its impact on serum concentrations of various metabolic parameters. The thesis is divided into two parts - theoretical and practical. Basic facts about bariatric-metabolic surgery such as its history, indications, contraindications, surgical methods and their results, nutrition after surgery and the frequency of micronutrient's deficits are described in the theoretical part. Furthermore, information about calcium-phosphate metabolism and metabolites such as calcium, phosphorus, magnesium, vitamin D, vitamin K, parathyroid hormone and osteomarkers is also included. The influence of nutrition and nutritional status on the quality of bone tissue is also mentioned. Last section of the theoretical part is focused on the important vitamins and minerals. The practical part discusses measurements of selected metabolites in serum before and half a year after the surgery. Results of questionnaires which were given to respondents are also included. Questionnaires were focused on lifestyle, nutrition, physical activities and whether the patients take some supplements of micronutrients and protein concentrates. The goal of this work is to evaluate the effect of the surgery on serum concentrations of metabolic parameters and their effect on the health and...