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Bakgrund: Överviktsoperationer ökar i snabb takt runt om i världen i samband med en eskalerande fetmaepidemi. En överviktsoperation innebär stora förändringar i livet och ställer krav på att sjukvårdspersonal är kunniga om dessa förändringar ur patientens perspektiv. Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser före och efter överviktskirurgi. Metod: 13 vetenskapliga artiklar granskades och analyserades. Sammanställningen resulterade i ett tema och fem presenterade underkategorier. Resultat: Överviktskirurgi blev en sista chans till ett bättre liv för patienterna. De hade förväntningar på ett förändrat liv, som i många fall till stor besvikelse inte blev bättre. Patienterna upplevde att den mentala hälsan blev åsidosatt vid överviktskirurgi, varav de önskade att vårdpersonalen la mer fokus på just detta. Slutsats: Då överviktskirurgi är en livsomvälvande process är det viktigt att sjuksköterskan har förståelse för patientens hela upplevelse, även den känslomässiga. / Background: The number of bariatric surgeries performed globally is increasing in relation to an escalating obesity epidemic. Bariatric surgery leads to life-changing processes and put demands on health care staff to have knowledge about these changes from the patients’ perspective. Purpose: The purpose of the literature review was to illuminate patients’ experiences before and after bariatric surgery. Method: Thirteen scientific articles were reviewed and analysed. The combination resulted in a theme and five presented subcategories. Results: Bariatric surgery became the last chance to a better life for the patients. They had expectations of a changed life, which in many cases to great disappointment didn’t became better. The patients experienced that the mental health was disacknowledged while going through bariatric surgery and was something they wished that the health care staff had focused more on. Conclusion: Bariatric surgery is a life-changing process, why it’s important for the nurse to understand the experiences of the patient, even the emotional experience.

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.

Introduction: Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. Methods: Retrospective cohort including patients ≥ 18 years old with BMI ≥ 35 kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥ 60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. Results: Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed. 29% less EWL% per each extra year of life (P = .019), and. 93% more EWL% per each extra HOMA-IR point (P = .004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P = .050), and 2% more chance of success per each additional HOMA-IR point (P = .038). Conclusions: There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes. / Revisión por pares

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥ 30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery. / Revisión por pares

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The prevalence of obesity is increasing globally. Obesity is characterized by increased fat mass and is a risk factor for type 2 diabetes (T2D). Obesity is associated with hyperglycaemia, hyperinsulinemia, insulin resistance and chronic inflammation. Currently, the most effective and durable treatment for obesity and its comorbidities is bariatric surgery. Bariatric surgery changes food intake, energy balance and the composition of gut microbiota. Bariatric surgery can lower blood glucose and put T2D into remission. It was unknown if bariatric surgery-induced changes in the gut microbiota was an independent yet sufficient factor to lower blood glucose. Fecal microbiota transplantation (FMT) was performed on conventional (specific-pathogen-free, SPF) and germ-free (GF) mice using fecal material obtained from patients before surgery and 12 months after bariatric surgery. We tested FMT into mice from the same patients before and after vertical sleeve gastrectomy (VSL) and biliopancreatic diversion with duodenal switch (BPD/DS). FMT did not alter body weight, fat mass, glucose tolerance or glucose transporter mRNA expression in all intestine segments in SPF mice. FMT lowered blood glucose during an oral glucose load in GF mice receiving bacteria after VSL and BPD/DS bariatric surgery. Post-BPD/DS surgery FMT decreased Glut1 transcript level in the ileum and increased Glut1 transcript level in the TA muscle of GF mice, but did not change GLUT1 protein levels. Post-BPD/DS surgery FMT also decreased goblet cell count, villus height and crypt depth in the ileum of GF mice. We conclude that changes in the gut microbiota caused by bariatric surgery is a standalone factor that can lower blood glucose and alter gut morphology. / Thesis / Master of Science (MSc) / Type 2 diabetes is a chronic disease that involves high blood sugar (i.e. glucose), which can damage many parts of the body leading to serious complications. Diabetes is a growing global problem and is the seventh leading cause of death. Obesity is one of the largest factors leading to type 2 diabetes. Bariatric surgery reduces obesity and is to date the most effective method to lower blood glucose and reverse type 2 diabetes. Bariatric surgery alters gut anatomy and the types of bacteria that inhabit the gut. Gut bacteria can change obesity and blood glucose levels, but it was not known if the bacterial community present after bariatric surgery was a factor that is sufficient to lower blood glucose. We found that transferring gut bacteria from humans after bariatric surgery into mice lowers the blood glucose and alters the gut barrier structure where food is absorbed. It is not yet clear how this happens, but these findings show that a change in gut microbes is a standalone factor that can alter host blood glucose. Finding the glucose lowering factor in bacteria may be a new treatment to combat type 2 diabetes.

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.