Applying the Principles of Trauma-Informed Care to the Evaluation and Management of Patients Who Undergo Metabolic and Bariatric Surgery.

Evaluation of relevant psychosocial variables is an important aspect of comprehensive, high-quality metabolic and bariatric surgery (MBS) care. Given the high rates of adverse childhood experience (ACEs) and other forms of trauma experienced later in life reported by individuals with class III obesity, it is time to apply the principles of trauma-informed care to the multidisciplinary care of MBS patients. This narrative review begins with a summary of the literature on the psychosocial functioning of individuals who present for MBS.

Early changes in the gut microbiota are associated with weight outcomes over 2 years following metabolic and bariatric surgery.

Objective: Metabolic and bariatric surgery (MBS) is associated with substantial, but variable, weight outcomes. The gut microbiome may be a factor in determining weight trajectory, but examination has been limited by a lack of longitudinal studies with robust microbiome sequencing. This study aimed to describe changes in the microbiome and associations with weight outcomes more than 2 years post surgery.

A naturalistic assessment of the relationship between negative affect and loss of control eating over time following metabolic and bariatric surgery.

Disordered eating behavior has been linked to suboptimal weight outcomes following metabolic and bariatric surgery (MBS), thereby threatening the most efficacious treatment for severe obesity. While up to 40% of patients may experience loss of control (LOC) eating following MBS, mechanisms driving this behavior are not fully understood. Preliminary evidence suggests that high levels of negative affect (NA) in the moment prompt LOC eating post-MBS; however, it remains unclear whether this momentary relationship is stable or changes over the first several years following surgery.

Examining the bidirectional longitudinal associations between body mass index and episodic memory following bariatric surgery.

Background: The relationship between obesity and episodic memory (i.e., conscious memory for specific events) is hypothesized to be bidirectional.

Should presurgical psychological evaluations still be a mandated requirement for metabolic and bariatric surgery? A critique of the literature and thoughts on future directions.

For more than 30 years, clinical practice guidelines for the perioperative support of patients who undergo metabolic and bariatric surgery have recommended a formal psychological evaluation before surgery. However, the predictive utility of the evaluation in determining future outcomes has been mixed, leading to controversy regarding whether such evaluations should be required for all potential patients. This empirically based commentary will review the utility and value of the psychological evaluation in addition to the limitations in the extant literature that reduce predictive validity and provide recommendations on how to improve quality of the empirical literature and refinements to increase the utility of preoperative evaluations.

Intestinal Energy Harvest Mediates Gut Microbiota-Associated Weight Loss Following Bariatric Surgery.

Purpose: Metabolic and bariatric surgery (MBS) is the most effective treatment for class III obesity. The capacity to efficiently extract intestinal energy is potentially a determinant of varying weight loss outcomes post-MBS. Prior research indicated that intestinal energy harvest is correlated with post-MBS weight loss.

Disordered eating behavior and dietary intake prior to metabolic and bariatric surgery.

Background: Disordered eating is a concern for patients seeking metabolic and bariatric surgery (MBS), but little is known about how these behaviors are reflected in typical dietary intake prior to surgery.

Objectives: This study examined the relationships between disordered eating behavior and the content and context of typical dietary intake among patients seeking MBS using an innovative combination of rigorous self-report and interview assessments.

Setting: Participants were recruited from two academic medical centers in the United States.

Intestinal energy harvest is associated with post-bariatric surgery weight loss.

Background/objectives: Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity; however, a significant subset of patients does not achieve expected weight loss or have substantial weight recurrence over time. The intestinal energy harvest is a potential determinant of varying weight loss outcomes, but with limited exploration. We assess the relationships between diet, intestinal energy harvest, and weight outcomes over 24 months in individuals who have undergone MBS.

Six-year postoperative associations between the Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) and weight recurrence, eating behaviors, adherence, alcohol misuse, and quality of life.

Background: Metabolic and bariatric surgery (MBS) leads to beneficial and sustained outcomes. However, many patients evidence weight recurrence and psychosocial functioning may be associated with weight recurrence. The Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) is validated for use in presurgical MBS evaluations and likely has clinical utility in understanding weight recurrence and other aspects of postoperative functioning.

Longer-Term Weight Loss Outcomes Are Not Primarily Driven by Diet Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for Class III obesity. Reduced dietary intake is considered a behavioral driver of post-surgical weight loss, but limited data have examined this association. Therefore, this study examined prospective, longitudinal relationships between dietary intake and weight loss over 24 months following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Examining sex differences in the association between sedentary behavior and cognitive function in bariatric surgery patients.

Background: Obesity is associated with cognitive impairment. A potential contributor to these deficits is sedentary behavior (SB), which is linked to poorer cognitive functioning in other populations. Little is known about the association between SB and cognitive function in bariatric surgery populations.

Associations Between Changes in Activity and Dietary Behaviors after Metabolic and Bariatric Surgery.

Introduction: Patients who undergo metabolic and bariatric surgery (MBS) are advised to make healthy activity and dietary changes. While previous research has examined post-surgical changes in activity and dietary behaviors separately, no study has assessed whether changes in these behaviors are beneficially associated with each other. We evaluated whether post-surgical improvements in activity behaviors related to favorable changes in dietary behaviors overall and by surgery type (Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]).

Reevaluating the Binge Eating Scale cut-off using DSM-5 criteria: analysis and replication in preoperative metabolic and bariatric surgery samples.

Background: Metabolic and bariatric surgery is effective for sustained weight loss, but binge eating disorder (BED) can be associated with poorer outcomes and lead to weight regain. A common measure used to screen for BED is the Binge Eating Scale (BES). A BES cut-off score of ≥17 previously identified patients who have a high likelihood of meeting criteria for BED.

Team Approach: Management of Mental Health in Orthopaedic Patients.

»: Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist.

»: The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures.

»: Psychological issues are multifaceted and require treatment tailored to each individual patient.

Social Isolation and Loneliness During the COVID-19 Pandemic: Impact on Weight.

Purpose Of Review: Social isolation and loneliness have long been identified as risk factors for poorer physical and mental health and increased mortality. These factors have also been shown to impact dietary behavior and physical activity which play a role in precipitating and maintaining obesity. Less is known about the impact of social isolation resulting from the COVID-19 pandemic in which social distancing is a major component of public health initiatives.

A microbial signature following bariatric surgery is robustly consistent across multiple cohorts.

Bariatric surgery induces significant shifts in the gut microbiota which could potentially contribute to weight loss and metabolic benefits. The aim of this study was to characterize a microbial signature following Roux-en-Y Gastric bypass (RYGB) surgery using novel and existing gut microbiota sequence data. We generated 16S rRNA gene and metagenomic sequences from fecal samples from patients undergoing RYGB surgery (n = 61 for 16S rRNA gene and n = 135 for metagenomics) at pre-surgical baseline and one, six, and twelve-month post-surgery.

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations.

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.

Remote unaffiliated presurgical psychosocial evaluations: a qualitative assessment of the attitudes of ASMBS members.

Background: A psychosocial evaluation is an important component of the preoperative assessment process for people seeking metabolic and bariatric surgery (MBS), and is required for accreditation of MBS programs. Recently, independent companies without affiliations with MBS programs have been marketing remotely administered, unaffiliated psychosocial evaluations for MBS (RUS), and American Society for Metabolic and Bariatric Surgery (ASMBS) members have raised concerns about these evaluations.

Objectives: To explore ASMBS members' beliefs about RUS.

Six-year bariatric surgery outcomes: the predictive and incremental validity of presurgical psychological testing.

Background: Research identifying preoperative psychosocial predictors of bariatric surgery outcomes has yielded inconsistent results with minimal examination of longer-term outcomes. Utilizing a broadband measure of personality and psychopathology during the preoperative evaluation helps to identify preoperative risk factors for suboptimal bariatric surgery outcomes.

Objective: Examine predictors of outcome and the incremental contribution of presurgical psychological testing to various long-term bariatric surgery outcomes.

Refractory Chronic Pain and Obesity: Promising Implications for Multidisciplinary Pain Rehabilitation.

Objective: Individuals with obesity frequently contend with chronic pain, but few studies address the clinical impact of coordinated pain services on this population. The current study addresses this topic by comparing the effectiveness of a comprehensive pain rehabilitation program for patients with and without obesity.

Methods: A retrospective analysis of registry data was conducted.

DSM 5 Lifetime Psychiatric Diagnoses in Two Bariatric Surgery Programs.

Patients presenting for bariatric surgery have been shown to have high rates of psychiatric disorders. These studies have utilized structured interviews using older versions of the DSM. This study examined whether similar lifetime frequencies would be similar using the recent DSM-5.

Associations among psychopathology and eating disorder symptoms and behaviors in post-bariatric surgery patients.

Purpose: A considerable number of post-bariatric surgery patients report problematic eating behaviors (PEBs) and/or eating disorders (EDs). Examining psychosocial variables associated with ED symptoms may identify targets for postoperative interventions to reduce these behaviors and improve surgical outcomes.

Methods: A total of 161 participants completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Eating Disorder Examination-Questionnaire (EDE-Q).

Factors Impacting Physician Referral To and Patient Attendance at Weight Management Programs Within a Large Integrated Health System.

Background: Identifying which patients receive referrals to and which ones attend weight management programs can provide insights into how physicians manage obesity.

Objective: To describe patient factors associated with referrals, which primarily reflect physician priorities, and attendance, which reflects patient priorities. We also examine the influence of the individual physician by comparing adjusted rates of referral and attendance across physicians.

Marijuana and Bariatric Surgery.

Purpose Of Review: Marijuana use presents a unique challenge to bariatric surgery programs. We review the recent evidence examining marijuana use on outcomes following bariatric surgery.

Recent Findings: Recent studies have not demonstrated an increased risk of short-term surgical complications or differences in up to 2-year weight loss following surgery among marijuana users.