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News Article | May 16, 2017
Site: www.eurekalert.org

PITTSBURGH, May 16, 2017 - One in five patients who undergo one of the most popular weight-loss surgical procedures is likely to develop problems with alcohol, with symptoms sometimes not appearing until years after their surgery, according to one of the largest, longest-running studies of adults who got weight-loss surgery. The finding--reported online today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery--indicates that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence. "We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn't expect the number of affected patients to continue to grow throughout seven years of follow-up," said lead author Wendy C. King, Ph.D., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. She and her team discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use. Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States. RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure--laparoscopic adjustable gastric banding--where the surgeon inserts an adjustable band around the patient's stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn't result in as much weight loss as RYGB. Both groups of patients increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding. "Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment," said King. The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone. The LABS-2 study was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward. In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms. King and her team found that although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems. "This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems," said King. "That's particularly troubling given the availability of effective treatments." Additional authors on this study are Jia-Yuh Chen, Ph.D., and Gretchen E. White, M.P.H., both of Pitt Public Health; Anita P. Courcoulas, M.D., M.P.H., of UPMC; Gregory F. Dakin, M.D., and Alfons Pomp, M.D., both of Weill Cornell Medical College; Scott G. Engel, Ph.D., and James E. Mitchell, M.D., both of the Neuropsychiatric Research Institute in Fargo, N.D.; David R. Flum, M.D., and Marcelo W. Hinojosa, M.D., both of the University of Washington; Melissa A. Kalarchian, Ph.D., of Pitt and Duquesne University; Samer G. Mattar, M.D., and Bruce M. Wolfe, M.D., both of the Oregon Health Sciences University; Walter J. Pories, M.D., of East Carolina University; Kristine J. Steffen, Pharm.D., Ph.D., of the Neuropsychiatric Research Institute and North Dakota State University; and Susan Z. Yanovski, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This clinical study was a cooperative agreement funded by the NIDDK. Grant numbers: Data Coordinating Center - U01 DK066557; Columbia - U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University - U01-DK66526; UPMC - U01-DK66585 (in collaboration with CTRC, grant UL1-RR024153); and Oregon Health & Science University - U01-DK66555. The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at http://www. .


News Article | May 16, 2017
Site: www.prweb.com

One in five patients who undergo one of the most popular weight-loss surgical procedures are likely to develop problems with alcohol, with symptoms sometimes not appearing until years after their surgery, according to one of the largest, longest-running studies of adults who got weight-loss surgery. The finding—reported online today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery—indicates that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence. “We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn’t expect the number of affected patients to continue to grow throughout seven years of follow-up,” said lead author Wendy C. King, Ph.D., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. She and her team discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use. Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States. RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure—laparoscopic adjustable gastric banding—where the surgeon inserts an adjustable band around the patient’s stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn’t result in as much weight loss as RYGB. Both groups of patients increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding. “Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment,” said King. The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone. The LABS-2 study was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward. In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms. King and her team found that although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems. “This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems,” said King. “That’s particularly troubling given the availability of effective treatments.” Additional authors on this study are Jia-Yuh Chen, Ph.D., and Gretchen E. White, M.P.H., both of Pitt Public Health; Anita P. Courcoulas, M.D., M.P.H., of UPMC; Gregory F. Dakin, M.D., and Alfons Pomp, M.D., both of Weill Cornell Medical College; Scott G. Engel, Ph.D., and James E. Mitchell, M.D., both of the Neuropsychiatric Research Institute in Fargo, N.D.; David R. Flum, M.D., and Marcelo W. Hinojosa, M.D., both of the University of Washington; Melissa A. Kalarchian, Ph.D., of Pitt and Duquesne University; Samer G. Mattar, M.D., and Bruce M. Wolfe, M.D., both of the Oregon Health Sciences University; Walter J. Pories, M.D., of East Carolina University; Kristine J. Steffen, Pharm.D., Ph.D., of the Neuropsychiatric Research Institute and North Dakota State University; and Susan Z. Yanovski, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This clinical study was a cooperative agreement funded by the NIDDK. Grant numbers: Data Coordinating Center – U01 DK066557; Columbia – U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, grant UL1-RR024996); University of Washington – U01-DK66568 (in collaboration with CTRC, grant M01RR-00037); Neuropsychiatric Research Institute – U01-DK66471; East Carolina University – U01-DK66526; UPMC – U01-DK66585 (in collaboration with CTRC, grant UL1-RR024153); and Oregon Health & Science University – U01-DK66555.


News Article | May 17, 2017
Site: www.futurity.org

One in five patients who undergo one of the most popular weight-loss surgical procedures are likely to develop problems with alcohol, report researchers, who found that symptoms sometimes didn’t appear until years after the surgery. The findings indicate that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence. “We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn’t expect the number of affected patients to continue to grow throughout seven years of follow-up,” says lead author Wendy C. King, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. Starting in 2006, King and colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States. They discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use. RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure—laparoscopic adjustable gastric banding—where the surgeon inserts an adjustable band around the patient’s stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn’t result in as much weight loss as RYGB. Both groups increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding. “Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment,” King says. The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone. The study, published in the journal Surgery for Obesity and Related Diseases, was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward. In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery, and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms. Although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems. “This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems,” King says. “That’s particularly troubling given the availability of effective treatments.” Other researchers from the University of Pittsburgh, and from Weill Cornell Medical College; the Neuropsychiatric Research Institute in Fargo, North Dakota; the University of Washington; Duquesne University; the Oregon Health Sciences University; East Carolina University; North Dakota State University; and the National Institute of Diabetes and Digestive and Kidney Diseases are coauthors of the study.


Meany G.,University of North Dakota | Conceicao E.,University of Minho | Mitchell J.E.,University of North Dakota | Mitchell J.E.,Neuropsychiatric Research Institute
European Eating Disorders Review | Year: 2014

There is increasing evidence that patients who have problems with binge eating (BE) or BE disorder (BED) are quite common among the severely obese, including bariatric surgery candidates. The literature suggests that in many cases such eating behaviours improve after bariatric surgery, although this is not uniformly true. The current paper reviews the data on the development of BE, BED and loss of control (LOC) eating after bariatric surgery and the impact of these problems on long-term weight outcome. A search was made of various databases regarding evidence of BE, BED and LOC eating post-operatively in bariatric surgery patients. The data extracted from the literature suggests that 15 research studies have now examined this question. Fourteen of the available 15 studies suggest that the development of problems with BE, BED or LOC eating post-bariatric surgery is associated with less weight loss and/or more weight regain post-bariatric surgery. These data suggests that it is important to identify individuals at high risk for these problems, to follow them post-operatively, and, if appropriate interventions can be developed if such behaviours occur in order to maximize weight loss outcomes. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.


Grilo C.M.,Yale University | Crosby R.D.,Neuropsychiatric Research Institute | Crosby R.D.,University of North Dakota | Wilson G.T.,Rutgers University | Masheb R.M.,Yale University
Journal of Consulting and Clinical Psychology | Year: 2012

Objective: The longer term efficacy of medication treatments for binge-eating disorder (BED) remains unknown. This study examined the longer term effects of fluoxetine and cognitive behavioral therapy (CBT) either with fluoxetine (CBT + fluoxetine) or with placebo (CBT + placebo) for BED through 12-month follow-up after completing treatments. Method: 81 overweight patients with BED within a randomized double-blind placebo-controlled acute treatment trial allocated to fluoxetine-only, CBT + fluoxetine, and CBT + placebo were assessed before treatment, during treatment, posttreatment, and 6 and 12 months after completing treatments. Outcome variables comprised remission from binge eating (0 binge-eating episodes for 28 days) and continuous measures of binge-eating frequency, eating disorder psychopathology, depression, and weight. Results: Intent-to-treat remission rates (missing data coded as nonremission) differed significantly across treatments at posttreatment and at 6-and 12-month follow-ups. At 12-month follow-up remission rates were 3.7% for fluoxetine-only, 26.9% for CBT + fluoxetine, and 35.7% for CBT + placebo. Mixed-effects models of all available continuous data (without imputation) at posttreatment and at 6-and 12-month follow-ups (controlling for baseline scores) revealed the treatments differed on all clinical outcome variables, except for weight, across time. CBT + fluoxetine and CBT + placebo did not differ and both were significantly superior to fluoxetine-only on the majority of clinical outcomes. Conclusions: This represents the first report from any randomized placebo-controlled trial for BED that has reported follow-up data after completing a course of medication-only treatment. CBT + placebo was superior to fluoxetine-only, and adding fluoxetine to CBT did not enhance findings compared to adding placebo to CBT. The findings document the longer term effectiveness of CBT, but not fluoxetine, through 12 months after treatment completion. © 2012 American Psychological Association.


Gagner M.,Florida International University | Gagner M.,Clinique Michel Gagner MD Inc. | Erickson A.L.,Neuropsychiatric Research Institute | Crosby R.D.,Neuropsychiatric Research Institute
Surgery for Obesity and Related Diseases | Year: 2011

Background: Laparoscopic sleeve gastrectomy (LSG) has been performed for morbid obesity in the past 10 years. LSG was originally intended as a first-stage procedure in high-risk patients but has become a stand-alone operation for many bariatric surgeons. Ongoing review is necessary regarding the durability of the weight loss, complications, and need for second-stage operations. Methods: The first International Summit for LSG was held in October 2007, the second in March 2009, and this third in December 2010. There were presentations by experts, and, to provide a consensus, a questionnaire was completed by 88 attendees who had >1 year (mean 3.6 ± 1.5, range 18) of experience with LSG. Results: The results of the questionnaire were based on 19,605 LSGs performed within 3.6 ± 1.5 years (228.8 ± 275.0 LSGs/surgeon). LSG had been intended as the sole operation in 86.4% of the cases; in these, a second-second stage became necessary in 2.2%. LSG was completed laparoscopically in 99.7% of the cases. The mean percentage of excess weight loss at 1, 2, 3, 4, and 5 years was 62.7%, 64.7%, 64.0%, 57.3%, and 60.0%, respectively. The bougie size was 2860F (mean 36F, 70% blunt tip). Resection began 1.57.0 cm (mean 4.8) proximal to the pylorus. Of the surgeons, 67.1% reinforced the staple line, 57% with buttress material and 43% with oversewing. The respondents excised an estimated 92.9% ± 8.0% (median 95.0%) of fundus (i.e., a tiny portion is maintained lateral to the angle of His). A drain is left by 57.6%, usually closed suction. High leaks occurred in 1.3% of cases (range 010%); lower leaks occurred in.5%. Intraluminal bleeding occurred in 2.0% of cases. The mortality rate was.1% ±.3%. Conclusion: According to the questionnaire, presentations, and debates, the weight loss and improvement in diabetes appear to be better than with laparoscopic adjustable gastric banding and on par with Roux-en-Y gastric bypass. High leaks are infrequent but problematic. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.


King W.C.,University of Pittsburgh | Chen J.-Y.,University of Pittsburgh | Mitchell J.E.,Neuropsychiatric Research Institute | Kalarchian M.A.,University of Pittsburgh | And 5 more authors.
JAMA - Journal of the American Medical Association | Year: 2012

Context: Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking. Objective: To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD. Design, Setting, and Participants: A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011. Main Outcome Measure: Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8). Results: The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P=.98), but was significantly higher in the second postoperative year (9.6%; P=.01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P≲λτ∀.001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P=.03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P≲λτ∀.001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P=.02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P≲λτ∀.001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P≲λτ∀.001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P=.01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P=.01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P≲λτ∀.001; reference category: laparoscopic adjustable gastric band procedure). Conclusion: In this cohort, the prevalence of AUD was greater in the second post-operative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure. ©2012 American Medical Association. All rights reserved.


Muller A.,Hannover Medical School | Mitchell J.E.,University of North Dakota | Mitchell J.E.,Neuropsychiatric Research Institute | De Zwaan M.,Hannover Medical School
American Journal on Addictions | Year: 2015

Objective Although compulsive buying (CB) seems to be not only prevalent but even increasing in prevalence, it often remains neglected or minimized in clinical settings. There is a need for a greater understanding and recognition of this problem. The aim of this article is to summarize the current knowledge regarding CB and to offer thoughts regarding classification. Method Review of published literature over the period 1994-2013 through Pubmed/Medline, PsychINFO, and Google Scholar using the key words 'compulsive buying', 'impulsive buying' and 'addictive buying'. Results CB is defined by a preoccupation with buying and shopping, by frequent buying episodes, or overpowering urges to buy that are experienced as irresistible and senseless. The maladaptive spending behavior is associated with serious psychological, social, occupational, and financial problems. Treatment-seeking patients with CB suffer from substantial psychiatric comorbidity (eg, anxiety and depressive mood disorders, compulsive hoarding, binge eating disorder). Representative surveys revealed prevalence estimates of CB between 6% and 7% and indicate that younger people are more prone to develop CB. Moreover, European data suggest an increase of CB in the adult population over the last 20 years. While there is no evidence for the efficacy of psychopharmacological treatment, group cognitive behavioral therapy has been shown to be effective. Conclusion The relevance of recognition of CB as mental disorder is undeniable in the face of its estimated prevalence and associated burden. As our understanding of contributing neurobiological and etiological factors is limited, further research should focus on these topics, taking into account the heterogeneity of individuals with CB. There is also a need for specific treatment options and for the development of prevention strategies. (Am J Addict 2015;24:132-137) © 2015 American Academy of Addiction Psychiatry.


Gagner M.,Florida International University | Deitel M.,Obesity Surg. | Erickson A.L.,Neuropsychiatric Research Institute | Crosby R.D.,Neuropsychiatric Research Institute
Obesity Surgery | Year: 2013

Background: LSG has been increasingly performed. Long-term follow-up is necessary. Methods: During the Fourth International Consensus Summit on LSG in New York Dec. 2012, an online questionnaire (SurveyMonkey®) was filled out by 130 surgeons experienced in LSG. The survey was submitted directly to the statisticians. Results: The 130 surgeons performed 354.9 ± SD 453 LSGs/surgeon (median 175), for a total of 46,133 LSGs. The LSGs had been performed over 4.9 ± 2.7 year (range 1-10). Of the 46,133 LSGs, 0.2 ± 1.0 % (median 0, range 0-10 %) were converted to an open operation. LSG was intended as the sole operation in 93.1 ± 14.8 %; in 3.0 ± 6.3 %, a second stage became necessary. Of the 130 surgeons, 40 (32 %) use a 36F bougie, which was most common (range 32-50F). Staple-line is reinforced by 79 %; of these, 57 % use a buttress and 43 % over-sew. Mean %EWL at year 1 was 59.3 %; year 2, 59.0 %; year 3, 54.7 %; year 4, 52.3 %; year 5, 52.4 %; and year 6, 50.6 %. If a second-stage operation becomes necessary, preference was: RYGB 46 %, duodenal switch 24 %, re-sleeve 20 %, single-anastomosis duodenoileal bypass 3 %, sleeve plication 3 %, minigastric bypass 3 %, non-adjustable band 2 %, and side-to-side jejunoileal anastomosis 1 %. Complications were: high leak 1.1 %, hemorrhage 1.8 %, and stenosis at lower sleeve 0.9 %. Postoperative gastroesophageal reflux occurred in 7.9 ± 8.2 % but was variable (0-30 %). Mortality was 0.33 ± 1.6 %, which translates to ∼152 deaths. Eighty-nine percent order multivitamins (including vitamin D, calcium, and iron) and 72 % order B12. A PPI is ordered by 29 % for 1 month, 29 % for 3 months, and others for 1-12 months depending on the case. Conclusions: LSG was relatively safe. Further long-term surveillance is necessary. © 2013 Springer Science+Business Media New York.


Zunker C.,Neuropsychiatric Research Institute | Mitchell J.E.,Neuropsychiatric Research Institute | Wonderlich S.A.,Neuropsychiatric Research Institute
International Journal of Eating Disorders | Year: 2011

Objective: To identify exercise interventions in the empirical literature to help inform clinical decision making in the treatment of underweight individuals with anorexia nervosa (AN) and review any recommended differences in treatment planning for those who excessively exercise and those who do not. Method: Online search engines and cross-referencing articles identified relevant studies. Results: Six exercise interventions in clinical settings were reviewed, including three conducted in hospitals. A few studies provided some evidence to support the implementation of moderate physical activity during treatment. Most did not include specific exercise program descriptions. Patient eligibility varied from obligatory for all patients to programs that specified weight requirements. Discussion: Few studies have systematically explored exercise as a part of treatment among patients with AN. Findings of the current review suggest a need for developing further research, but currently the field may benefit from standardized guidelines for treating excessive exercisers with AN. Copyright © 2010 Wiley Periodicals, Inc.

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