Obesity: Sarwer DB

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S, Anonymous00032, Anonymous00033, Anonymous00034. · No affiliation provided · Obesity (Silver Spring). · Pubmed #19319140 No free full text.

Abstract: American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. · No affiliation provided · Surg Obes Relat Dis. · Pubmed #18848315 No free full text.

Abstract: American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. · No affiliation provided · Endocr Pract. · Pubmed #18723418 No free full text.

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Sarwer DB, Allison KC, Fabricatore AN, Faith MS, Tsai AG, Wadden TA. · No affiliation provided · Plast Reconstr Surg. · Pubmed #17312523 No free full text.

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Sarwer DB, Thompson JK, Mitchell JE, Rubin JP. · Department of Psychiatry, (Center for Weight and Eating Disorders), University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Plast Reconstr Surg. · Pubmed #18520869 No free full text.

Abstract: BACKGROUND: Body contouring following the massive weight loss associated with bariatric surgery has grown in popularity. Little is known, however, about the psychosocial aspects of these procedures. This article discusses the psychological considerations of the postoperative bariatric surgery patient who undergoes body contouring surgery. METHODS: A review of the psychosocial and physical characteristics of individuals with extreme obesity who undergo bariatric surgery, and the changes in these traits that typically occur postoperatively, is provided. The relationship of body image dissatisfaction to both bariatric and plastic surgery is discussed. The breast reduction literature is reviewed and used to provide a framework with which to understand the psychosocial issues of body contouring patients. RESULTS: These related literatures are used as a guide to provide suggestions for future research investigating the physical and psychosocial outcomes following body contouring surgery. Preliminary recommendations for the psychosocial assessment of body contouring patients are provided. CONCLUSIONS: Given the current popularity of both bariatric and plastic surgery, the number of individuals who present for body contouring following massive weight loss is likely to increase. Appropriate psychosocial assessment and management of these patients is believed to play an important role in successful postoperative outcomes.

Sarwer DB, Fabricatore AN. · Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Clin Plast Surg. · Pubmed #18061795 links to  free full text

Abstract: As bariatric surgery for extreme obesity continues to grow in popularity, so does interest in postbariatric surgery body-contouring surgery. There is an extensive literature on the psychological characteristics of persons with extreme obesity who undergo bariatric surgery and the psychological changes that typically occur postoperatively. Far less, however, is known about the psychological aspects of body contouring following massive weight loss. This article reviews the psychosocial characteristics of individuals with extreme obesity who undergo bariatric surgery, as well as the changes in these traits that typically occur postoperatively. Because there have been few studies of the psychological aspects of patients who have lost massive amounts of weight, we use related literatures on the relationship between body image dissatisfaction and other plastic surgical procedures to identify the most relevant research and clinical issues for this unique patient population. Appropriate psychiatric screening and management of these patients is believed to play an important role in successful postoperative outcomes.

Wadden TA, Sarwer DB, Fabricatore AN, Jones L, Stack R, Williams NS. · Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA. · Med Clin North Am. · Pubmed #17509389 No free full text.

Abstract: Extreme obesity, characterized by a body mass index (BMI) of 40 kg/m(2) or greater, is associated with significantly increased mortality, principally from cardiovascular disease, type 2 diabetes, and several cancers. It also is associated with an increased risk of psychosocial complications, including depression, eating disorders, and impaired quality of life. This article briefly examines the psychosocial status of extremely obese individuals who seek bariatric surgery and describes changes in functioning that can be expected with surgically induced weight loss. The article combines a review of the literature with clinical impressions gained from the more than 2500 candidates for bariatric surgery whom the authors have evaluated at the Hospital of the University of Pennsylvania.

Sarwer DB, Allison KC, Gibbons LM, Markowitz JT, Nelson DB. · Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. · J Womens Health (Larchmt). · Pubmed #16910904 No free full text.

Abstract: At present, more than 60% of American women of childbearing age are either overweight or obese. As the obesity epidemic in the United States and many other countries continues to grow unchecked, there is greater interest in the relationship between obesity and other major health issues. This paper reviews the literature on the relationship between obesity and pregnancy. We begin with a discussion of the relationship between excess body weight and fertility and then turn to the relationship between maternal body weight and pregnancy-related complications. The role of pregnancy as a possible risk factor for the development of obesity is noted. The studies investigating the efficacy of behavioral interventions to control excessive weight gain during pregnancy or help women lose weight after childbirth are then reviewed. The paper concludes with an agenda for future research examining the relationship between obesity and pregnancy.

Wadden TA, Sarwer DB. · Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA. · Obesity (Silver Spring). · Pubmed #16648595 No free full text.

Abstract: This paper discusses the behavioral evaluation of patients who seek bariatric surgery and the psychosocial complications most frequently observed in these individuals. The effects of such complications on surgical outcome are briefly examined, as is the challenge of predicting therapeutic response on the basis of preoperative variables. The paper concludes with a description of the goals and methods of a behavioral assessment used at the University of Pennsylvania. This evaluation includes the use of the Weight and Lifestyle Inventory, a questionnaire that guides our interview with patients.

Wadden TA, Sarwer DB, Williams NN. · Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA. · Obesity (Silver Spring). · Pubmed #16648594 No free full text.

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Sarwer DB, Wadden TA, Fabricatore AN. · Weight and Eating Disorders Program, 3535 Market Street, Suite 3022, Philadelphia, PA 19104-3309, USA. · Obes Res. · Pubmed #15897471 No free full text.

Abstract: Bariatric surgery has become an increasingly popular treatment option for individuals with extreme obesity (defined as a BMI > or = 40 kg/m2) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes. This paper reviews the literature on the preoperative psychosocial status, eating behaviors, and quality of life of patients who seek bariatric surgery. In addition, the paper examines studies that investigated changes in these factors postoperatively. The review concludes with an agenda for future research in this area.

Sarwer DB, Thompson JK, Cash TF. · Departments of Psychiatry and Surgery, The Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3108, Philadelphia, PA 19104, USA. · Psychiatr Clin North Am. · Pubmed #15733612 No free full text.

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Gustafson TB, Sarwer DB. · University of Pennsylvania School of Medicine, Department of Psychiatry, Weight and Eating Disorders Program, 3535 Market Street, Philadelphia, PA 19104, USA. · Obes Rev. · Pubmed #15245381 No free full text.

Abstract: The causes of the current obesity epidemic are multifactorial and include genetic, environmental, and individual factors. One potential risk factor may be the experience of childhood sexual abuse. Childhood sexual abuse is remarkably common and is thought to affect up to one-third of women and one-eighth of men. A history of childhood sexual abuse is associated with numerous psychological sequelae including depression, anxiety, substance abuse, somatization, and eating disorders. Relatively few studies have examined the relationship between childhood sexual abuse and adult obesity. These studies suggest at least a modest relationship between the two. Potential explanations for the relationship have focused on the role of disordered eating, particularly binge eating, as well as the possible "adaptive function" of obesity in childhood sexual abuse survivors. Nevertheless, additional research on the relationship between childhood sexual abuse and obesity is clearly needed, not only to address the outstanding empirical issues but also to guide clinical care.

Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A. · Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA. · Surg Clin North Am. · Pubmed #11589242 No free full text.

Abstract: There is a growing consensus that bariatric surgery is the treatment of choice for extremely obese individuals who have failed to reduce their weight satisfactorily using behavioral or pharmacologic interventions. The gastric bypass in particular is associated with excellent long-term weight loss. Although most extremely obese individuals will have essentially normal psychological functioning, a significant minority suffer from depression, binge eating, trauma, or other emotional complications that may require treatment before or after bariatric surgery. A structured behavioral assessment, conducted by a mental-health professional and a registered dietitian, can readily identify those who are most likely to require adjunct counseling.

Wadden TA, Sarwer DB, Berkowitz RI. · Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA. · Baillieres Best Pract Res Clin Endocrinol Metab. · Pubmed #10932678 No free full text.

Abstract: The goal of obesity treatment has changed significantly in the past decade. Where once the goal was a reduction to ideal weight, the current objective is the achievement of a healthier weight. For many obese individuals, this means losing as little as 5-15% of their initial weight. This article briefly describes behavioural methods to help obese individuals modify their eating and activity habits in order to achieve these new goals. A review of recent studies shows that patients treated by a comprehensive group behavioural programme lose approximately 9% of their initial weight in 20 weeks and, without further treatment, maintain a loss of 5% 1 year later. Methods of improving the maintenance of weight loss include increasing physical activity, extending the length of behavioural treatment and, with appropriately selected individuals, combining behavioural and pharmacological interventions. The importance of helping obese individuals adopt realistic treatment expectations is also discussed.

Sarwer DB, Wadden TA. · University of Pennsylvania School of Medicine, Philadelphia 19104-2648, USA. · J Womens Health Gend Based Med. · Pubmed #10839703 No free full text.

Abstract: The prevalence of obesity in the United States has increased, with approximately one third of American men and women considered obese. Obese individuals who seek weight reduction frequently lose weight with the goal of returning to their ideal body weight. For the majority of obese persons, however, reaching their ideal body weight is an unattainable goal, few people are able to maintain even more modest weight losses over the long term. The result is that many obese persons end up feeling frustrated, if not defeated, by their weight loss efforts. Recent weight loss treatment recommendations have focused on helping patients lose 5%-10% of their body weight and maintaining these losses for longer durations. These more modest losses frequently are associated with reductions in obesity-related comorbidities and improvements in psychological status. The practitioner assisting obese individuals with weight reduction is presented with a variety of treatment options, including behavioral programs, pharmacotherapy, and low-calorie diets. Each of these approaches has been shown to be effective in producing the 5%-10% weight losses now recommended. A combination of these approaches, such as the use of pharmacotherapy with a behavioral modification program, ultimately may prove to be the most effective treatment for obese persons. We review the new weight loss recommendations and provide suggestions for assessing patients for weight loss treatment. We also discuss both existing and new treatment options and focus on their application in a primary care setting.

Wadden TA, Foster GD, Sarwer DB, Anderson DA, Gladis M, Sanderson RS, Letchak RV, Berkowitz RI, Phelan S. · Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA. · Am J Clin Nutr. · Pubmed #15321793 links to  free full text

Abstract: BACKGROUND: Some investigators fear that dieting may precipitate binge eating and other adverse behavioral consequences. OBJECTIVE: The objective of the study was to examine whether dieting would elicit binge eating and mood disturbance in individuals free of these complications before treatment. DESIGN: A total of 123 obese women were randomly assigned to 1) a 1000 kcal/d diet that included 4 servings/d of a liquid meal replacement (MR); 2) a 1200-1500 kcal/d balanced deficit diet (BDD) of conventional foods; or 3) a nondieting (ND) approach that discouraged energy restriction. All women attended weekly group sessions for 20 wk and biweekly sessions from week 20 to week 40. RESULTS: At week 20, participants in the MR, BDD, and ND groups lost 12.1 +/- 6.7%, 7.8 +/- 6.0%, and 0.1 +/- 2.4% of initial weight, respectively (P < 0.001). During the first 20 wk, there were no significant differences among groups in the number of persons who had objective binge episodes or in reports of hunger or dietary disinhibition. Symptoms of depression decreased significantly more (P < 0.001) in the MR and BDD groups than in ND participants. At week 28, significantly more (P < 0.003) cases of binge eating were observed in MR participants than in the 2 other groups. No differences, however, were observed between groups at weeks 40 or 65 (a follow-up visit). At no time did any participant meet criteria for binge-eating disorder. CONCLUSION: Concerns about possible adverse behavioral consequences of dieting should not dissuade primary care providers from recommending modest energy restriction to obese individuals.

Wadden TA, Womble LG, Sarwer DB, Berkowitz RI, Clark VL, Foster GD. · Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. · J Consult Clin Psychol. · Pubmed #14622084 No free full text.

Abstract: This study investigated whether informing obese individuals that they would lose only modest amounts of weight would lead them to adopt more realistic weight loss expectations. At a screening interview, 53 obese women reported that they expected to lose the equivalent of 28% of their initial weight during 1 year of treatment with the medication sibutramine. Prior to beginning treatment, participants were informed, both verbally and in writing, that they could expect to lose 5% to 15% of initial weight, the loss typically induced by current behavioral and pharmacologic approaches. This information, however, had little impact on their weight loss expectations when assessed on subsequent occasions. Results are discussed in terms of the origins, clinical significance, and potential malleability of obese individuals' weight loss expectations.

Wadden TA, Berkowitz RI, Sarwer DB, Prus-Wisniewski R, Steinberg C. · Department of Psychiatry, University of Pennsylvania School of Medicine, 3600 Market St, Suite 738, Philadelphia, PA 19104, USA. · Arch Intern Med. · Pubmed #11176735 links to  free full text

Abstract: BACKGROUND: Weight loss medications are recommended as an adjunct to diet and exercise modification but seem to be prescribed as a monotherapy by many physicians. This practice is likely to be associated with suboptimal weight loss. METHODS: This 1-year, randomized trial compared the effects of sibutramine hydrochloride used alone (ie, the drug-alone group) to sibutramine plus group lifestyle modification, prescribed with either a 5021- to 6276-kJ/d diet (1200-1500-kcal/d diet) (ie, the drug-plus-lifestyle group) or, for the first 4 months, a 4184-kJ/d diet (1000-kcal/d diet (ie, drug-plus-lifestyle with a portion-controlled diet [the combined treatment] group). Participants were 53 women with a mean (+/-SD) age of 47.2 +/- 9.8 years and weight of 101.3 +/- 9.7 kg. At baseline, they reported the number of pounds they expected to lose at the end of treatment. RESULTS: At month 12, patients treated with the drug alone lost (mean +/- SD) 4.1% +/- 6.3% of their initial body weight compared with significantly (P<.05) larger losses in the drug-plus-lifestyle group of 10.8% +/- 10.3% and the combined treatment group of 16.5% +/- 8.0%. Women in the 2 lifestyle groups achieved a significantly (P<.05) greater percentage of their expected weight loss than those in the drug-alone group and were significantly more satisfied with the medication and with changes in weight, health, appearance, and self-esteem (P<.05 for all). Significant reductions were observed at 12 months in triglyceride and low-density lipoprotein cholesterol levels but systolic and diastolic blood pressure both increased significantly (P<.05 for all). CONCLUSION: The addition of group lifestyle modification to the pharmacologic management of obesity significantly improved weight loss and patients' satisfaction with treatment outcome.

Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Arnold ME, Steinberg CM. · University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia 19104, USA. · Obes Res. · Pubmed #11011909 No free full text.

Abstract: OBJECTIVE: This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone. RESEARCH METHODS AND PROCEDURES: Patients were 34 women with a mean age of 44.1 +/- 10.4 years, weight of 89.4 +/- 13.8 kg, and body mass index (BMI) of 33.9 +/- 4.9 kg/m2 who had lost an average of 11.6 +/- 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double-blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16-week continuation trial. RESULTS: Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 +/- 4.1 kg vs. +0.5 +/- 2.1 kg, respectively). DISCUSSION: These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses > or =15% of initial weight, as desired by many obese individuals.

Faulconbridge LF, Wadden TA, Berkowitz RI, Sarwer DB, Womble LG, Hesson LA, Stunkard AJ, Fabricatore AN. · Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Obesity (Silver Spring). · Pubmed #19197266 links to  free full text

Abstract: Recent studies of rimonabant have re-awakened interest in the possible adverse psychiatric effects of weight loss, as well as of weight loss medications. This study examined changes in symptoms of depression in 194 obese participants (age = 43.7 +/- 10.2 years; BMI = 37.6 +/- 4.1 kg/m(2)) in a 1-year randomized trial of lifestyle modification and medication. Participants were assigned to (i) sibutramine alone; (ii) lifestyle modification alone; (iii) sibutramine plus lifestyle modification (i.e., combined therapy); or (iv) sibutramine plus brief therapy. Participants completed the Beck Depression Inventory-II (BDI-II) at baseline and weeks 6, 10, 18, 26, 40, and 52. At 1 year, participants in combined therapy lost the most weight and those in sibutramine alone the least (12.1 +/- 8.8% vs. 5.5 +/- 6.5%; P < 0.01). Mean BDI-II scores across all participants declined from 8.1 +/- 6.9 to 6.2 +/- 7.7 at 1 year (P < 0.001), with no significant differences among groups. Despite this favorable change, 13.9% of participants (across the four groups) reported potentially discernible increases (>or= 5 points on the BDI-II) in symptoms of depression at week 52. They lost significantly less weight than participants in the rest of the sample (5.4 +/- 7.8% vs. 9.0 +/- 7.8%, respectively; P < 0.03). The baseline prevalence of suicidal ideation was 3.6%. Seven new cases of suicidal ideation were observed during the year, with three in lifestyle modification alone. Further research is needed to identify characteristics of obese patients at risk of negative mood changes (and suicidal ideation) in response to behavioral and pharmacologic therapies.

Shikora SA, Bergenstal R, Bessler M, Brody F, Foster G, Frank A, Gold M, Klein S, Kushner R, Sarwer DB. · Tufts Medical Center, Boston, Massachusetts 02111, USA. · Surg Obes Relat Dis. · Pubmed #19071066 No free full text.

Abstract: BACKGROUND: To compare implantable gastric stimulation therapy with a standard diet and behavioral therapy regimen in a group of carefully selected class 2 and 3 obese subjects by evaluating the difference in the percentage of excess weight loss (EWL) between the control and treatment groups. The primary endpoint was the percentage of EWL from baseline to 12 months after randomization. Implantable gastric stimulation has been proposed as a first-line treatment for severely obese patients; however, previous investigations have reported inconclusive results. METHODS: A total of 190 subjects were enrolled in this prospective, randomized, placebo-controlled, double-blind, multicenter study. All patients underwent implantation with the implantable gastric stimulator and were randomized to 1 of 2 treatment groups: the control group (stimulation off) or treatment group (stimulation on). The patients were evaluated on a monthly basis. All individuals who enrolled in this study agreed to consume a diet with a 500-kcal/d deficit and to participate in monthly support group meetings. RESULTS: The procedure resulted in no deaths and a low complication rate. The primary endpoint of a difference in weight loss between the treatment and control groups was not met. The control group lost 11.7% +/- 16.9% of excess weight and the treatment group lost 11.8% +/- 17.6% (P = .717) according to an intent-to-treat analysis. CONCLUSION: Implantable gastric stimulation as a surgical option for the treatment of morbid obesity is a less complex procedure than current bariatric operations. However, the results of the present study do not support its application. Additional research is indicated to understand the physiology and potential benefits of this therapy.

Sarwer DB, Fabricatore AN, Eisenberg MH, Sywulak LA, Wadden TA. · Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Obesity (Silver Spring). · Pubmed #18978767 No free full text.

Abstract: The popularity of bariatric surgery has increased the focus on the psychological aspects of extreme obesity. Although a growing literature has documented the psychosocial burden associated with extreme obesity, surprisingly little attention has been paid to the experience of weight-related stigmatization among extremely obese individuals. The present study investigated self-reported experiences of weight-related stigmatization, weight-related quality of life, and depressive symptoms among 117 extremely obese individuals (BMI = 48.2 +/- 7.5 kg/m2) who presented for bariatric surgery at the Hospital of the University of Pennsylvania. In general, these individuals reported infrequent weight-related stigma, which was unrelated to BMI. Some specific forms of stigmatization, however, appear to be related to body size. The occurrence of stigmatization was associated with poorer weight-related quality of life and greater symptoms of depression.

Mitchell JE, Crosby RD, Ertelt TW, Marino JM, Sarwer DB, Thompson JK, Lancaster KL, Simonich H, Howell LM. · The Neuropsychiatric Research Institute and the Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA. · Obes Surg. · Pubmed #18560946 No free full text.

Abstract: BACKGROUND: Obesity has become far more prevalent over the last few decades. In parallel, bariatric surgery has been increasingly utilized as a method of treatment. This appears to be having an impact on the rate of body contouring surgery for hanging redundant skin after the massive weight loss that usually results from bariatric surgery. Little literature is available addressing how frequently patients who have undergone bariatric surgery receive or desire body contouring surgery or regarding how satisfied these patients are with the hanging skin in certain body areas. METHODS: Seventy individuals (out of 250 who were mailed the questionnaire) who had undergone Roux-en-Y gastric bypass surgery 6-10 years previously completed a questionnaire, which obtained information regarding their experiences with as well as their desire for body contouring surgery and more general body area satisfaction. RESULTS: Thirty three of the seventy patients reported having undergone a total of 38 body contouring procedures. The most common were abdominoplasties (24.3%), breast lifts (8.6%), and thigh lifts (7.1%). However, subjects were not uniformly satisfied with body areas that had undergone body contouring surgery; some found the areas unattractive. The majority of patients, at least to some extent, desired body contouring surgery, often in several areas, most notably the waist/abdomen, rear/buttock, upper arms, and chest/breast. CONCLUSION: Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.

Tsai AG, Wadden TA, Sarwer DB, Berkowitz RI, Womble LG, Hesson LA, Phelan S, Rothman R. · Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. · Obesity (Silver Spring). · Pubmed #18223613 No free full text.

Abstract: BACKGROUND: No previous research has examined the association between metabolic syndrome (MetSyn) and health-related quality of life (HRQoL) using standard criteria for defining MetSyn. We hypothesized that MetSyn would be associated with lower HRQoL on measures of physical and mental health. METHODS AND PROCEDURES: Participants were 361 individuals in two randomized weight loss trials. MetSyn was defined by the National Cholesterol Education Panel criteria. The Medical Outcomes Study, Short Form-36 (SF-36) was used to assess HRQoL. Differences in HRQoL and in clinical and psychosocial characteristics were compared among participants with and without MetSyn. Multiple regression was used to determine predictors of HRQoL. RESULTS: MetSyn was associated with lower scores on the physical function and general health subscales of the SF-36 and on the physical component summary (PCS) score. This association remained after controlling for age or depression but was eliminated by controlling for BMI. MetSyn was not associated with lower mental quality of life, a higher depression score, tobacco or alcohol use, or a higher rate of psychosocial stressors. DISCUSSION: Individuals with MetSyn reported lower HRQoL. This appeared to be an effect of increased weight, rather than a unique effect of MetSyn. Larger studies are needed to assess whether MetSyn may have an independent effect on HRQoL.