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Practical considerations of developing and conducting a successful telehealth practice in response to COVID-19.
Tewksbury, C, Deleener, ME, Dumon, KR, Williams, NN
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2021;(4):769-774
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic posed significant challenges to clinicians practicing in outpatient settings focused on chronic disease treatment and management. Many interprofessional teams transitioned to telehealth to continue to provide care while minimizing in-person interaction to reduce risk of transmission. Given that telehealth will likely remain as a care option even as the pandemic subsides, this review summarizes the applied recommendations on telehealth in interprofessional patient care, provides practical insights for successfully transitioning care from an academic medical center bariatric surgery program, and highlights future opportunities for research.
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Surgical management of obesity.
Torres-Landa, S, Kannan, U, Guajardo, I, Pickett-Blakely, OE, Dempsey, DT, Williams, NN, Dumon, KR
Minerva chirurgica. 2018;(1):41-54
Abstract
Obesity is a spreading epidemic associated with significant morbidity and mortality with a prevalence of over 36% worldwide. In the face of a growing epidemic, increasing medical costs, and the disappointing limitations of medical and lifestyle modification bariatric surgery was found to consistently lead to significant weight loss and improvement in obesity-associated comorbidities when compared to non-surgical interventions. Bariatric procedures fall within three basic categories: restrictive procedures, malabsorptive procedures, and procedures that combine both restrictive and malabsorptive mechanisms. Four major procedures are currently performed (most often laparoscopically): Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch, adjustable gastric banding, and sleeve gastrectomy. Although the laparoscopic Roux-en-Y gastric bypass was the most frequently performed bariatric procedure, the laparoscopic sleeve gastrectomy has since become the most popular. Bariatric surgery currently has similar mortality rates to standard general surgical operations. Morevoer, bariatric surgery reduces mortality by the improvement and remission of obesity-related comorbidities. Newer minimally-invasive weight loss procedures and endoscopic methods continue to evolve as we expand our understanding of the intricacies of obesity and the effects of currently available surgical treatments.
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Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: Two-year results.
Chao, AM, Wadden, TA, Faulconbridge, LF, Sarwer, DB, Webb, VL, Shaw, JA, Thomas, JG, Hopkins, CM, Bakizada, ZM, Alamuddin, N, et al
Obesity (Silver Spring, Md.). 2016;24(11):2327-2333
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Plain language summary
Binge eating disorder is characterised by the consumption of an objectively large amount of food in a discrete period of time (i.e. 2hrs) with an accompanying loss of control over eating. This study is a follow-up study that examined weight loss over an average of 24 months post bariatric surgery (as most studies are based on a shorter duration i.e. less than 12 months) in 59 patients. Another aim of the study was whether bariatric surgery had any effects on the remission or precipitation of binge eating. Results indicate that patients with a preoperative diagnosis of binge-eating disorder lost significantly less weight 2 years after surgery than those individuals who were free from binge-eating prior surgery. However, those with a diagnosis of binge-eating disorder who received lifestyle modifications lost significantly less than those who had bariatric surgery. Authors conclude that bariatric-surgery may be a useful long-term weight loss strategy for patients with eating disorders. However, they also recommend that these patients may benefit from additional counselling and behavioural support, such as cognitive behaviour therapy.
Abstract
OBJECTIVE A previous study reported that preoperative binge-eating disorder (BED) did not attenuate weight loss at 12 months after bariatric surgery. This report extends the authors' prior study by examining weight loss at 24 months. METHODS A modified intention-to-treat population was used to compare 24-month changes in weight among 59 participants treated with bariatric surgery, determined preoperatively to be free of a current eating disorder, with changes in 33 surgically treated participants with BED. Changes were also compared with 49 individuals with obesity and BED who sought lifestyle modification for weight loss. Analyses included all available data points and were adjusted for covariates. RESULTS At month 24, surgically treated patients with BED preoperatively lost 18.6% of initial weight, compared with 23.9% for those without BED (P = 0.049). (Mean losses at month 12 had been 21.5% and 24.2%, respectively; P = 0.23.) Participants with BED who received lifestyle modification lost 5.6% at 24 months, significantly less than both groups of surgically treated patients (P < 0.001). CONCLUSIONS These results suggest that preoperative BED attenuates long-term weight loss after bariatric surgery. We recommend that patients with this condition, as well as other eating disturbances, receive adjunctive behavioral support, the timing of which remains to be determined.
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The Surgical Management of Obesity.
Neylan, CJ, Kannan, U, Dempsey, DT, Williams, NN, Dumon, KR
Gastroenterology clinics of North America. 2016;(4):689-703
Abstract
In the United States, more than one-third of the population is obese. Currently, bariatric surgery is the best known treatment for obesity, and multiple meta-analyses have shown bariatric surgery to be more effective for treating obesity than diet and exercise or pharmacologic treatment. The modern era of bariatric surgery began in 2005, which is defined by a drastic increase in the use of laparoscopy. Bariatric surgery has the potential to improve obesity-related comorbidities, such as type 2 diabetes, cardiovascular disease, and sleep apnea. The effect of bariatric surgery on weight loss and comorbidities varies by the type of procedure.
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GLP-1 plays a limited role in improved glycemia shortly after Roux-en-Y gastric bypass: a comparison with intensive lifestyle modification.
Vetter, ML, Wadden, TA, Teff, KL, Khan, ZF, Carvajal, R, Ritter, S, Moore, RH, Chittams, JL, Iagnocco, A, Murayama, K, et al
Diabetes. 2015;(2):434-46
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Abstract
Rapid glycemic improvements following Roux-en-Y gastric bypass (RYGB) are frequently attributed to the enhanced GLP-1 response, but causality remains unclear. To determine the role of GLP-1 in improved glucose tolerance after surgery, we compared glucose and hormonal responses to a liquid meal test in 20 obese participants with type 2 diabetes mellitus who underwent RYGB or nonsurgical intensive lifestyle modification (ILM) (n = 10 per group) before and after equivalent short-term weight reduction. The GLP-1 receptor antagonist exendin(9-39)-amide (Ex-9) was administered, in random order and in double-blinded fashion, with saline during two separate visits after equivalent weight loss. Despite the markedly exaggerated GLP-1 response after RYGB, changes in postprandial glucose and insulin responses did not significantly differ between groups, and glucagon secretion was paradoxically augmented after RYGB. Hepatic insulin sensitivity also increased significantly after RYGB. With Ex-9, glucose tolerance deteriorated similarly from the saline condition in both groups, but postprandial insulin release was markedly attenuated after RYGB compared with ILM. GLP-1 exerts important insulinotropic effects after RYGB and ILM, but the enhanced incretin response plays a limited role in improved glycemia shortly after surgery. Instead, enhanced hepatic metabolism, independent of GLP-1 receptor activation, may be more important for early postsurgical glycemic improvements.
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A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery.
Sarwer, DB, Moore, RH, Spitzer, JC, Wadden, TA, Raper, SE, Williams, NN
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2012;(5):561-8
Abstract
BACKGROUND Bariatric surgery is a powerful treatment of severe obesity. During the past several years, a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed, and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery. The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling, delivered by a registered dietitian, would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with standard postoperative care. The study was performed at an academic medical center. METHODS Eighty-four individuals who underwent bariatric surgery were randomly assigned to receive either dietary counseling or standard postoperative care for the first 4 months after surgery. The participants completed measures of macronutrient intake and eating behavior at baseline and 2, 4, 6, 12, 18, and 24 months after surgery. RESULTS The patients who received dietary counseling achieved greater weight loss than those who received standard postoperative care that did not involve this counseling, although this difference did not reach statistical significance. Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance. CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery.
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Surgical treatments for obesity.
Vetter, ML, Dumon, KR, Williams, NN
The Psychiatric clinics of North America. 2011;(4):881-93
Abstract
Bariatric surgery is currently the most effective and durable treatment option for extreme obesity. Restrictive procedures, such as AGB and SG, limit gastric capacity and, thus, food intake while leaving the gastrointestinal tract intact. Malabsorptive procedures, such as BPD, shorten the length of the intestine to decrease nutrient absorption. Combined procedures, such as RYGB, include restriction and gastrointestinal rearrangement. Procedures that bypass segments of the gut are associated with greater weight loss and greater improvements in comorbid conditions than is gastric banding. This may be due, in part, to the differential effects of gastrointestinal rearrangement on the secretion of orexigenic and anorexigenic gut peptides that regulate appetite, glucose homeostasis, and body weight. Bariatric surgery is generally associated with low rates of perioperative and postoperative morbidity and mortality, although rigorous comparative safety data are lacking. High-quality, long-term, randomized, controlled trials are needed to compare the efficacy, safety, and cost effectiveness of the various bariatric surgery procedures with each other, as well as with intensive nonsurgical weight loss interventions.