The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Does bariatric surgery improve the patient's quality of life? Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study Validation of the Adapted Bariatric Quality of Life Index (BQL) in a Prospective Study in 446 Bariatric Patients as One-Factor Model Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study. Influence of Reoperations on Long-Term Quality of Life After Restrictive Procedures: A Prospective Study Two-year changes in generic and obesity-specific quality of life after gastric bypass The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35–60 kg/m2 – a multi-centre randomized patient and observer blind non-inferiority trial Medium-Term Results of Laparoscopic Sleeve Gastrectomy: a Matched Comparison with Gastric Bypass Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial Optimizing long-term weight control after bariatric surgery: a pilot study. Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Laparoscopic Gastric Banding: A Prospective, Randomized Study Comparing the Lapband and the SAGB: Early Results Laparoscopic adjustable gastric banding: efficacy and consequences over a 13-year period. The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population Decreased Levels of Circulating Cancer-Associated Protein Biomarkers Following Bariatric Surgery Improvement of migraine headaches in severely obese patients after bariatric surgery Quality of Life After Laparoscopic Gastric Banding: Prospective Study (152 Cases) With a Follow-up of 2 Years Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Comparison of short-term outcomes between laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Health‐related quality of life after gastric banding Does Surgically Induced Weight Loss Improve Daytime Sleepiness? A bariatric surgery center of excellence: operative trends and long-term outcomes. Bariatric surgery in patients with liver cirrhosis. Comparison of laparoscopic sleeve gastrectomy to laparoscopic Roux-en-Y gastric bypass for morbid obesity in a military institution. Musculoskeletal function following bariatric surgery. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. Laparoscopic sleeve gastrectomy in patients over 60 years: impact of age on weight loss and co-morbidity improvement. 10-year Follow-up of Laparoscopic Vertical Banded Gastroplasty: Good Results in Selected Patients Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study. Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. Early Results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS)
Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery OBJECTIVE The aim of this investigation was to assess the effect of malabsorptive bariatric surgery ( BS ) on the quality of life ( QoL ) , applying the Nottingham Health Profile ( NHP ) and the bariatric analysis and reporting outcome system ( BAROS ) . DESIGN A prospect i ve cohort study was performed in 100 adult patients ( > 18 years ) undergoing bariatric surgery by malabsorptive technique for one year . RESEARCH METHODS AND PROCEDURES Patients were monitored from the beginning of the BS program until a year after the intervention , applying the NHP and the BAROS test . At baseline , the mean weight of the women was 132 ± 22 kg and the Body Mass Index ( BMI ) was 50.7 kg/m² . RESULTS The values obtained from different areas applying the NHP question naire showed statistical significant differences ( p < 0.001 ) with respect to baseline values . According to the BAROS test , 48 % of patients lost 25 - 49 % of weight excess and 80.8 % had resolved major comorbidities at 1 yr . According to the Moorehead-Ardelt QoL score , there were major improvements in employment and self-esteem in 89 % and 87 % of patients , respectively , and improvements in physical activity , sexual and social relationships . According to the total mean BAROS score , the outcome was considered " very good " . CONCLUSION NHP and BAROS question naires appear to be useful and easily applicable tools to assess the QoL of obese patients Laparoscopic adjustable gastric b and ing ( LAGB ) and vertical-b and ed gastroplasty ( VBG ) are surgical treatment modalities for morbid obesity . This prospect i ve study describes the long-term results of LAGB and VBG .  One hundred patients were included in the study . Fifty patients underwent LAGB and 50 patients , open VBG .  Study parameters were weight loss , changes in obesity-related comorbidities , long-term complications , re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status .  From 91 patients ( 91 % ) , data were obtained with a mean follow-up duration of 84 months ( 7 years ) . Weight loss [ percent excess weight loss ( EWL ) ] was significantly more after VBG compared with LAGB , 66 % versus 54 % , respectively . All comorbidities significantly decreased in both groups . Long-term complications after VBG were mainly staple line disruption ( 54 % ) and incisional hernia ( 27 % ) . After LAGB , the most frequent complications were pouch dilatation ( 21 % ) and anterior slippage ( 17 % ) . Major re-operations after VBG were performed in 60 % of patients . All re-operations following were conversions to Roux-en-Y gastric bypass ( RYGB ) . In the LAGB group , 33 % of patients had a refixation or replacement of the b and , and 11 % underwent conversion to another bariatric procedure . There were no significant differences in weight loss between patients with or without re- interventions . No vitamin deficiencies were present after 7 years , although supplement usage was inconsistent . This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery . The failure rate of 65 % after VBG is too high , and this procedure is not performed anymore in our institution . The re-operation rate after LAGB is decreasing as a result of new techniques and material s. Results of the re-operations are good with sustained weight loss and reduction in comorbidities . However , in order to achieve these results , a durable and complete follow-up after restrictive procedures is imperative Background : The Bariatric Quality of Life Index ( BQL ) was created and vali date d as a nine-factor model in 2005 for the measurement of quality of life (QoL)in  patients before and after bariatric surgery .  Even though the results were acceptable , the statistical structure of the test was very unclear . Methods : A total·f466 patients were enrolled in an ongoing prospect i ve longitudinal German study . The assessment took place preoperatively and at 1 , 3 , 6 , 9 , and 12 months postoperatively . After that period , reevaluations were done on a yearly basis . In addition to demographic and clinical data , QoL data were collected using the  BQL  , the Short Form12 ( SF-12v2 ) , the Gastrointestinal Quality of Life Index ( GIQLI ) , and the  Bariatric Analysis and Reporting Outcome System  ( BAROS ; old version since the study started in 2001 ) . Statistical parameters for contingency ( Cronbach ’s Α),construct and criterion validity ( Pearson ’s r ) , and responsiveness ( st and ardized effect sizes ) were calculated . The data of the assessment s conducted preoperatively and after 6 and 12 months were used for the validation . Results : The factor analysis and the screeplot showed that a one-factor solution explained 45.37%of variance . The selectivity of the items ranged between 0.61 and 0.85 , and Cronbach ’s Α was 0.898 . The measurements showed similar excellent results with the analysis of all measurement points . Pearson ’s test showed a good retest reliability ( r = 0.9 ) . The correlations with the SF-12 and the Moorehead-Ardelt I question naire ( MA-I ) were significant , while the correlation with the GIQLI was low . The results of the correlation with the excess weight loss (EWL)(0.45 and 0.49 ) and the BMI ( –0.38 and –0.47 ) were good . Conclusion : The BQL is a valid instrument and should be preferred over generic question naires as it provides betterresponsiveness Background : Approximately 20 - 30 % of obese patients do not achieve successful weight outcomes after bariatric surgery . Objective : We examined whether short-term changes ( ≤0.5 y postsurgery ) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change . Design : Participants were recruited from the Swedish Obese Subjects ( SOS ) study , which was a matched ( nonr and omized ) prospect i ve trial that compared bariatric surgery with usual care for obese patients . A total of 2010 patients who underwent bariatric surgery were included in the study .  Physical examinations ( e.g. , weight ) and question naires ( e.g. , dietary question naire ) were completed before and 0.5 , 1 , 2 , 3 , 4 , 6 , 8 , and 10 y after surgery . For the main analytic strategy , a linear mixed model was implemented , which included repeated measures with a r and om intercept and an unstructured covariance matrix . Results : Short-term changes in energy intake ( P < 0.001 ) and in relative proportions of energy from carbohydrates ( P < 0.001 ) , fat ( P < 0.001 ) , and protein ( P < 0.05 ) were associated with 10-y weight change after bariatric surgery . At the 10-y follow-up , men and women with the largest reductions in energy intake had lost 7.3 % and 3.9 % more weight , respectively , compared with that of subjects with the smallest intake reductions ( P < 0.001 ) . Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition ( P < 0.05 ) . Conclusions : The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss . Weight loss is also associated with a changing dietary macronutrient composition . This trial was registered at clinical trials.gov as NCT01479452 Quality of life improves after  bariatric surgery .  However , long-term results and the influence of reoperations are not well known . A prospect i ve quality of life assessment before , 1 and 7 years after  laparoscopic adjustable gastric b and ing ( LAGB ) and vertical b and ed gastroplasty ( VBG )  was performed in order to determine the influence of reoperations during follow-up . One hundred patients were included in the study . Fifty patients underwent VBG and 50 LAGB .  Patients completed the  quality of life question  naires prior to surgery and two times during follow-up . Health-related quality of life ( HRQoL ) question naires included the Nottingham Health Profile I and II and the Sickness Impact Profile 68 . Follow-up was 84 % with a mean duration of 84 months ( 7 years ) . During follow-up , 65 % of VBG patients underwent conversion to Roux-en-Y gastric bypass while 44 % of LAGB patients underwent a reoperation or conversion . One year after the procedure , nearly all quality -of-life parameters significantly improved . After 7 years , the Nottingham Health Profile (NHP)-I domain “ physical ability ” , the NHP-II and the SIP-68 domains “ mobility control ” , “ social behavior ” , and “ mobility range ” were still significantly improved in both groups . The domains “ emotional reaction ” , “ social isolation ” ( NHP-I ) , and “ emotional stability ” ( SIP-68 ) remained significantly improved in the VBG group while this was true for the domain “ energy level ” ( NHP-I ) in the LAGB group . Both the type of procedure and reoperations during follow-up were not of significant influence on the HRQoL results . Weight loss and decrease in comorbidities were the only significant factors influencing quality of life . Restrictive bariatric surgery improves quality of life . Although results are most impressive 1 year after surgery , the improvement remains significant after long-term follow-up . Postoperative quality of life is mainly dependent on weight loss and decrease in comorbidities and not on the type of procedure or surgical complications The study objectives were to assess 2-year changes in health-related quality of life ( HRQL ) after gastric bypass in patients with severe obesity and to analyze HRQL improvements in relation to weight loss after bariatric surgery . This was a prospect i ve intervention study with consecutive patients referred to two bariatric surgical units in the Basque Country . We used both generic ( Short Form Health Survey , SF-36 and EuroQol , EQ-5D ) , and specific question naires ( Moorehead-Ardelt , MA II and Obesity-related Problems Scale , OP ) . Effect sizes and receiver operating characteristic ( ROC ) curves were calculated to assess the change in quality of life . Spearman ’s correlation coefficient was calculated to assess whether there was an association between changes in body mass index ( BMI ) and HRQL . Of 82 patients who underwent surgery , 79 were followed-up for 2 years . Mean weight loss was 37 % of body weight ( 49 kg ) and BMI fell from 50.6 to 31.8 . The initial problems and final improvements were greater in the physical dimensions . Considerable benefits were observed in assessment s with all the instruments used . However , the changes in weight/ BMI and HRQL were not linear . The comparison with general population showed a similar profile in SF-36 dimensions after surgery . Severely obese patients have lower perceived health across all dimensions of quality of life . Moreover , the impact on functioning is so important that severe obesity can be described as a cause of disability that disappears 2 years after surgical treatment . ROC curves indicate that most of the HRQL measures are poor predictors of change in terms of reduction in body weight or BMI Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 ( or 35 with co morbidities ) . A minority of patients , however , either do not show the desired loss of excess weight or show weight regain by follow up . Research highlights some of the reasons for this variability , most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body , psychological issues relating to dietary control , self esteem , coping and emotional eating remain neglected . The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service ( BRS ) on patient health outcomes . The bariatric rehabilitation service will provide information , support and mentoring pre and post surgery and will address psychological issues such as dietary control , self esteem , coping and emotional eating . The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes . Methods / Design The study is a r and omised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery . Follow up measures of weight loss and psychological issues will be taken at baseline ( 2 weeks preoperatively ) , 3 , 6 and 12 months postoperatively . The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups ( BOSPA & WLSinfo ) . This study will take place in St Richard 's Hospital in Chichester in the UK . Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life , dietary control , self esteem , coping and emotional eating . This also has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term . Trial registration Clinical Trials.gov NCT01264120 Background Roux-en-Ygastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation . A systematic review revealed a similar excess weight loss ( EWL ) 2 years postoperatively between SG and RYGB . However , there is a lack of r and omized controlled multi-centre trials comparing SG and RYGB , not only concerning EWL , but also in terms of remission of obesity-related co-morbidities , gastroesophageal reflux disease ( GERD ) and quality of life ( QoL ) in the mid- and long-term . Methods The BariSurg trial was design ed as a multi-centre , r and omized controlled patient and observer blind trial . The trial protocol was approved by the corresponding ethics committees of the centres . To demonstrate EWL non-inferiority of SG compared to RYGB , power calculation was performed according to a non-inferiority study design . Morbidity , mortality , remission of obesity-related co-morbidities , GERD course and QoL are major secondary endpoints . 248 patients between 18 and 70 years , with a body mass index ( BMI ) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3- guidelines will be r and omized . The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6 , 12 , 24 , 36 , 48 and 60 months postoperatively . Discussion With its five year follow-up , the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL , remission of obesity-related co-morbidities , the course of GERD and QoL.Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004766 Background Laparoscopic sleeve gastrectomy ( LSG ) is considered a primary bariatric surgery and is increasingly being performed worldwide ; however , long-term data regarding the durability of this procedure are inadequate . Here , we report the long-term results of LSGs in comparison to those of gastric bypass surgeries . Methods A prospect ively collected bariatric data base from Ming-Shen General Hospital was retrospectively studied . Five hundred nineteen morbidly obese patients ( mean age 36.0 ± 9.1 years old ( 14–71 ) , 74.6 % female , mean body mass index ( BMI ) 37.5 ± 6.1 kg/m2 ) underwent LSG as a primary bariatric procedure from 2006 to 2012 at our institute . The operative parameters , weight loss , laboratory data , and quality of life were followed . Another two matched groups of laparoscopic Roux-en-Y gastric bypass ( RYGB ) and laparoscopic single anastomosis ( mini- ) gastric bypass ( SAGB ) patients who were matched in terms of age , sex , and BMI were recruited for comparisons . Results The mean surgical time  for LSG was 113.5 ± 31.3 min , and the mean blood loss was 49.1 + 100.9 ml . The rate of major complications was 1.6 % , and the average length of the postoperative stay was 3.0 ± 1.7 days . The operation times of the RYGB patients were longer than those of both the LSG and SAGB patients . The RYGB and SAGB patients experienced higher major complication rate than the LSG patients . The weight loss of the LSG patient at 5 years was 28.3 + 8.9 % , and the mean BMI was 27.1 + 4.3 . The RYGB patients exhibited a 5-year weight loss similar to the LSG patients , and the SAGB patients exhibited greater weight loss than both of the other groups . Both the RYGB and SAGB patients exhibited significantly better glycemic control and lower blood lipids than the LSG patients , but the LSG patients exhibited a lesser micronutrient deficiency than the RYGB and SAGB groups . All three of the groups exhibited improved quality of life at 5 years after surgery , and there was no significant between-group difference in this measure . Conclusions LSG appears to be an ideal bariatric surgery , and the efficacy of this surgery is not inferior to that of gastric bypass Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux-en-Y gastric bypass ( 60.4 % ) than after sleeve gastrectomy ( 25.0 % ) . Gastric reflux worsened ( more symptoms or increase in therapy ) more often after sleeve gastrectomy ( 31.8 % ) than after Roux-en-Y gastric bypass ( 6.3 % ) . The number of patients with reoperations or interventions was 16/101 ( 15.8 % ) after sleeve gastrectomy and 23/104 ( 22.1 % ) after Roux-en-Y gastric bypass . Conclusions and Relevance Among patients with morbid obesity , there was no significant difference in excess BMI loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass at 5 years of follow-up after surgery . Trial Registration clinical trials.gov Identifier : BACKGROUND Although bariatric surgery is associated with significant overall weight loss , many patients experience suboptimal outcomes . Our objective was to document the preliminary efficacy of a behavioral intervention for bariatric surgery patients with relatively poor long-term weight loss and to explore the factors related to outcome at an academic medical center in the United States . METHODS Patients with a body mass index ( BMI ) ≥ 30 kg/m(2 ) who had undergone bariatric surgery ≥ 3 years before study entry and had < 50 % excess weight loss were enrolled . The participants were r and omly assigned to a 6-month behavioral intervention or wait list control group . The assessment s were conducted at baseline ( before intervention ) and 6 months ( after intervention ) and 12 months ( 6-mo follow-up ) . RESULTS On average , the participants ( n = 36 ) had undergone surgery 6.6 years before study entry . The average age was 52.5 ± 7.1 years , and the BMI was 43.1 ± 6.2 kg/m(2 ) ; most participants were women ( 75 % ) and white ( 88.9 % ) . The intervention patients had a greater percentage of excess weight loss than did the wait list control group at 6 ( 6.6 % ± 3.4 % versus 1.6 % ± 3.1 % ) and 12 ( 5.8 % ± 3.5 % versus .9 % ± 3.2 % ) months . However , the differences were not significant and the results varied . The intervention patients with more depressive symptoms ( P = .005 ) and less weight regain before study entry ( P = .05 ) experienced a greater percentage of excess weight loss . CONCLUSION Behavioral intervention holds promise in optimizing long-term weight control after bariatric surgery . More research is needed on when to initiate the intervention and to identify which patients will benefit from this type of approach BACKGROUND Joint pain is a common musculoskeletal complaint of morbidly obese patients that can result in gait abnormalities , perceived mobility limitations , and declining quality of life ( QOL ) . It is not yet known whether weight loss 3 months after bariatric surgery can induce favorable changes in joint pain , gait , perceived mobility , and QOL . Our objectives were to examine whether participants who had undergone bariatric surgery ( n = 25 ; laparoscopic Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing )  demonstrate improvements in joint pain , gait ( speed , stride/step length , width of base of support , toe angles , single/double support , swing and stance time , functional ambulatory profile ) , mobility , and QOL by 3 months compared with nonsurgical controls ( n = 20 ) . The setting was an orthopedics laboratory at a university hospital in the United States . METHODS The present study was a prospect i ve , comparative study . Numeric pain scales ( indicating the presence and severity of pain ) , mobility-related surveys , and the Medical Outcomes Study short-form 36-item question naire ( SF-36 ) were completed , and gait and walking speed were assessed at baseline and at month 3 . RESULTS The bariatric group lost an average of 21.6 ± 7.7 kg . Significant differences existed between the 2 groups at month 3 in step length , heel to heel base of support , and the percentage of time spent in single and double support during the gait cycle ( all P < .05 ) . The severity of low back pain and knee pain decreased by 54 % and 34 % , respectively , with no changes in the control group ( P = .05 ) . The walking speed increased by 15 % in the bariatric group ( 108 - 123 cm/s ; P < .05 ) but not in the control group . Compared with the control group , fewer bariatric patients perceived limitations with walking and stair climbing by month 3 . The bariatric group had a 4.8-cm increase in step length , 2.6 % increase in single support time during the gait cycle , and 2.5-cm reduction in the base of support ( all P < .05 ) . The SF-36 physical component scores increased 11.8 points in the bariatric group compared with the control group , which showed no improvement by month 3 ( P < .0001 ) . CONCLUSIONS Improvements in some , but not all , gait parameters , walking speed , and QOL and of perceived functional limitations occur by 3 months after a bariatric procedure Objective : The objective of this study was to evaluate the results of laparoscopic gastric b and ing using 2 different b and s ( the Lapb and [ Bioenterics , Carpinteria , CA ] and the SAGB [ Swedish Adjustable Gastric B and ; Obtech Medical , 6310 Zug , Switzerl and ] ) in terms of weight loss and correction of comorbidities , short- and long-term complications , and improvement of quality of life in morbidly obese patients Summary Background Data : During the past 10 years , gastric b and ing has become 1 of the most common bariatric procedures , at least in Europe and Australia . Weight loss can be excellent , but it is not sufficient in a significant proportion of patients , and a number of long-term complications can develop . We hypothesized that the type of b and could be of importance in the outcome . Methods : One hundred eighty morbidly obese patients were r and omly assigned to receive the Lapb and or the SAGB . All the procedures were performed by the same surgeon . The primary end point was weight loss , and secondary end points were correction of comorbidities , early- and long-term complications , importance of food restriction , and improvement of quality of life . Results : Initial weight loss was faster in the Lapb and group , but weight loss was eventually identical in the 2 groups . There was a trend toward more early b and -related complications and more b and infections with the SAGB , but the study had limited power in that respect . Correction of comorbidities , food restriction , long-term complications , and improvement of quality of life were identical . Only 55 % to 60 % of the patients achieved an excess weight loss of at least 50 % in both groups . There was no difference in the incidence of long-term complications . Conclusions : Gastric b and ing can be performed safely with the Lapb and or the SAGB with similar short- and midterm results with respect to weight loss and morbidity . Only 50 % to 60 % of the patients will achieve sufficient weight loss , and close to 10 % at least will develop severe long-term complications BACKGROUND Laparoscopic adjustable gastric b and ing ( LAGB ) is a common bariatric surgery . Although it is a safe and effective method of weight reduction in short term , it may result in some problems in long term . The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients . METHODS In this prospect i ve study , 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006 . Long-term postoperative consequences and complications of these patients were recorded . RESULTS The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2 ) , respectively . Over the 13-year follow-up period , 56 patients ( 84.8 % ) experienced at least one complication . The most common complications were b and erosion ( 20 patients ) and weight regains ( 13 patients ) . Fifty-one patients ( 78.5 % ) required reoperation . The b and of 48 patients ( 72.7 % ) was removed ; of these , twenty patients ( 30.3 % ) underwent other bariatric surgeries . Percent of excess weight loss was 47.1 % ± 30.1 % , and the success rate was 48.7 % . CONCLUSIONS LAGB is a successful method with low complications in short term ; however , over long term , it results in various complications Our purpose was to assess the cost , quality of life impact , and the cost – utility of bariatric surgery in a managed care population . We studied 221 patients who underwent bariatric surgery between 2001 and 2005 . We analyzed medical cl aims data for all patients and survey data for 122 survey respondents ( 55 % response rate ) . Patients were generally middle-aged , female , and white . Sixty-four percent underwent open and 33 % underwent laparoscopic Roux-en-Y procedures .  One year after surgery , mean body mass index fell from 51 to 31 kg/m2 in women and from 59 to 35 kg/m2 in men with substantial improvements in comorbidities . Postsurgical mortality and morbidity were low . Total per member per month costs increased in the 6 months before bariatric surgery , were lower in the 12 months after bariatric surgery , but increased somewhat over the next 12 months . When presurgical quality of life was assessed prospect ively , average health utility scores improved by 0.14 one year after surgery . In analyses that took a lifetime time horizon , projected future costs based on age and obesity and discounted costs and health utilities at 3 % per year , the cost – utility ratio for bariatric surgery versus no surgery was approximately $ 1,400 per quality -adjusted life-year gained . In sensitivity analyses , bariatric surgery was more cost-effective in women , non-whites , more obese patients , and when performed laparoscopically . Although not cost-saving , bariatric surgery represents a very good value for money . Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity Background Epidemiological studies have identified obesity as a major risk factor for cancer in humans , and trials have demonstrated a significant reduction in the incidence of cancer after bariatric surgery . The rapidity of weight loss after bariatric surgery provides an opportunity to identify the molecular changes associated with effective obesity treatment . Indirectly , this may provide some insights into the mechanisms that drive the association between obesity and cancer . We sought to measure circulating cancer-associated proteins before and after laparoscopic sleeve gastrectomy ( LSG ) . Methods We prospect ively enrolled 15 patients undergoing LSG .  Thirty-four plasma protein biomarkers thought to be associated with cancer processes were analyzed at baseline and following successful weight loss at 12 weeks using a multiplex bead-based assay .  Results Mean excess body weight loss was 44 % at 12-week follow-up . After LSG , a significant reduction in circulating plasma levels was observed for half ( 17/34 ) of the proteins assessed : VEGF-A , VEGF-C , VEGF-D , endoglin , PLGF , sFASL , IGFBP-1 , IL-18 , prolactin , EGF , TGFα , sCD40L , IL-18 , TNFα , IL-6 , HB-EGF , and PAI-1 . Nonsignificant decreases were found for the remaining proteins . Conclusions Circulating cancer-related biomarker levels were reduced by surgical weight loss , and this benefit was achieved as early as 3 months after operation . The observed reduction in cancer biomarkers may be related to the reported decrease in cancer incidence following bariatric surgery Objectives : Research increasingly suggests that obesity is an exacerbating factor for migraine . However , it is less clear whether weight loss may help to alleviate  migraine in obese individuals . We examined whether weight loss after bariatric surgery is associated with improvements in migraine headaches . Methods : In this prospect i ve observational study , 24 patients who had migraine according to the ID-Migraine screener were assessed before and 6 months after bariatric surgery .  At both time points , patients had their weight measured and reported on frequency of headache days , average headache pain severity , and headache-related disability over the past 90 days via the Migraine Disability Assessment question naire . Changes in headache measures and the relation of weight loss to these changes were assessed using paired- sample t tests and logistic regression , respectively . Results : Patients were mostly female ( 88 % ) , middle-aged ( mean age 39.3 ) , and severely obese ( mean body mass index 46.6 ) at baseline  . Mean ( ±SD ) number of headache days was reduced from 11.1 ± 10.3 preoperatively to 6.7 ± 8.2 postoperatively ( p < 0.05 ) , after a mean percent excess weight loss ( % EWL ) of 49.4 % . The odds of experiencing a ≥50 % reduction in headache days was related to greater % EWL , independent of surgery type ( p < 0.05 ) . Reductions in severity were also observed ( p < 0.05 ) and the number of patients reporting moderate to severe disability decreased from 12 ( 50.0 % ) before surgery to 3 ( 12.5 % ) after surgery ( p < 0.01 ) . Conclusions : Severely obese migraineurs experience marked alleviation of headaches after significant weight reduction via bariatric surgery . Future studies are needed to determine whether more modest , behaviorally produced weight losses can effect similar migraine improvements . Classification of evidence : This study provides Class III evidence that bariatric surgery is associated with reduction of migraine headaches in severely obese individuals To evaluate influence of laparoscopic gastric b and ing ( LGB ) on quality of life ( QOL ) in patients with morbid obesity .  Laparoscopic adjustable gastric b and ing is a popular bariatric operation in Europe . The objectives of surgical therapy in patients with morbid obesity are reduction of body weight , and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients . In a prospect i ve clinical trial , development of the individual patient QOL was analyzed , after LGB in patients with morbid obesity . From October 1999 to January 2001 , 152 patients [ 119 women , 33 men , mean age 38.4 y ( range 24 to 62 ) , mean body mass index 44.3 ( range 38 to 63 ) ] underwent evaluation for LGB  according the following protocol : history of obesity ; concise counseling of patients and relative on nonsurgical treatment alternatives , risk of surgery , psychologic testing , question naire for eating habits , necessity of lifestyle change after surgery ; medical evaluation including endocrinologic and nutritionist work-up , upper GI endoscopy , evaluation of QOL using the Gastro Intestinal Quality of Life Index ( GIQLI ) . Decision for surgery was a multidisciplinay consensus . This group was follow-up at least 2 years , focusing on weight loss and QOL . Mean operative time was 82 minutes ; mean hospital stay was 2.3 days and the mean follow-up period was 34 months . The BMI dropped from 44.3 to 29.6 kg/m2 and all comorbid conditions improved markedly : diabetes melitus resolved in 71 % of the patients , hypertension in 33 % , and sleep apnea in 90 % . However , 26 patients ( 17 % ) had late complications requiring reoperation . Preoperative global GIQLI score was 95 ( range 56 to 140 ) , significant different of the healthy volonteers score ( 120 ) ( 70 to 140 ) P<0.001 . Correlated with weight loss ( percentage loss of overweight and BMI ) , the global score of the group increased to 100 at 3 months , 104 at 6 , 111 at 1 year to reach 119 at 2 years which is no significant different of healthy patients . Analyzing the subscale , physical condition , emotional status , and social integration increased significantly ( P<0.001 ) from preoperative to end of follow-up . Digestive symptoms were not modified . In case of failure of the procedure ( 10.5 % ) global Giqli score is not modified . Patients who have required successfull revisional surgery for late complications ( 6.5 % ) have an excellent QOL outcome that are not different from the whole group . Together with a satisfactory reduction of the excess overweight , laparoscopic gastric b and ing may lead in a carefully selected population of patients with morbid obesity to a significant improvment of patient QOL , in at least 2 years follow-up Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Background Laparoscopic greater curvature plication ( LGCP ) is an emerging restrictive bariatric procedure that successfully reduces the gastric volume by plication of the gastric greater curvature . The aim of this prospect i ve nonr and omized study was to compare short-term outcomes and associated complications between  LGCP and laparoscopic sleeve gastrectomy ( LSG ) .  Methods From January 2011 to November 2011 , a total of 39 patients were allocated to undergo either LGCP ( n = 19 ) or LSG ( n = 20 ) . Data on the operative time , complications , hospital stay , overall cost of  LSG and LGCP , body mass index loss ( BMI L ) , percentage of excess weight loss ( % EWL ) , loss of appetite and improvement of comorbidities were collected during the follow-up examinations . Results All procedures were completed laparoscopically . The mean operative time was 95.0 ± 17.4 minutes for the LGCP group and 85.5 ± 18.4 minutes for the LSG group ( P = 0.107 ) . No patient required reoperation due to an early complication . One patient in the LSG group was readmitted because of gastric stenosis . The mean hospital stay was 4.2 ± 1.9 days in the LGCP group and 3.9 ± 1.7 days in the LSG group ( P = 0.595 ) . The total cost of LSG was $ 7,826 ± 537 compared to LGCP ( $ 3,358 ± 264 ) ( P < 0.001 ) . One year after surgery , the mean % EWL was 58.8 ± 16.7 % ( n = 11 ) in the LGCP group and 80.0 ± 26.8 % ( n = 11 ) in the LSG group ( P = 0.038 ) . Loss of feeling of hunger was reported in 27.3 % LGCP patients and 72.7 % LSG patients ( P = 0.033 ) at 1 year after surgery . The comorbidities , including diabetes , sleep apnea and hypertension , were markedly improved in both groups 6 months after surgery . Conclusions The short-term outcomes of our study demonstrate that compared with LSG , LGCP is inferior as a restrictive procedure for weight loss , despite its significantly smaller cost . Longer follow-up and prospect i ve comparative trials are needed to confirm the long-term outcomes of this novel procedure and make definitive conclusions Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity Bariatric surgery ameliorates  obesity‐associated diseases  , result ing in psychological and social benefits . Long‐term studies of its effects on quality of life ( QOL ) assessed with well established instruments are lacking . This prospect i ve study investigated the long‐term effects of  gastric b and ing  on health‐related QOL using an obesity‐specific vali date d measure Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life . We prospect ively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale ( ESS ) and the Short Form-12 . Participants ( n = 223 ; 79 % women ) with a mean body mass index ( BMI ) and ESS of 44.8 ± 7.9 kg/m2 and 7.9 ± 4.5 , respectively , received a vertical gastrectomy ( 76 % ) or Roux-en-Y gastric bypass ( 12 % ) . Preoperatively , 30 % of patients complained of excessive daytime sleepiness ( ESS > 10 ) . Patients with preoperative excessive daytime sleepiness were more obese ( p = 0.002 ) , had higher fasting glucose levels ( p = 0.02 ) , more likely to have a diagnosis of sleep-disordered breathing ( p < 0.001 ) , report snoring ( p < 0.001 ) , and had lower health-related quality of life measures particularly physical function ( p < 0.001 ) , depression ( p = 0.006 ) , and sexual satisfaction ( p = 0.04 ) than non-sleepy patients . At 12-months postoperatively , most patients experienced a significant reduction in BMI ( 28.6 ± 5.5 kg/m2 , p < 0.001 ) and excessive daytime sleepiness ( mean ESS 5.3 ± 3.3 , p < 0.001 ) . Patients with a clinical ly relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function ( p = 0.009 ) and snoring ( p = 0.010 ) and were more likely still using positive airway pressure therapy ( p = 0.032 ) than patients without a clinical ly relevant improvement . Statistically and clinical ly significant improvements in all health-related quality of life measures were noted at 24 months . Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness BACKGROUND Surgery remains the most effective intervention for obesity and its comorbidities . However , the long-term efficacy of bariatric procedures is rarely reported . This study addresses operative trends , efficiency , and long-term outcomes from a large bariatric program . STUDY DESIGN Data were prospect ively collected on 3,460 patients undergoing 3,503 operations from January 2004 to March 2013 . Primary procedures included  Roux-en-Y gastric bypass  ( RY ; n = 2,966 ) , adjustable b and ( AB ; n = 352 ) , and sleeve gastrectomy ( SG ; n = 118 ) . There were 67 revisional procedures ( RP ) . Mean operative time , hospital length of stay , major 30-day morbidity/mortality , follow-up compliance , and weight loss per procedure at follow-up were recorded . RESULTS Mean operative times decreased to the following : RY , 53 minutes ; AB , 35 minutes ; SG , 46 minutes ; and RP , 71 minutes . Mean length of stay was reduced to the following : RY , 1.53 days ; AB , 0.97 days ; SG , 2.12 days ; and RP , 2.68 days . Major complications were mortality , 0.09 % ; leak , 0.51 % ; bleed , 2.37 % ; pneumonia , 0.63 % ; venous thromboembolism , 0.40 % ; and reoperation , 2.34 % . The complication rate was lowest for AB and highest for SG ( p < 0.05 ) . Adjustable b and was the initial procedure in 73 % of cases requiring RP . Follow-up compliance was 93 % at 1 year , 79 % at 3 years , 71 % at 5 years , and 33 % at 9 years . Adjustable b and offered significant weight loss at 1 and 3 years ( p < 0.0001 ) , but less than RY or SG ( p < 0.0001 ) . Excess weight loss was not significantly different between RY and SG at 1 year . Significant weight loss with RY persisted at 7 to 9 years ( p < 0.0001 ) . CONCLUSIONS Our bariatric program experienced an increase in SG and RP and a decrease in AB . Optimization of care reduced operative time and length of stay . All procedures achieved significant weight loss in the first year . Adjusted b and had the lowest morbidity , but inferior weight loss and greater need for revision . Long-term weight-loss data are only available for RY BACKGROUND Data regarding the management of bariatric patients with cirrhosis are scarce , and there is no strong evidence that supports a specific approach for this group of patients . The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery .  METHODS A prospect ively maintained data base was review ed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery ( unknown cirrhosis ) . RESULTS From April 2004 to September 2011 , 23 patients ( 12 with known cirrhosis and 11 with unknown cirrhosis ) met inclusion criteria . There were 14 females and 9 males with a mean age of 51.5 ± 8.3 and a mean body mass index of 48.2 ± 8.6 kg/m2 . Child-Pugh classes were A ( n = 22 ) and B ( n = 1 ) . Patients had a high frequency of diabetes ( 83 % ) , dyslipidemia ( 61 % ) , and hypertension ( 83 % ) . Procedures performed were laparoscopic Roux-en-Y gastric bypass ( LRYGB ) ( n = 14 ) , laparoscopic sleeve gastrectomy ( LSG ) ( n = 8) , and laparoscopic adjustable gastric b and ing ( n = 1 ) . Two patients underwent LSG successfully after transjugular intrahepatic portosystemic shunt . Mean length of hospital stay was 4.3 ± 2.7 days . Complications developed in 8 patients . One patient died of unknown cause 9 months after surgery . No patients had liver decompensation after surgery . The patients lost 67.4 % ± 30.9 % of their excess weight at 12 months follow-up and 67.7 % ± 24.8 % at 37 months follow-up . CONCLUSION LRYGB and LSG can be performed without prohibitive complication rates in carefully selected patients with cirrhosis . In our experience , bariatric patients with cirrhosis achieved excellent weight loss and improvement in obesity-related co-morbidities BACKGROUND Laparoscopic sleeve gastrectomy ( LSG ) is gaining acceptance in the bariatric community as a definitive weight loss procedure ; however , longitudinal data remain limited . The objective of this study was to compare weight loss results of LSG with laparoscopic Roux-en-Y gastric bypass ( LRYGB ) up to 5 years postoperatively using anthropometric measurements . METHODS Prospect ively collected bariatric data base at the Naval Medical Center San Diego was retrospectively review ed from 2005 - 2011 .  Anthropometric factors , including weight and hip circumference were measured during st and ard yearly follow-up appointments . Surgical outcomes were tested by the Student t test and demographic variables by Fisher 's exact and Wilcoxon rank-sum tests . RESULTS Follow-up was achieved in 147/226 LRYGB versus 130/208 LSG at year 1 , 92/195 versus 81/151 at year 2 , 64/145 versus 50/100 at year 3 , 32/81 versus 18/54 at year 4 , and 12/42 versus 14/15 at year 5 . The excess weight loss ( EWL ) for LRYGB versus LSG was 72 % versus 64.7 % at 1 year ( P = .002 ) , 71.3 % versus 65.5 % at 2 years ( P = .113 ) , and 68.3 % versus 57.4 % at 5 years ( P = .252 ) , respectively . Similarly , the body mass index ( BMI ) decrease was statistically significant at 1 year ( P = .001 ) but not on subsequent annual visits . Mean percent body adiposity index ( BAI ) decrease was 28.4 % for LRYGB versus 26.8 % for LSG at 1 year ( P = .679 ) and 21.8 % versus 29.8 % at 2 years ( P = .134 ) , respectively . Weight loss measured in terms of % EWL and decrease in BMI and BAI did not show significance between LRYGB and LSG 2 years after surgery . CONCLUSION Our study provides similar long-term weight loss between LSG and LRYGB , and therefore , LSG is a viable option as a definitive bariatric procedure OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential OBJECTIVE This study examined the clinical significance of  loss of control ( LOC ) over eating in bariatric surgery patients over 24 months of prospect i ve , multiwave follow-ups . METHOD Three hundred sixty-one gastric bypass surgery patients completed a battery of assessment s before surgery and at 6 , 12 , and 24 months following surgery . In addition to weight loss and LOC over eating , the assessment s targeted eating disorder psychopathology , depression levels , and quality of life . The study was conducted between January 2002 and February 2008 . RESULTS Prior to surgery , 61 % of patients reported general LOC ; postsurgery , 31 % reported LOC at 6-month follow-up , 36 % reported LOC at 12-month follow-up , and 39 % reported LOC at 24-month follow-up . Preoperative LOC did not predict postoperative outcomes . In contrast , mixed models analyses revealed that postsurgery LOC was predictive of weight loss outcomes : patients with LOC postsurgery lost significantly less weight at 12-month ( 34.6 % vs 37.2 % BMI loss ) and 24-month ( 35.8 % vs 39.1 % BMI loss ) postsurgery follow-ups . Postsurgery LOC also significantly predicted eating disorder psychopathology , depression , and quality of life at 12- and 24-month postsurgery follow-ups . CONCLUSIONS Preoperative LOC does not appear to be a negative prognostic indicator for postsurgical outcomes . Postoperative LOC , however , significantly predicts poorer postsurgical weight loss and psychosocial outcomes at 12 and 24 months following surgery . Since LOC following bariatric surgery significantly predicts attenuated postsurgical improvements , it may signal a need for clinical attention BACKGROUND Advanced age has traditionally been considered a relative contraindication to bariatric surgery due to increased perioperative risk and less weight loss . However , it is now being reconsidered in older patients after encouraging results in recent series and the increasing life expectancy . We compared operative and postoperative outcomes of  laparoscopic sleeve gastrectomy in patients over 60 years with outcomes in younger patients . We also , analyzed the effect of bariatric surgery on improvement and resolution of co-morbidities in the older group . METHODS From November 2008 to November 2013 , 130 patients underwent laparoscopic sleeve gastrectomy . Of these , 28 patients ( 21.5 % ) were 60 years or older . Outcomes in terms of perioperative complications , short-term and medium-term weight loss , remission or improvement of co-morbidities and medication requirements were extracted from our prospect i ve data base . RESULTS Short-term mortality was 0 % and 30-day complication rate was similar in both groups ( 17.9 % versus 17.6 % according to Clavien-Dindo classification ) . At 12 months postsurgery , older patients had lost 49 % percent of excess weight compared to 60 % in the younger group ( P = 0.012 ) . At 2 years , the results were 45 % versus 60 % , respectively , with P = 0.015 . At least 1 major co-morbidity improved in 65.2 % of older patients . Before surgery , the older group took an average of 4.3 medications compared to 2.7 at 1 year after surgery ( P<0.001 ) . CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective treatment for morbid obesity in people over 60 years , although younger patients show greater weight loss . Daily medication requirements and co-morbidities decrease significantly in older patients after this procedure Objective : To evaluate the long-term results of laparoscopic vertical b and ed gastroplasty ( VBG )  for morbid obesity . Background : Laparoscopic VBG , a safe and straightforward bariatric procedure characterized by good short-term results , has been progressively replaced by other more complex procedures on the basis of a presumed high rate of long-term failure . Nevertheless , some authors have recently reported long-term efficacy in selected patients . Methods : All patients who underwent laparoscopic VBG  were included in a prospect i ve data base . Patients reaching 10-year follow-up received a complete evaluation including clinical , endoscopic , and biochemical examinations . Results : Between January 1996 and March 1999 , 266 morbidly obese patients underwent bariatric procedures . Among them , 213 were selected for laparoscopic VBG ; exclusion criteria were as follows : contraindications to pneumoperitoneum , gastroesophageal reflux disease , and psychological contraindications to restrictive procedures . Mean age , preoperative weight , and body mass index were 36.9 years , 123.6 kg , and 45.4 kg/m2 , respectively .  Intraoperative complication rate and conversion rate were 0.9 % and 0.9 % , respectively . Early postoperative complication rate was 4.2 % and early reoperation rate was 0.5 % . Mean hospital length of stay was 6.3 days . Mortality was nil . The 10-year follow-up rate was 70.4 % ( 150 patients ) . Late postoperative complication rate was 14.7 % , and 10-year revisional surgery rate was 10.0 % . The excess weight loss percentages at 3 , 5 , and 10 years were 65.0 % , 59.9 % , and 59.8 % , respectively . The resolution and /or improvement rate for comorbidity were 47.5 % for hypertension , 55.6 % for diabetes , 75 % for sleep apnea , and 47.4 % for arthritis . Mean Moorehead-Ardelt Quality of Life Question naire and BAROS values were 1.4 and 3.8 , respectively . Conclusions : The present study demonstrates that laparoscopic VBG in carefully selected patients leads to long-term results comparable with more complex and invasive procedures . Given the low postoperative morbidity for laparoscopic VBG , its present clinical role should be , in our opinion , reevaluated Importance Bariatric surgery is a life-changing treatment for patients with severe obesity , but little is known about its association with interpersonal relationships . Objectives To investigate if relationship status is altered after bariatric surgery . Design , Setting , and Participants Changes in relationship status after bariatric surgery were examined in 2 cohorts : ( 1 ) the prospect i ve Swedish Obese Subjects ( SOS ) study , which recruited patients undergoing bariatric surgery from September 1 , 1987 , to January 31 , 2001 , and compared their care with usual nonsurgical care in matched obese control participants ; and ( 2 ) participants from the Sc and inavian Obesity Surgery Registry ( SOReg ) , a prospect i ve , electronically captured register that recruited patients from January 2007 through December 2012 and selected comparator participants from the general population matched on age , sex , and place of residence . Data was collected in surgical departments and primary health care centers in Sweden . The current analysis includes data collected up until July 2015 ( SOS ) and December 2012 ( SOReg ) . Data analysis was completed from June 2016 to December 2017 . Main Outcomes and Measures In the SOS study , information on relationship status was obtained from question naires . In the SOReg and general population cohort , information on marriage and divorce was obtained from the Swedish Total Population Registry . Results The SOS study included 1958 patients who had bariatric surgery ( of whom 1389 [ 70.9 % ] were female ) and 1912 matched obese controls ( of whom 1354 [ 70.8 % ] were female ) and had a median ( range ) follow-up of 10 ( 0.5 - 20 ) years . The SOReg cohort included 29 234 patients who had gastric bypass surgery ( of whom 22 131 [ 75.6 % ] were female ) and 283 748 comparators from the general population ( of whom 214 342 [ 75.5 % ] were female ) , and had a median ( range ) follow-up of 2.9 ( 0.003 - 7.0 ) years . In the SOS study , the surgical patients received gastric b and ing ( n = 368 ; 18.8 % ) , vertical b and ed gastroplasty ( n = 1331 ; 68.0 % ) , or gastric bypass ( n = 259 ; 13.2 % ) ; controls received usual obesity care . In SOReg , all 29 234 surgical participants received gastric bypass surgery . In the SOS study , bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship ( adjusted hazard ratio [ aHR ] = 1.28 ; 95 % CI , 1.03 - 1.60 ; P = .03 ) and increased incidence of marriage or new relationship ( aHR = 2.03 ; 95 % CI , 1.52 - 2.71 ; P < .001 ) in those who were unmarried or single at baseline . In the SOReg and general population cohort , gastric bypass was associated with increased incidence of divorce compared with married control participants ( aHR = 1.41 ; 95 % CI , 1.33 - 1.49 ; P < .001 ) and increased incidence of marriage in those who were unmarried at baseline ( aHR = 1.35 ; 95 % CI , 1.28 - 1.42 ; P < .001 ) . Within the surgery groups , changes in relationship status were more common in those with larger weight loss . Conclusions and Relevance In addition to its association with obesity comorbidities , bariatric surgery – induced weight loss is also associated with changes in relationship status BACKGROUND For over a decade , the laparoscopic adjustable gastric b and ( LAGB ) was 1 of the most performed bariatric procedures in Europe . This study is a retrospective analysis with prospect ively collected data of the experience in 1 specialized Dutch center with the adjustable gastric b and over 14 years . METHODS Between 1995 and 2003 , 201 patients underwent an LAGB for morbid obesity in our hospital . Data on preoperative clinical characteristic , postoperative outcome and weight loss patterns , and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System ( BAROS ) . RESULTS Average follow-up was 13.6 ( ± 2.0 ) years ( 163 mo ) and 99 % of patients with complete follow-up . Two thirds of patients reached an excess weight loss (EWL)>50 % at some point after LAGB placement . However , due to insufficient weight loss or complications in 53 % of patients , the LAGB had to be removed or converted to a Roux-en-Y gastric bypass . Additionally , half of the remaining patients had disappointing results according to the BAROS score . In total , less than one quarter ( 22 % ) of patients had a functioning b and with a good result after the follow-up period . Although initially the number of patients experiencing co-morbidities was reduced , most of them returned and a large number of patients developed new co-morbidities . Complications , other than weight regain , were numerous as 47 % of patients experienced at least 1 . In total , 204 reoperations were performed in 137 ( 68 % ) patients . Furthermore , patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up . CONCLUSION Morbid obesity is a chronic disease that can be resolved with bariatric surgery . One of the treatment options is the LAGB , which in the short term shows good results in terms of EWL and co-morbidity reduction . In the long term , however , EWL and co-morbidity reduction are disappointing , and the LAGB does not seem to live up to expectations . Besides the decrease in EWL over time , the number of reoperations required is alarming . In total , less than a quarter of patients still had a functioning b and after a mean 14 years of follow-up BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach Objective : Laparoscopic sleeve gastrectomy ( LSG ) has been proposed as an effective alternative to the current st and ard procedure , laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . Prospect i ve data comparing both procedures are rare . Therefore , we performed a r and omized clinical trial assessing the effectiveness and safety of these 2 operative techniques . Methods : Two hundred seventeen patients were r and omized at 4 bariatric centers in Switzerl and . One hundred seven patients underwent LSG using a 35-F bougie with suturing of the stapler line , and 110 patients underwent LRYGB with a 150-cm antecolic alimentary and a 50-cm biliopancreatic limb . The mean body mass index of all patients was 44 ± 11.1 kg/m2 , the mean age was 43 ± 5.3 years , and 72 % were female . Results : The 2 groups were similar in terms of body mass index , age , sex , comorbidities , and eating behavior . The mean operative time was less for LSG than for LRYGB ( 87 ± 52.3 minutes vs 108 ± 42.3 minutes ; P = 0.003 ) . The conversion rate was 0.9 % in both groups . Complications ( < 30 days ) occurred more often in LRYGB than in LSG ( 17.2 % vs 8.4 % ; P = 0.067 ) . However , the difference in severe complications did not reach statistical significance ( 4.5 % for LRYGB vs 1 % for LSG ; P = 0.21 ) . Excessive body mass index loss 1 year after the operation was similar between the 2 groups ( 72.3 % ± 22 % for LSG and 76.6 % ± 21 % for LRYGB ; P = 0.2 ) . Except for gastroesophageal reflux disease , which showed a higher resolution rate after LRYGB , the comorbidities and quality of life were significantly improved after both procedures . Conclusions : LSG was associated with shorter operation time and a trend toward fewer complications than with LRYGB . Both procedures were almost equally efficient regarding weight loss , improvement of comorbidities , and quality of life 1 year after surgery . Long-term follow-up data are needed to confirm these facts
Only outcomes of the IWQoL , SF-36 and OWQoL show QoL outcomes that exceed community norms .
The QoL is increased after bariatric surgery on both the short and long term .
However , due to the heterogeneity of the studies and the generality of the question naires is it hard to make a distinction between different surgeries and difficult to see a relation with medical profit .
Currently the effects of bariatric surgery are generally expressed in excess weight loss or comorbidity reduction .
Therefore the aim of this review was to provide insight in the available prospect i ve evidence regarding the short and long-term effects of bariatric surgery on Quality of Life ( QoL ) and a comparison with community norms .