The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population Evaluation of Gastric Bypass Patients 1 Year After Surgery: Changes in Quality of Life and Obesity-Related Conditions Improvement in health-related quality of life following Roux-en-Y gastric bypass. Two-year changes in generic and obesity-specific quality of life after gastric bypass Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Influence of Reoperations on Long-Term Quality of Life After Restrictive Procedures: A Prospective Study Changes in mood predict disease activity and quality of life in patients with psoriasis following emotional disclosure. Influence of administration method on oral health-related quality of life assessment using the Oral Health Impact Profile. 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 Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Does bariatric surgery improve the patient's quality of life? Employment Outcomes One Year after Bariatric Surgery: the Role of Patient and Psychosocial Factors Quality of life and prevalence of osteoarticular pain in patients submitted to bariatric surgery. Does Surgically Induced Weight Loss Improve Daytime Sleepiness? Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol Evaluation of Health Status and Quality of Life after Bariatric Surgery: Comparison of Standard Roux-en-Y Gastric Bypass, Vertical Banded Gastroplasty and Laparoscopic Adjustable Silicone Gastric Banding Female Pelvic Floor Symptoms Before and After Bariatric Surgery Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. Relationship between Quality of Life and Weight Loss 1 Year after Gastric Bypass Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. Health-related quality of life after the surgical treatment of obesity. Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery Mapping utility scores from a disease-specific quality-of-life measure in bariatric surgery patients. Psychological outcomes and predictors of initial weight loss outcomes among severely obese adolescents receiving laparoscopic adjustable gastric banding. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Validation of the Adapted Bariatric Quality of Life Index (BQL) in a Prospective Study in 446 Bariatric Patients as One-Factor Model Randomized trial of a video-based patient decision aid for bariatric surgery. The impact of a primary care-based weight loss intervention on the quality of life Health‐related quality of life after gastric banding 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 Laparoscopic Gastric Banding in Over 60s Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT.
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 Obesity has recently been cited as the number one killer in the USA . This problem is both a national and regional epidemic . The health care costs of obesity and obesity-related illnesses are ever increasing , and gastric bypass surgery is becoming a popular treatment strategy . Recently , reports describe not only surgical outcomes , but also quality of life outcomes . The bigger issue of obesity-related illness resolution is still evolving . Our institution has performed well over 500 gastric bypasses since 2002 . We evaluated over 100 patients prior to and 1 year after gastric bypass surgery .  Methods A prospect i ve study was design ed in order to systematic ally examine quality of life in  gastric bypass patients and couple the results with both objective and subjective assessment of bariatric surgery outcomes . One hundred nineteen patients undergoing gastric bypass at our institution from January 2005 to December of 2005 were enrolled in the study . In addition to routine preprocedural and postprocedural follow-up , completion of  quality of life  forms and anthropometric measurements were performed . Using these data , we then correlated the change in quality of life scores with social factors , weight loss success , and status of obesity-related conditions . We also examined the impact of alcohol intake and other demographic factors on both quality of life and obesity related conditions . Results A total of 119 patients were enrolled in the study during the calendar year 2005 . Follow-up at approximately 1 year ( average 12.86 months ) postsurgery was obtained in 75 patients . A significant reduction in weight ( 144.4 ± 34.4 vs. 91.5 ± 28.8 ; p < 0.0001 ) , body mass index ( 52.4 ± 12.2 vs. 32.3 ± 8.6 ; p < 0.0001 ) , mean systolic blood pressure ( 140.4 ± 14.7 vs. 130.0 ± 21.7 ; p < 0.001 ) , and lipids ( 194.3 ± 33.8 vs. 165.7 ± 32.1 ; p < 0.0001 ) was noted . Quality of life scores 1 year after gastric bypass surgery were also significantly improved ( 35.9 ± 19.5 vs. 82.2 ± 23.5 ; p < 0.0001 ) . There was also a significant reduction in the reported usage of medications for obesity related conditions . Various measures of success ( change in BMI , change in quality of life scores , and follow up health ranking ) were compared across demographic and social factors and no significant associations were identified . Conclusions Gastric bypass is associated with a reduction in weight , BMI , mean systolic blood pressure , cholesterol , and the usage of medications for obesity-related conditions . A significant improvement in quality of life was also noted 1 year after surgery INTRODUCTION This study explored whether health-related quality of life ( HRQOL ) changes following  Roux-en-Y gastric bypass surgery  were associated with identifiable socio-demographic or clinical characteristics , and it examined the impact on health outcomes of changes in the Danish criteria for bariatric surgery . MATERIAL AND METHODS Participants ( n = 55 ) completed the Short Form Health Survey v2 ( SF-36 ) before and 22 ± 4.2 months after surgery . Information on socio-demographics , body mass index ( BMI ) , co-morbidity and satisfaction with surgery were collected through patient question naires and hospital records . RESULTS There was overall improvement on all SF-36 subscales and in the mean physical score ( PCS ) and mean mental score ( MCS ) ( p = 0.001 ) . A total of five patients had lower PCS and 13 patients had lower MCS after surgery , but we identified no particular characteristics associated with this poorer outcome . Co-morbidity and preoperative PCS/MCS showed a strong correlation with change in PCS/MCS score . CONCLUSION Gastric bypass had a positive overall effect on HRQOL , but further investigation of individual variations is needed . We found no significant differences in HRQOL outcome between those patients who would be accepted for bariatric surgery under the current Danish criteria for bariatric surgery and those patients who only fulfilled the criteria for bariatric surgery before 2011 . FUNDING not relevant . TRIAL REGISTRATION Clinical Trials.gov : NCT02032199 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 The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment 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 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 OBJECTIVE The present study examined the effects of emotional disclosure ( ED ) intervention on both disease severity and quality of life in patients with psoriasis . METHODS Fifty-nine patients were recruited ( mean age , 50 years ; 32 men and 27 women ; mean length of diagnosis , 22 years ) . Individuals were r and omly assigned to receive ED intervention or st and ard control writing intervention .  Disease severity , quality of life , and mood were assessed at baseline and at 2 , 8 , and 12 weeks postintervention . RESULTS Disease severity and quality of life improved in both groups over the follow-up period . Preliminary analysis suggested no differences in the magnitude of improvement between the groups . However , predictors of improvement were found to differ . Disease severity on Week 12 was predicted by changes in mood in intervention patients and seasonal variation in control patients . In contrast , quality of life on Week 12 was predicted by baseline quality of life in intervention patients , while seasonal variation approached significance for control patients . CONCLUSIONS Changes in mood following ED predicted improvements in disease severity in patients with psoriasis . However , the degree of improvement did not differ between intervention and control patients The influence of the administration method used to collect oral health-related quality of life ( OHRQoL ) data is largely unknown . Therefore , the aim of this study was to determine whether OHRQoL information obtained using the Oral Health Impact Profile ( OHIP ) differed with different methods of collection ( personal interview , via telephone or as a self-administered question naire ) . The OHRQoL was measured using the German version of the OHIP . The instrument was administered to each of 42 patients using three different methods , in a r and omized order , about 1 wk apart . The test-retest reliability coefficient for the repeated OHIP assessment across the three methods of administration , and the magnitude of the variance component for administration method , were determined , characterizing the degree of OHIP score variation that is caused by this factor . Whereas OHIP mean score differences of 3.9 points were present between administration methods , the reliability coefficient of 0.90 ( 95 % CI , 0.85 - 0.95 ) indicated that 90 % of the OHIP score variation was caused by differences between subjects ( and not by the administration method or measurement error ) . The variance component for administration method explained 0.5 % of the OHIP score variation . In conclusion , the method of administration ( personal interview , telephone interview or self-administered question naire ) did not influence substantially OHIP scores in prosthodontic patients 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 Few weight loss surgery trials have evaluated the changes in health-related quality of life ( HRQOL ) relative to obese individuals not participating in weight loss interventions . In a prospect i ve study at a bariatric surgery practice , we evaluated the 2-year changes in HRQOL in gastric bypass patients compared with 2 severely obese groups who did not undergo surgical weight loss .  METHODS A total of 308 gastric bypass patients were compared with 253 individuals who sought but did not undergo gastric bypass and 272 population -based obese individuals using the weight-related ( Impact of Weight on Quality of Life-Lite ) and general ( Medical Outcomes Study 36-item Short-Form Health Survey ) HRQOL question naires at baseline and 2 years of follow-up . RESULTS The percentage of weight loss was 34.2 % for the gastric bypass and 1.4 % for the no gastric bypass groups , with a .5 % gain for population -based obese group . Both measures of HRQOL showed greater improvements for the gastric bypass group , even after controlling for baseline differences . Effect sizes for changes in physical and weight-related HRQOL were very large for gastric bypass , but small to medium for the 2 comparison groups . Effect sizes for changes in the psychosocial aspects of HRQOL were moderate to very large for gastric bypass , but small for the 2 comparison groups . Of the gastric bypass patients , 97 % had meaningful improvements in the Impact of Weight on Quality of Life-Lite total score compared with 43 % of the no gastric bypass group and 30 % of the population -based obese group . CONCLUSION Dramatic improvements had occurred in weight-related and physical HRQOL for gastric bypass patients at 2 years after surgery compared with 2 severely obese groups who had not undergone surgery . These results support the effectiveness of gastric bypass surgery in improving patients ' HRQOL 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 Background Patients undergoing bariatric surgery  generally report improved work performance after this procedure ; however , previous research has been limited by a lack of st and ardized employment measures and a failure to account for the impact of psychiatric illness on employment outcomes . To address these limitations , this study aims to assess changes in patients ’ employment impairment and productivity 12 months post-surgery and to identify psychosocial predictors of change in employment outcomes . Methods A total of 164 patients underwent bariatric surgery between February 2010 and November 2012 in this prospect i ve cohort study . The primary outcome was a change in employment impairment ( EI ) as measured by total Lam Employment Absence and Productivity Scale ( LEAPS ) scores and changes in participants ’ job status category . Multiple linear regression models assessed whether baseline demographic or clinical factors , including a history of psychiatric illness and changes in depressive , anxiety and quality of life ( QOL ) symptoms , were associated with a change in LEAPS scores . Results Participants reported a significant reduction in EI post-surgery ( p < 0.0001 ) and improvement in work productivity ( p < 0.0001 ) 12 months after surgery . Only changes in depression ( confidence interval ( CI ) 0.46 , 0.76 , p < 0.0001 ) , anxiety ( CI 0.49 , 0.85 , p < 0.0001 ) and mental QOL ( CI −0.30 , −0.17 , p < 0.0001 ) were significant predictors of change in EI total scores . Logistic regression analysis did not identify significant predictors of change in participant job status . Conclusions Patients with pre-bariatric surgery psychiatric distress are more likely to report greater employment impairment and worse employment productivity pre-surgery . These patients also experience the greatest improvements in post-surgery employment functioning OBJECTIVE To analyze quality of life and observe the prevalence of musculoskeletal pain in patients su bmi tted to bariatric surgery .  METHODS A prospect i ve , observational and comparative study with 26 individuals aged 18 to 60 years , 25 women , which included two evaluations , one preoperative and the other approximately 42 months after surgery . The  Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 )  and the Human Body Diagram with Visual Analogue Scale were employed . RESULTS The individual sample s showed grade III obesity , with a predominance of postoperative overweight , hypertension and diabetes in 65.4 % and 42.3 % of the sample s , with remission of hypertension in 50 % and of diabetes mellitus in 38.5 % ( p < 0.001 ) . The SF-36 demonstrated improved quality of life , especially in aspects related to motricity ; vitality and mental health showed no significant changes . Osteoarticular pain was reported and identified in various sites by the subjects ; however , 87.5 % of patients in the preoperative period and 88.5 % in the postoperative period reported not having any physical therapy orientation , while 65.4 % reported being engaged in some type of regular physical activity after surgery ( p<0.001 ) . CONCLUSION Morbidly obese individuals have a high probability of suffering from clinical , psychic , and musculoskeletal alterations , compromising their quality of life and showing improvement after bariatric surgery ; on the other h and , the psycho-emotional manifestations did not progress in the same way 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 Introduction and hypothesisThe objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years  after midurethral sling surgery .  Methods Secondary analysis of the 5-year results of a r and omized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery .  Women ( n = 176 ) were classified as obese or non-obese based on preoperative height and weight . Women self-reported symptoms and quality of life , and underwent st and ardized physical examinations and pad-testing . Categorical data were analyzed using Chi-squared or Fisher ’s exact tests , continuous data by Mann – Whitney U test . Primary outcome was objective cure defined as < 1 g urine lost on pad-test at 5 years post-surgery . Secondary outcomes were subjective cure of incontinence , urinary urge incontinence symptoms , and quality of life scores . Results Non-obese women had a higher rate of objective cure , 87.4 % ( n = 83 out of 95 ) compared with 65.9 % ( n = 29 out of 44 ) in the obese group ( P = 0.003 , risk difference [ RD ] 21.5 % , 95 % CI 5.9–37.0 % ) . Subjectively , non-obese women also reported higher rates of cure , 76.7 % ( n = 89 out of 116 ) compared with 53.6 % ( n = 30 out of 56 ) of obese women ( P = 0.002 , RD 23.2 % , 95 % CI 8.0–38.3 % ) . Overall rates of urge incontinence symptoms were similar in the two groups , but rates of bothersome symptoms were higher for obese women ( 58.9 % vs 42.1 % , P = 0.039 , RD 16.8 % 95 % CI 1.1–32.6 ) . Conclusions Five years after surgery , obese women continued to experience lower rates of cure compared with non-obese women 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 : This study is a trial to compare the effects and outcomes of three different  bariatric procedures performed in two centers .  St and ard Roux-en-Y gastric bypass was performed by Dr. Norman Samuels in Fort Lauderdale ( Florida ) ; vertical b and ed gastroplasty and laparoscopic adjustable silicone gastric b and ing were done in Hallein ( Salzburg ) by Dr. Emanuel Hell and Dr. Karl Miller . Methods : In a prospect i ve comparative study 30 matched patients from each group were followed to assess post-operative improvement in health status and quality of life , to compare the three different techniques . The  Bariatric Analysis and Reporting Outcome System ( BAROS  ) as described by Oria and Moorehead has been used for evaluation . Results : The observation time was at least 3 years ( 3 to 8 years ) in each individual case . A significant increase in quality of life and health status in 75 % of the surgically-treated patients was observed when compared with a non-operated control group of morbidly obese patients . Conclusions : By utilizing BAROS it has been found possible to compare the results of different procedures done by different surgeons with different techniques , utilizing patients from different cultures and with different language s. The results of this comparative study favor the st and ard gastric bypass for the treatment of morbid obesity . This operation is superior to purely gastric restrictive procedures in weight loss and improvement of quality of life Background Obesity is a risk factor for female pelvic floor disorders . The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery . Methods This was a prospect i ve cohort study of female patients that underwent bariatric surgery .  Patients completed a demographic question naire , the Pelvic Floor Distress Inventory-20 ( PFDI-20 ) , and the Pelvic Floor Impact Question naire-7 ( PFIQ-7 ) before surgery and at 6 and 12 months following surgery . Body mass index ( BMI ) was compared between time points using Student ’s t tests ( P < 0.05 significant ) . Symptom and impact on quality of life prevalence were compared using McNemar ’s test and question naire scores were compared using the Wilcoxon matched pairs test ( P < 0.025 significant ) . Results At 12 months after surgery , 63 patients had completed the study . Even with significant weight loss ( BMI , 43.7 kg/m2 to BMI , 29 kg/m2 ; P < 0.001 ) , there was no significant difference in the prevalence of pelvic floor symptoms before and after surgery ( 94 % to 81 % , P = 0.2 ) . Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery ( 56 % to 30 % ; P = 0.004 ) . Baseline PFDI-20 and PFIQ-7 scores were low ; however , there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery ( P < 0.001 ) . Conclusions Prevalence of pelvic floor symptoms did not vary greatly after surgery ; however , significant weight reduction did improve the degree of bother and quality of life related to these symptoms BACKGROUND In short-term r and omized trials ( duration , 1 to 2 years ) , bariatric surgery has been associated with improvement in type 2 diabetes mellitus . METHODS We assessed outcomes 3 years after the r and omization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy .  The primary end point was a glycated hemoglobin level of 6.0 % or less . RESULTS The mean ( ±SD ) age of the patients at baseline was 48±8 years , 68 % were women , the mean baseline glycated hemoglobin level was 9.3±1.5 % , and the mean baseline body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 36.0±3.5 . A total of 91 % of the patients completed 36 months of follow-up . At 3 years , the criterion for the primary end point was met by 5 % of the patients in the medical-therapy group , as compared with 38 % of those in the gastric-bypass group ( P<0.001 ) and 24 % of those in the sleeve-gastrectomy group ( P=0.01 ) . The use of glucose-lowering medications , including insulin , was lower in the surgical groups than in the medical-therapy group . Patients in the surgical groups had greater mean percentage reductions in weight from baseline , with reductions of 24.5±9.1 % in the gastric-bypass group and 21.1±8.9 % in the sleeve-gastrectomy group , as compared with a reduction of 4.2±8.3 % in the medical-therapy group ( P<0.001 for both comparisons ) . Quality -of-life measures were significantly better in the two surgical groups than in the medical-therapy group . There were no major late surgical complications . CONCLUSIONS Among obese patients with uncontrolled type 2 diabetes , 3 years of intensive medical therapy plus bariatric surgery result ed in glycemic control in significantly more patients than did medical therapy alone . Analyses of secondary end points , including body weight , use of glucose-lowering medications , and quality of life , also showed favorable results at 3 years in the surgical groups , as compared with the group receiving medical therapy alone . ( Funded by Ethicon and others ; STAMPEDE Clinical Trials.gov number , NCT00432809 . ) Background / Aims : Improving health-related quality of life ( HRQoL ) along with decreasing obesity-related morbidity is one of the cornerstones of bariatric surgery . The aim of the study was to investigate how losing weight influences the HRQoL 1 year after gastric bypass and whether HRQoL prior to surgery predicts the amount of weight loss 1 year after gastric bypass . Methods : One hundred and thirty-nine obese women [ median ( range ) : age 45 years ( 20–71 ) , BMI 44 ( 29–88 ) ] admitted for gastric bypass  were selected prospect ively and completed the Nottingham Health Profile ( NHP ) quality of life  question naire before and 1 year after surgery . Results : Weight loss 1 year after gastric bypass was significant [ –37 kg ( 9–74 ) , p < 0.001 ] and led to an improvement of quality of life [ NHP total score before surgery 62 ( 39–76 ) and after surgery 20 ( 7–65 ) , p < 0.001 ] . Conclusions : HRQoL improves dramatically 1 year after gastric bypass . This HRQoL improvement is not influenced by the amount of weight loss , but rather by the BMI achieved at that time 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 The aim of the study is to answer the question : what is the range and character of changes within health-related quality of life ( HRQL ) in obese patients who have undergone surgical treatment ( VBG - vertical b and ed gastroplasty or RYGBP - Roux-en-Y gastric bypass )  in the period of three and six months after operation ? Three groups of patients participated in the study : G I ( n=33 ; BMI 49.90 + /- 6.74 kg/m(2 ) ) - tested prior to the operation , G II ( n=17 ; BMI 34.26 + /- 5.28 kg/m(2 ) ) - tested six months after the operation , and G III ( n=11 ) - examined prior to the operation ( BMI 45.72 + /- 5.27 kg/m(2 ) ) as well as three months after the operation ( BMI 36.10 + /- 4.60 kg/m(2 ) ) . The Nottingham Health Profile ( NHP ) question naire was used as an indicator of HRQL . Surgical treatment of obesity result ed in significant positive changes in relation to the basic dimensions of NHP : energy , pain , physical mobility and in the influence of the current health state on selected spheres of life : paid employment , jobs around the house , social life , sex life , interests and hobbies , holidays . Significant changes in HRQL result ing from bariatric surgery occur in a relatively short period of time and are related not only to physical but also to social functioning OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Background Bariatric surgery is often associated with reduced food tolerance and sometimes frequent vomiting , which influence quality of life , but are not included in the overall evaluation of these procedures , notably the BAROS . Our aim was to develop a simple question naire to evaluate food tolerance during follow-up visits . Methods A one-page question naire including questions about overall satisfaction regarding quality of alimentation , timing of eating over the day , tolerance to several types of food , and frequency of vomiting/ regurgitation was developed . A composite score was derived from this question naire , giving a score of 1 to 27.Validation was performed with a group of nonobese adults and a group of morbidly obese nonoperated patients . Patients were administered the question naire at follow-up visits since January 1999 . Data were collected prospect ively . Results It takes 1–2 minutes to fill out the question naire . Food tolerance is worse in the morbidly obese population compared with non-obese adults ( 24.2 vs 25.2 , P=0.004 ) . Following Roux-en-Y gastric bypass , food tolerance is reduced after 3 months ( 21.2 ) , but becomes comparable to that of the normal population and remains so at 1 year postoperatively . Following gastric b and ing , food tolerance is already significantly reduced after 3 months ( 22.3 ) , and worsens continuously over time ( 19.03 after 7 years ) . In the gastric b and ing population , the decision to adjust the b and is based at least partially on food tolerance , and the question naire proved helpful in that respect . Conclusion Our new question naire proved very easy to use , and helpful in day-to-day practice , especially after gastric b and ing . It was also helpful in comparing food tolerance over time after surgery , and in comparing food tolerance between procedures . Evaluation of food tolerance should be part of the overall evaluation of the results after bariatric surgery OBJECTIVES To develop algorithms for a conversion of disease-specific quality -of-life into health state values for morbidly obese patients before or after bariatric surgery . METHODS A total of 893 patients were enrolled in a prospect i ve cross-sectional multicenter study . In addition to demographic and clinical data , health-related quality -of-life ( HRQoL ) data were collected using the disease-specific Moorehead-Ardelt II question naire ( MA-II ) and two generic question naires , the EuroQoL-5D ( EQ-5D ) and the Short Form-6D ( SF-6D ) . Multiple regression models were constructed to predict EQ-5D- and SF-6D-based utility values from MA-II scores and additional demographic variables . RESULTS The mean body mass index was 39.4 , and 591 patients ( 66 % ) had already undergone surgery . The average EQ-5D and SF-6D scores were 0.830 and 0.699 . The MA-IIwas correlated to both utility measures ( Spearman 's r = 0.677 and 0.741 ) . Goodness-of-fit was highest ( R(2 ) = 0.55 in the validation sample ) for the following item-based transformation algorithm : utility ( MA-II-based ) = 0.4293 + ( 0.0336 x MA1 ) + ( 0.0071 x MA2 ) + ( 0.0053 x MA3 ) + ( 0.0107 x MA4 ) + ( 0.0001 x MA5 ) . This EQ-5D-based mapping algorithm outperformed a similar SF-6D-based algorithm in terms of mean absolute percentage error ( P = 0.045 ) . CONCLUSIONS Because the mapping algorithm estimated utilities with only minor errors , it appears to be a valid method for calculating health state values in cost-utility analyses . The algorithm will help to define the role of bariatric surgery in morbid obesity OBJECTIVE Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery . The role of mental health providers in this population is not well defined , and the selection of c and i date s is often the result of clinical judgment alone . The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric b and ing ( LAGB )  by ( 1 ) examining changes in depressive symptoms and quality of life in the year following surgery ; ( 2 ) evaluating the interaction between patterns of change in depression , quality of life , and weight postsurgery ; and ( 3 ) identifying presurgical psychological predictors of initial weight change . METHOD Participants were 101 severely obese adolescents aged 14 to 18 years receiving LAGB at the Center for Adolescent Bariatric Surgery at the Morgan Stanley Children 's Hospital of New York Presbyterian/Columbia University Medical Center between August 2006 and December 2009 . Measures of height , weight , depressive symptoms , and quality of life were obtained in the first year following surgery . Changes in the Beck Depression Inventory ( BDI ) , Pediatric Quality of Life Inventory ( PedsQL ) , and body mass index were analyzed using latent growth curve modeling . RESULTS Short-term changes in psychiatric symptoms and weight were analyzed using latent growth curve modeling . Significant changes in total BDI ( βslope = -0.885 , SE = 0.279 , P < .01 ; βquadratic = 0.054 , SE = 0.021 , P < .001 ) and PedsQL ( βslope = -0.885 , SE = 0.279 , P < .001 ) scores were observed following LAGB , and comparable postoperative changes between psychosocial variables and body mass index were also noted ( BDI : covariance [ COV ] = 0.21 , SE = 0.06 , P < .001 ; PedsQL : COV = -0.41 , SE = 0.10 , P < .01 ) . Two variables ( family conflict/loss of control eating ) were found to be significant predictors of weight change over the year following surgery ( P < .05 ) . CONCLUSIONS Adolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB , and measures of preoperative binge eating and family conflict affected postsurgery body mass index among youth . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01045499 OBJECTIVE To examine the impact of a pre-bariatric surgery physical activity intervention ( PAI ) , design ed to increase bout-related ( ≥10 min ) moderate to vigorous PA ( MVPA ) , on health-related quality of life ( HRQoL ) . METHODS Analyses included 75 adult participants ( 86.7 % female ; BMI = 45.0 ± 6.5 kg m(-2 ) ) who were r and omly assigned to 6 weeks of PAI ( n = 40 ) or st and ard pre-surgical care ( SC ; n = 35 ) .  PAI received 6 individual weekly counseling sessions to increase walking exercise . Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey  at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes , respectively . RESULTS PAI increased bout-related MVPA from baseline to post-intervention ( 4.4 ± 5.5 to 21.0 ± 21.4 min day(-1 ) ) versus no change ( 7.9 ± 16.6 to 7.6 ± 11.5 min day(-1 ) ) for SC ( P = 0.001 ) . PAI reported greater improvements than SC on all SF-36 physical and mental scales ( P < 0.05 ) , except role-emotional . In PAI , better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases ( P < 0.05 ) , and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function , bodily pain , and general health scales ( P < 0.05 ) . CONCLUSIONS Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery c and i date s. Future studies should examine whether this effect improves surgical safety , weight loss outcomes , and postoperative 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 The decision to have bariatric surgery should be based on accurate information on possible risks and benefits of all treatment options . The goal of this study was to determine whether a video-based bariatric decision aid intervention results in superior decision quality compared to an educational booklet . We conducted a prospect i ve , r and omized controlled trial among adult patients in a single health plan who met st and ard criteria for bariatric surgery . Patients were r and omly assigned to review either a video-based decision aid ( intervention ) or an educational booklet on bariatric surgery ( control ) . Changes in patient decision quality were assessed using bariatric-specific measures of knowledge , values , and treatment preference after 3 months . Of 152 eligible participants , 75 were r and omly assigned to the intervention and 77 to the control . The 3-month follow-up rate was 95 % . Among all participants , significant improvements were observed in knowledge ( P < 0.001 ) , values concordance ( P = 0.009 ) , decisional conflict ( P < 0.001 ) , decisional self-efficacy ( P < 0.001 ) , and in the proportion who were " unsure " of their treatment choice ( P < 0.001 ) . The intervention group had larger improvements in knowledge ( P = 0.03 ) , decisional conflict ( P = 0.03 ) , and outcome expectancies ( P = 0.001 ) . The proportion of participants choosing bariatric surgery did not differ significantly between groups , although there was a trend toward decreased surgical choice in the intervention group ( 59 % booklet vs. 42 % video at 3 months ; P = 0.16 ) . The use of bariatric surgery decision aids was followed by improved decision quality and reduced uncertainty about treatment at 3 months . The video-based decision aid appeared to have a greater impact than the educational booklet on patient knowledge , decisional conflict , and outcome expectancies Objective : This study investigated changes in the quality of life of men and women who participated in a primary care-based weight loss intervention program .  Methods : Participants were enrolled in a 2-year r and omized clinical trial ( POWER-UP ) conducted at the University of Pennsylvania and in six affiliated primary care practice s. Inclusion criteria included the presence of obesity ( body mass index of 30–50 kg m−2 ) and at least two components of the metabolic syndrome . Main Outcome Measures : Quality of life was assessed by three measures : the Short Form Health Survey ( SF-12 ) ; the Impact of Weight on Quality of Life-Lite ; and the EuroQol-5D . Results : Six months after the onset of treatment , and with a mean weight loss of 3.9±0.3 kg , participants reported significant improvements on all measures of interest with the exception of the Mental Component Score of the SF-12 . These changes remained significantly improved from baseline to month 24 , with the exception of the EuroQol-5D . Many of these improvements were correlated with the magnitude of weight loss and , for the most part , were consistent across gender and ethnic group . Conclusions : Individuals with obesity and components of the metabolic syndrome reported significant improvements in most domains of the quality of life with a modest weight loss of 3.7 % of initial weight , which was achieved within the first 6 months of treatment . The majority of these improvements were maintained at month 24 , when participants had lost 3.0 % of their weight 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 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 The aggressive pursuit of weight loss in the elderly remains a controversial objective . In this series of 113 patients over 60 years of age who underwent laparoscopic gastric b and ing surgery  , we report on complications , co-morbidity change , quality -of-life improvement and changes in medication use over a median follow-up period of 25.5 months . Methods A prospect ively kept data base was review ed from January 1999 to September 2008 identifying patients over 60 who underwent gastric b and ing surgery .  Baseline and follow-up SF-36 ® survey scores were compared longitudinally . Co-morbidity change and medication use were assessed by question naire and electronic record review . Results Major complications were experienced by 7.1 % over the follow-up period with a re-operation rate of 15.0 % . Excess BMI loss was 44.1 % after 5 years and combined mean SF-36 ® quality -of-life scores ( out of 100 ) improved 22.1 points , achieving parity with age-matched norms for the general population . Diabetes improved in 74.2 % with hypertension , hyperlipidaemia and depression improving in 57.1 , 51.1 and 35.9 % of cases . A significant drop in medication use was not seen , and cancer was responsible for three deaths over the follow-up period . No surgical mortality was incurred . Conclusion Laparoscopic gastric b and ing can markedly improve quality of life for morbidly obese over 60s . Health gains are significant , but medication use is not substantially altered . Gastric b and ing is an ideal weight loss operation for this age group due to its safety and efficacy , and the primary goal should be quality -of-life improvement SUMMARY Bariatric surgery ( BS ) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date . Although BS interventions are effective , 20 - 30 % of BS patients start to regain weight within 24 months . Emotional eating is a behavior pattern which has been found to predict poor outcome . The aim of this study is to evaluate the effects of acceptance and commitment therapy  ( ACT ) for patients who underwent BS  , with regard to emotional eating , body dissatisfaction and quality of life . This study is a r and omized controlled trial ( n = 39 ) with two conditions ( 1 ) ACT including two face-to-face sessions and support via an Internet application and ( 2 ) treatment as usual ( TAU ) comprising the st and ard follow-up used by the BS team . Results show that participants in the ACT condition significantly improve on eating disordered behaviors , body dissatisfaction , quality of life and acceptance for weight related thoughts and feelings , as compared to those in the TAU group . This study shows that it is possible to improve effects of  BS  by specifically targeting emotional eating behavior .
The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 ( 95 % CI : 0.80 - 0.96 ) , indicating that bariatric surgery has a significant positive influence on quality of life in general .
The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life .
Bariatric surgery is effective in improving quality of life , especially when looking at physical well-being .
Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people
This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between- study variation by examining the st and ardized mean magnitude of effect in change in the levels of quality of life .