Patients with Atrial Fibrillation perform better after Bariatric Surgery
22 October 2019
This is a hot-off-the-press article comparing how effective treatment for atrial fibrillation is in patients who have lost weight after bariatric surgery compared with obese patients who haven't had weight loss surgery. It is good quality science because it's from a single hospital and compares two groups of patients with the only variable being whether they have had bariatric surgery or not. There's a good correlation between having had significant weight loss from weight loss surgery and successful treatment for Atrial fibrillation. This suggests that taking off the weight eases the overall stress on the heart and improves cardiac function. Something we knew but is a nice demonstration of the beneficial effects of surgery.
Given the link between morbid obesity and unacceptable high recurrence rates after atrial fibrillation (AF) ablation—as well as the recent revelation that risk-factor modification plays a role in reducing arrhythmia recurrence post-ablation—researchers undertook a single-center observational cohort study to compare recurrence rates of arrhythmia in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients after AF ablation in addition to morbidly obese patients who did not undergo BS. They found a link between bariatric surgery and a reduction in arrhythmia recurrence post-ablation for AF in morbidly obese patients compared with those of nonobese patients. Experts recommended considering morbidly obese patients for BS prior to AF ablation.
Circulation: Arrhythmia and Electrophysiology — Donnellan E, Wazni O, Kanj M, et al. | October 17, 2019
Dysfunctional eating patterns and habits in overweight and obese adults
17 October 2019
This study highlights something that I encounter commonly with my patients. Dysfunctional eating behaviours such as sweet tooth craving, emotional eating and binge eating are described by many of my patients. Dealing with the physical stomach volume by having a Bariatric operation is not necessarily going to address these eating behaviours. This highlights why it is so important to have assistance with gaining skills and strategies for modifying dysfunctional eating behaviours in conjunction with your new, reduced size stomach. Usually seeing a psychologist or counsellor with a special interest in eating disorders is a very positive approach. It is not that these things can't be managed and controlled but rather that they need to be accepted and addressed as part of the total weight loss surgical experience. I am a strong advocate for including other healthcare professionals in the care of my patients when necessary. Anything to improve long term outcomes for my patients!
Dysfunctional eating patterns and habits in overweight and obese adults can be triggered by early life experiences that are deeply rooted within patients' personality features, meaning weight loss interventions such as bariatric surgery and cognitive-behaviour therapy might not be sufficient to guarantee long-term success.
"While the biological and environmental causes of obesity are well known, psychological determinants that might indicate chronic predispositions are less clear," explained lead investigator, Dr Barbara Basile, Association of Cognitive Psychology (APC), School of Cognitive Psychotherapy (SPC), Rome, Italy. "The results of our study suggest that dysfunctional eating patterns and habits associated with overweight and obesity are deeply rooted within patients' personality features and current interventions are not enough to guarantee a long-lasting effect."
For the study, ‘Early maladaptive schemas in overweight and obesity: A schema mode model’, published in Heliyon, cognitive psychologists used the Schema Therapy (ST) model to gain a deeper understanding of the emotional and psychological functioning of these individuals with a view towards developing more effective treatment options.
The key concepts within the ST approach include Early Maladaptive Schemas, Schema Modes and dysfunctional Coping strategies. All of these develop across the life span and originated in early childhood and adolescence, where emotional core needs, such as love and nurturance, safety, acceptance, autonomy, limits setting, etc, might not have been adequately satisfied by caregivers and significant others.
Using an ST framework, investigators assessed early maladaptive schema and coping modes in 75 normal, overweight and patients with obesity. Adults with overweight/obesity reported more maladaptive schemas and dysfunctional coping strategies when compared to normal-weight individuals. Moreover, investigators found that stressors trigger shifts from one coping mode to another, some predictive of frequent binge and bulimic behaviours.
Maladaptive schemas encapsulate dysfunctional thoughts and behaviours and map out patterns of perception, emotion, and physical sensation rooted in early life experiences that subsequently shape individuals' beliefs about themselves and the world. The dysfunctional schemas observed in obesity are linked to coping mechanisms resulting in self-defeating thoughts and emotion-avoidant food attitudes and behaviours.
"Our findings highlight the role of the Insufficient Self-Control schema among overweight and obese individuals, which manifests as difficulties in tolerating distress and restraining impulses,” noted Basile. “We also documented that overeating and bingeing behaviours serve as self-soothing strategies that help individuals to cut off their feelings and quiet their internalized ‘Punitive Parent’."
Among study participants, overeating and bingeing behaviours served as self-soothing strategies when they experienced feelings of abandonment (the belief others will be unavailable or unpredictable in their support or connection); dependence/incompetence (the belief that one has failed, or will fail in important life areas of achievement); and subjugation (the belief that one must surrender control to others), as well as to quiet internalised Punitive Parent voices (inner dialogue that is self-blaming, punishing, and abusive that causes one to detach emotionally and reject help). Frequent bingeing was associated with belief patterns of abandonment, enmeshment (being excessively emotionally involved and connected with others at the expense of full individuation or normal social development); and failure (the belief that one always fails in important life areas of achievement) schemas, as well as by those who react impulsively with anger and frustration (Impulsive/Undisciplined Child) and by those with a Punitive Parent inner dialogue.
Professor Basile and her co-investigators believe that this deeper understanding of the emotional and psychological functioning of obese patients, recognising the impact of early life experiences, might help clinicians promote the long-term efficacy of psychological interventions in overeating related pathologies.
Identifying each patient's unique maladaptive schema and modes is the first step of ST intervention. To help the patient deal with their future needs and emotions in a healthier way, treatment might also include:
- Addressing and satisfying the frustrated core emotional needs, embedded in the vulnerable child mode, in a safe therapeutic relationship
- De-potentiating the punitive parental mode and its destructive messages
- Reducing dysfunctional coping mechanisms, such as the detached protector self-soothing
- Expanding the healthy adult mode
"Addressing actual schema modes and the connected early experiences within a caring and solid clinical setting, such as the one used within ST practice, might be of particular value for obese patients," concluded Basi
Bariatric surgery reverses Fatty Liver Disease
23 July 2019
This is an area of improvement following weight loss surgery that is less well remembered. The liver is just like any other organ in that it stores fat very efficiently if there is too much in the system. However, over time these fatty deposits impair the ability of the liver to do its job! Each cell stores fat which then compromises its essential cellular level functioning. The liver is generally a very forgiving organ and unlike lots of adult structures, has the ability to self regenerate. Shockingly, obesity has become the leading cause of liver cirrhosis in America - overtaking alcohol and viruses! It is only once the liver develops cirrhosis that it loses the battle and is unable to regain its function in the longterm. So, this is very reassuring news and yet another positive side effect of significant and long term weight loss that bariatric surgery can offer patients. Good news huh!
Laparoscopic sleeve gastrectomy reverses non-alcoholic fatty liver disease modulating oxidative stress and inflammation
Metabolism — Cabré N, et al. | July 09, 2019
Researchers studied the modulation of hepatic indices of oxidative stress and inflammation in obese patients undergoing laparoscopic sleeve gastrectomy (LSG) to examine the molecular mechanisms of hepatic alterations and to identify molecules that could be used as potential therapeutic targets. Study participants included 436 patients attending the obesity clinic who had LSG for weight loss. One year after surgery, there has been a significant reduction in the incidence of diabetes, dyslipidemia and hypertension. The findings demonstrate that patients with morbid obesity have considerably enhanced histology and liver function after LSG through mechanisms involving a decrease of oxidative stress and inflammatory processes. These data promote the use of LSG as a therapeutic alternative for non-alcoholic fatty liver disease improvement or resolution.
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