Health-related quality of life, sexuality and hormone status after laparoscopic Roux-En-Y gastric bypass in women
29 October 2019
Quality of life scoring after surgical interventions is something that is often overlooked in the medical world. Although for a lot of patients the improvement in quality of life aspects of significant weight loss following Bariatric surgery (Gastric Bypass, Sleeve or Band) are just as important. All of the data is subjective but self reporting of these types of parameters are the most accurate way of getting objective evidence of benefit. I think the corollary of those who notice improvements are those who notice no improvements - and there are a significant proportion of these women. This could be for 2 reasons - they didn't have an issue with these things prior to surgery anyway or they did have deficits but didn't notice any change.
Interesting research all the same.
Feel free to contact me if you have any questions regarding this or any other parts of the Bariatric surgery process.
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
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