title: Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Three years durability of the improvements in health-related quality of life observed after gastric banding. A new approach to multicultural item generation in the development of two obesity-specific measures: the Obesity and Weight Loss Quality of Life (OWLQOL) questionnaire and the Weight-Related Symptom Measure (WRSM). Changes in health-related quality of life in people with morbid obesity attending a learning and mastery course. A longitudinal study with 12-months follow-up Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study. Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls. Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes Laparoscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Life at One Year Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. Two-year changes in generic and obesity-specific quality of life after gastric bypass Validation of the Adapted Bariatric Quality of Life Index (BQL) in a Prospective Study in 446 Bariatric Patients as One-Factor Model Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study Does bariatric surgery improve the patient's quality of life? Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study Early Results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS) 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 Quality of life and prevalence of osteoarticular pain in patients submitted to bariatric surgery. Gastrointestinal Quality of Life Following Laparoscopic Vertical Banded Gastroplasty A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs Health-related quality of life after the surgical treatment of obesity. Prognostic Significance of Depressive Symptoms on Weight Loss and Psychosocial Outcomes Following Gastric Bypass Surgery: A Prospective 24-Month Follow-Up Study Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial. Health benefits of gastric bypass surgery after 6 years. Improvement in Quality of Life After Laparoscopic Sleeve Gastrectomy Quality of life following laparoscopic gastric banding in patients with morbid obesity. Ten Years Experience of Banded Gastric Bypass: Does It Make a Difference? Health‐related quality of life after gastric banding Prospective study of the quality of life in patients assessed for liver transplantation: outcome in transplanted and not transplanted groups. Quality-of-Life Assessment of Morbidly Obese Patients who have Undergone a Lap-Band® Operation: 2-Year Follow-Up Study: Is the MOS SF-36 a useful instrument to measure quality of life in morbidly obese patients? Improvement in health-related quality of life following Roux-en-Y gastric bypass. The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population Relationship between Quality of Life and Weight Loss 1 Year after Gastric Bypass Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. The Effect of Bariatric Surgery on Patient HRQOL and Sexual Health During a 1-Year Postoperative Period
abstract: BACKGROUND We analyzed the health-related quality of life ( HRQOL ) and its determinants in the first year after laparoscopic adjustable gastric b and ing ( LAGB ) .  The setting was 10 Italian public and private bariatric surgery centers . METHODS Data collected in an ongoing , prospect i ve , 3-year multicenter Italian study on the changes in HRQOL after LAGB were used . HRQOL was investigated using the Medical Outcomes Study Short-Form 36 question naire . Hunger , satiety , and the self-perceived effects of LAGB  were recorded . RESULTS A total of 334 patients were enrolled . The follow-up rate was 92.2 % . The percentage of excess weight loss was 39.6 % ± 25.8 % , with very few side effects or complications . Hunger in the morning ( 0 - 10 scale ) was 4.5 ± 2.7 before surgery and 3.8 ± 2.4 after 1 year ( P < .001 ) . Satiety after a meal ( 0 - 10 scale ) was 7.1 ± 2.7 before surgery and 8.2 ± 1.9 at 1 year ( P < .001 ) . The self-perceived effect of LAGB on caloric intake ( 0 - 10 scale ) was 8.4 ± 1.9 after 1 year . The scores for the 8 Medical Outcomes Study Short-Form 36 subscales were significantly improved after surgery . The physical component summary score was 52.6 ± 11.9 at baseline and 79.1 ± 15.6 after 1 year ( P < .001 ) . The corresponding mental component summary scores were 52.2 ± 12.3 and 76.5 ± 17.2 ( P < .001 ) . Greater physical component summary improvement was independently associated with a low initial physical component summary ( P < .001 ) , high satiety ( P = .002 ) , a high percentage of excess weight loss ( P = .013 ) , and a high self-perceived effect of the LAGB ( P = .026 ) . Greater mental component summary improvement was associated with a low initial mental component summary ( P < .001 ) , high satiety ( P < .001 ) , a low frequency of heartburn ( P = .004 ) , and a high percentage of excess weight loss ( P = .012 ) . CONCLUSIONS Significant improvements in HRQOL were observed in the first year after LAGB . A poor baseline HRQOL , a high efficacy of the b and ing in eating control , and better weight loss might influence HRQOL changes BACKGROUND Improvements in health-related quality of life ( HR-QoL ) occur after  bariatric surgery .  However , sustainability of these changes over time remains debated . METHODS Data collected in a prospect i ve 3-year multicenter Italian study on changes of HR-QoL after laparoscopic adjustable gastric b and ing were used .  HR-QoL has investigated with the SF-36 question naire .  Hunger , satiety , and the self-perceived effects of LAGB were recorded . RESULTS A total of 230 patients ( 53 male and 177 female ) were analyzed . Body mass index was 41.4±5.4 kg/m2 at baseline , declined to 33.8±5.8 kg/m2 12 months after surgery ( P<.001 ) , and further reduced to 31.9±5.1 kg/m2 36 months after surgery ( P<.001 versus 12 months ) . Scores in the SF-36 subscales were lower than in the general Italian population at baseline . The physical component summary score was 51.9±11.6 at baseline , improved to 79.2±15.4 at 12 months ( P<.001 ) , and stabilized to 79.8±15.6 at 36 months . The mental summary score was 52.3±11.8 at baseline , improved to 75.2±17.3 at 12 months ( P<.001 ) , and stabilized to 74.2±17.5 at 36 months . A decline>10 points between 12 and 36 months in the summary scores was observed in 22.0 % of the patients for PCS and in 26.8 % for MCS . In a multiple linear regression analysis , deterioration in HR-QoL in the 12 - 36 months period was associated to the presence of better HR-QoL values at 12 months and to a more pronounced reduction of the self-perceived effect of the b and ing at 36 months . CONCLUSION Improvements in HR-QoL observed in the first year after surgery maintained up to the third year after gastric b and ing BACKGROUND Being overweight or obese has substantial effects on individuals ' perceptions of their health and quality of life ( QoL ) . Generic measures often miss important QoL information , and existing obesity-specific instruments have shortcomings with respect to cross-cultural input , application to differing levels of severity , conceptual clarity , and patient burden . OBJECTIVE This study aim ed to develop culturally sensitive measures of QoL and symptoms in overweight or obese persons , both those trying to lose weight and those not trying to lose weight . METHODS Currently accepted criteria and guidelines for question naire development were streamlined and augmented to include cross-cultural input from 5 European countries and the United States . The preliminary pool of items was created based on qualitative interviews conducted in the United States , followed by an early check of item translatability and preharmonization across all language s. Ten additional qualitative in-country interviews were then conducted to produce further culture-specific items . This was followed by 2 forward and 1 backward translation , plus cognitive debriefing interviews in each country . Finally , an exp and ed international harmonization meeting was held to ensure inclusion of appropriate new items and their acceptability across all 6 cultures . RESULTS The procedures described result ed in development of the 41-item Obesity and Weight Loss Quality of Life question naire and the 20-item Weight-Related Symptom Measure . These question naires are subject to further psychometric validation . CONCLUSIONS Augmentation of the initial item-generation and international harmonization steps of question naire development through integration of cross-cultural input allowed greater validity of cross-cultural content while meeting time , budget , and re source constraints Background Severe obesity is a complex condition that is associated with a wide range of serious health complications and reduced health-related quality of life ( HRQoL ) . In addition to physiological factors , activity and participation , environmental factors , and personal factors are related to an individual ’s overall quality of life HRQoL. In Norway , a course based on cognitive behavioral principles is offered to people seeking medical treatment for weight management . The aim is to assist participants to achieve a healthier lifestyle and thereby improve their HRQoL. We therefore investigated changes in HRQoL in participants after they attended this learning and mastery course  , and explored how well sociodemographic variables , paid work , social support , personal factors , and surgery predicted HRQoL at 12-month follow-up . Methods A single-group longitudinal study was conducted . Data were collected by self-reported question naires . This article reports on those who had completed the question naire at the 12-month ( n = 69 ) follow-up . HRQoL was assessed with the EQ-5D . Other st and ardized instruments measured employment , social support , self-efficacy , and surgery . Results At the 12-month follow-up , participants scored higher on all dimensions of the EQ-5D and on the EQ-VAS . Generalized linear model showed that having paid work , and social support were statistically significant predictors of HRQoL at the 12-month follow-up . Sex , self-efficacy , and surgery were not statistically significant associated with HRQoL. Conclusions Participation in paid work , and receiving social support from persons with whom they had a close relationship were strongly related to HRQoL  in obese people 12 months after participating in a learning and mastery course . Trial registration The study is registered in Clinical Trials : NCT01336725 BACKGROUND There is a lack of adequate prospect i ve data on quality -of-life ( QOL ) and its predictors in patients undergoing laparoscopic sleeve gastrectomy ( LSG ) .  The aim of this study was to assess longitudinal changes in QOL after LSG with the use of the obesity-specific Moorehead-Ardelt II question naire ( MAII ) and to identify clinical parameters associated with QOL outcome . METHODS Morbidly obese patients consecutively admitted for LSG , over a 30-month period , were prospect ively studied . QOL was assessed using the vali date d Greek version of the MAII question naire and a visual analogueue scale ( VAS ) , preoperatively and at 6 , 12 , and 24 months postoperatively . Anthropometric data and obesity-related co-morbidities were recorded . RESULTS A total of 111 patients with a mean age 36.8±9.2 years were included . Mean preoperative body mass index ( BMI ) was 49.1±7.5 kg/m2 . Percentage excess BMI loss ( % EBL ) was 51.1±14.9 , 64.2±17.9 and 66.4±18.0 at 6 , 12 , and 24 months , respectively . Postoperatively , all obesity-related co-morbidities were significantly improved . MAII score increased from -.40±1.30 preoperatively to 1.75±.83 , 2.18±.80 , and 1.95±.71 at 6 , 12 , and 24 months postoperatively ( trend P<.001 ) . Preoperative median ( interquartile range ) VAS was 3 ( 1 ) increasing to 9 ( 2 ) , 10 ( 1 ) , and 9 ( 1 ) at 6 , 12 , and 24 months postoperatively ( P<.001 ) . % EBL and reduction in obesity-related co-morbidities , especially resolution of diabetes and sleep apnea , correlated significantly with higher QOL during the course of the study . CONCLUSION LSG , a safe and effective bariatric operation , results in sustained weight loss and significant improvements in QOL . Both weight loss and amelioration of co-morbidities contribute to higher level of postsurgical QOL 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 To evaluate the impact of Roux-en-Y gastric bypass ( RYGB ) on quality of life in obese diabetic patients compared to st and ard medical therapy for type 2 diabetes mellitus . Methods We prospect ively studied two matched obese population s with type 2 diabetes . Thirty patients underwent laparoscopic RYGB and 31 received st and ard medical therapy combined with a diabetes support and education program ( DSE ) , consisting of educational sessions on diet and exercise . Groups were matched by age , gender , weight , glucostatic parameters , and use of glucose-lowering medications ( oral agents and insulin therapy ) . Health-related quality of life ( HRQOL ) was assessed using the normalized SF-36 question naire , and data were collected at baseline and at 12-month follow-up . Results Diabetic patients who underwent RYGB experienced a statistically significant increase in their overall HRQOL . However , the role-physical and mental health domains increased but did not reach statistical significance . Diabetic patients in the medical therapy and DSE group did not show any significant increase in HRQOL . The between-group differences for the HRQOL changes from baseline were significant , other than for role-physical and mental health domains . Percentage changes in glucostatic parameters , discontinuation of glucose-lowering medications , and T2DM remission were not found to predict the percentage change in SF-36 scores at 12 months after RYGB . Conclusions For the first time , with a prospect i ve matched control study , we demonstrate a significant improvement in HRQOL in obese diabetic patients who underwent RYGB , but not in those who were offered st and ard medical therapy and DSE Background : The objective of this study was to determine the weight loss , changes in co-morbidities , medication usage and general health status at 1 year after laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : Prospect i ve data were obtained from all subjects undergoing LAGB .  These measurements included a medical history and review of systems , medications , height and weight and the SF-36 general health survey . Patients were seen for b and adjustments as needed throughout the year . At the 1-year follow-up visit , patients were weighed and interviewed about the status of their health conditions and their current medications , and the SF-36 was repeated . Results : Between November 2002 and November 2003 , 195 patients had LAGB . The majority of subjects were female ( 82.8 % ) , married ( 65.1 % ) , and white ( 94.9 % ) .  Complications occurred in 18 subjects ( 9.2 % ) . These included 3 slipped b and s ( 1.5 % ) , 4 port problems ( 2.1 % ) , 8 patients with temporary stoma occlusion ( 4.1 % ) , 1 explantation ( 0.5 % ) , and 1 mortality ( 0.5 % ) . Mean BMI decreased from 45.8 kg/m2 ( ± 7.7 ) to 32.3 kg/m2 ( ± 7.0 ) . Mean percent excess body weight lost was 45.7 % ( ± 17.1 ) during the first year . Major improvements occurred in arthritis , asthma , depression , diabetes , gastro-esophageal reflux disease , hyperlipidemia , hypertension , joint and back pain , sleep apnea and stress incontinence . Medication usage declined remarkably . Quality of life ( QoL ) by the SF-36 showed highly significant improvements . Conclusions : At 1 year after LAGB , patients had experienced significant weight loss , resolution of comorbidities , decreases in medication usage , and improvements in IMPORTANCE Emerging data support bariatric surgery as a therapeutic strategy for management of type 2 diabetes mellitus . OBJECTIVE To test the feasibility of methods to conduct a larger multisite trial to determine the long-term effect of Roux-en-Y gastric bypass ( RYGB ) surgery compared with an intensive diabetes medical and weight management ( Weight Achievement and Intensive Treatment [ Why WAIT ] ) program for type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A 1-year pragmatic r and omized clinical trial was conducted in an academic medical institution . Participants included persons aged 21 to 65 years with type 2 diabetes diagnosed more than 1 year before the study ; their body mass index was 30 to 42 ( calculated as weight in kilograms divided by height in meters squared ) and hemoglobin A1c ( HbA1c ) was greater than or equal to 6.5 % . All participants were receiving antihyperglycemic medications . INTERVENTIONS RYGB ( n = 19 ) or Why WAIT ( n = 19 ) including 12 weekly multidisciplinary group lifestyle , medical , and educational sessions with monthly follow-up thereafter . MAIN OUTCOMES AND MEASURES Proportion of patients with fasting plasma glucose levels less than 126  mg/dL  and HbA1c less than 6.5 % , measures of cardiometabolic health , and patient-reported outcomes . RESULTS At 1 year , the proportion of patients achieving HbA1c below 6.5 % and fasting glucose below 126 mg/dL was higher following RYGB than Why WAIT ( 58 % vs 16 % , respectively ; P = .03 ) . Other outcomes , including HbA1c , weight , waist circumference , fat mass , lean mass , blood pressure , and triglyceride levels , decreased and high-density lipoprotein cholesterol increased more after RYGB compared with Why WAIT . Improvement in cardiovascular risk scores was greater in the surgical group . At baseline the participants exhibited moderately low self-reported quality -of-life scores reflected by Short Form-36 total , physical health , and mental health , as well as high Impact of Weight on Quality of Life-Lite and Problem Areas in Diabetes health status scores . At 1 year , improvements in Short Form-36 physical and mental health scores and Problem Areas in Diabetes scores did not differ significantly between groups . The Impact of Weight on Quality of Life-Lite score improved more with RYGB and correlated with greater weight loss compared with Why WAIT . CONCLUSIONS AND RELEVANCE In obese patients with type 2 diabetes , RYGB produces greater weight loss and sustained improvements in HbA1c and cardiometabolic risk factors compared with medical management , with emergent differences over 1 year . Both treatments improve general quality -of-life measures , but RYGB provides greater improvement in the effect of weight on quality of life . These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger r and omized trials are performed . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01073020 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 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 Guidelines and experts describe 5 % to 10 % reductions in body weight as ` clinical ly important ’ ; however , it is not clear if 5 % to 10 % weight reductions correspond to clinical ly important improvements in health-related quality of life ( HRQL ) . Our objective was to calculate the amount of weight loss required to attain established minimal clinical ly important differences ( MCIDs ) in HRQL , measured using three vali date d instruments . Methods Data from the Alberta Population -based Prospect i ve Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery ( APPLES ) study , a population -based , prospect i ve Canadian cohort including 150 wait-listed , 200 medically managed and 150 surgically treated patients were examined . Two-year changes in weight and HRQL measures ( Short-Form (SF)-12 physical ( PCS ; MCID = 5 ) and mental ( MCS ; MCID = 5 ) component summary score , EQ-5D Index ( MCID = 0.03 ) and Visual Analog Scale ( VAS ; MCID = 10 ) , Impact of Weight on Quality of Life (IWQOL)-Lite total score ( MCID = 12 ) ) were calculated . Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs . Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument . Results Mean age was 43.7 ( SD 9.6 ) years , 88 % were women , 92 % were white , and mean initial body mass index was 47.9 ( SD 8.1 ) kg/m2 . In surgically treated patients ( two-year weight loss = 16 % ) , HRQL MCIDs were reached for all instruments except the SF-12 MCS . In medically managed patients ( two-year weight loss = 3 % ) , MCIDs were attained in the EQ-index but not the other instruments . In all patients , percent weight reductions to achieve MCIDs were : 23 % ( 95 % confidence interval ( CI ) : 17.5 , 32.5 ) for PCS , 25 % ( 17.5 , 40.2 ) for MCS , 9 % ( 6.2 , 15.0 ) for EQ-Index , 23 % ( 17.3 , 36.1 ) for EQ-VAS , and 17 % ( 14.1 , 20.4 ) for IWQOL-Lite total score . Conclusions Weight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5 % to 10 % . Surgical , but not medical treatment , consistently led to clinical ly important improvements in HRQL over two years . Trial registration Clinical trials.gov NCT00850356 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 The purpose of this study was to determine whether pre- to postoperative increases in physical activity ( PA ) are associated with weight loss and health-related quality of life ( HRQoL )  following bariatric surgery . Participants were 199 Roux-en-Y gastric bypass ( RYGB ) surgery patients . The International Physical Activity Question naire ( IPAQ ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level : ( i ) Inactive/Active ( < 200-min/week/>or=200-min/week ) , ( ii ) Active/Active ( > or=200-min/week/>or=200-min/week ) and ( iii ) Inactive/Inactive ( < 200-min/week/<200-min/week ) . The  Medical Outcomes Study Short Form-36 ( SF-36 ) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes . Inactive/Active participants , compared with Inactive/Inactive individuals , had greater reductions in weight ( 52.5 + /- 15.4 vs. 46.4 + /- 12.8 kg ) and BMI ( 18.9 + /- 4.6 vs. 16.9 + /- 4.2 kg/m(2 ) ) . Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other . Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary ( MCS ) score and the general health , vitality and mental health domains ( P < 0.01 ) . Although the direction of causation is not clear , these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active . Future r and omized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes Background There is little robust evidence relating to changes in health related quality of life ( HRQL ) in morbidly obese patients following a multidisciplinary non-surgical weight loss program or laparoscopic Roux-en-Y Gastric Bypass ( RYGB ) .  The aim of the present study was to describe and compare changes in five dimensions of HRQL in morbidly obese subjects . In addition , we wanted to assess the clinical relevance of the changes in HRQL between and within these two groups after one year . We hypothesized that RYGB would be associated with larger improvements in HRQL than a part residential intensive lifestyle-intervention program ( ILI ) with morbidly obese subjects . Methods A total of 139 morbidly obese patients chose treatment with RYGB ( n=76 ) or ILI ( n=63 ) . The ILI comprised four stays ( seven weeks ) at a specialized rehabilitation center over one year . The daily schedule was divided between physical activity , psychosocially-oriented interventions , and motivational approaches . No special diet or weight-loss drugs were prescribed . The participants completed three HRQL- question naires before treatment and 1 year thereafter . Both linear regression and ANCOVA were used to analyze differences between weight loss and treatment for five dimensions of HRQL ( physical , mental , emotional , symptoms and symptom distress ) controlling for baseline HRQL , age , age of onset of obesity , BMI , and physical activity . Clinical relevance was assessed by effect size ( ES ) where ES<.49 was considered small , between .50-.79 as moderate , and ES>.80 as large . Results The adjusted between group mean difference ( 95 % CI ) was 8.6 ( 4.6,12.6 ) points ( ES=.83 ) for the physical dimension , 5.4 ( 1.5–9.3 ) points ( ES=.50 ) for the mental dimension , 25.2 ( 15.0–35.4 ) points ( ES=1.06 ) for the emotional dimension , 8.7 ( 1.8–15.4 ) points ( ES=.37 ) for the measured symptom distress , and 2.5 for ( .6,4.5 ) fewer symptoms ( ES=.56 ) , all in favor of RYGB . Within-group changes in HRQOL in the RYGB group were large for all dimensions of HRQL . Within the ILI group , changes in the emotional dimension , symptom reduction and symptom distress were moderate . Linear regression analyses of weight loss on HRQL change showed a st and ardized beta-coefficient of –.430 ( p<.001 ) on the physical dimension , –.288 ( p=.004 ) on the mental dimension , –.432 ( p<.001 ) on the emotional dimension , .287 ( p=.008 ) on number of symptoms , and .274 ( p=.009 ) on reduction of symptom pressure . Conclusions Morbidly obese participants undergoing RYGB and ILI had improved HRQL after 1 year . The weaker response of ILI on HRQL , compared to RYGB , may be explained by the difference in weight loss following the two treatments . Trial registration Clinical Trials.gov number 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 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 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 Background : Laparoscopic vertical b and ed gastroplasty ( LVBG ) is a safe and effective treatment for morbid obesity . Previous studies disclosed a significant improvement in the health-related quality of life after substantial weight loss following VBG . Data regarding the specific gastrointestinal quality of life following LVBG is lacking . Material s and Methods : 223 patients who underwent LVBG for morbid obesity were studied prospect ively . Quality of life was measured by the Gastrointestinal Quality of life Index ( GIQLI ) , a 36- item question naire before surgery , and at 6 months , 1 year and 2 years after surgery . The question naire is divided into 5 domains , and the maximum score is 144 . Results : After LVBG , weight loss has been good . Mean BMI decreased from 43.2 to 31.3 after 2 years . Co-morbidities were eliminated in 71 % . 84.3 % of patients were satisfied with the results . However , the score of GIQLI remained similar before and after surgery . Preoperative score was 106.2±19 points . The score became 116.6±9 , 106.8±21 , and 108.5±20 at 6 months , 1 year and 2 years after surgery respectively . The patients had improvement in 3 domains of the question naire ( social function , physical status and psychological emotions ) but decreased in domains of core symptoms and disease-specific items . Conclusion : Although LVBG was effective in reduction of weight and resolution of co-morbidities in morbidly obese patients , the specific gastrointestinal quality of life did not improve . Many patients developed some specific gastrointestinal symptoms in order to obtain weight reduction Background : Laparoscopic adjustable gastric b and ing ( LAGB ) is a safe and effective method for the treatment of obesity . The most common problem after LAGB has been the occurrence of prolapse ( slippage ) of the stomach through the b and . It has been proposed that the pars flaccida ( PF ) pathway ( dissection from the base of the right crus , along the left crus to the angle of His ) is less likely to be associated with prolapse than the traditional perigastric ( PG ) pathway ( dissection between the lesser curvature of stomach and lesser omentum , across the apex of the lesser sac , to the angle of His ) . We have tested this hypothesis using a r and omized controlled trial format . Methods : We have performed a r and omized controlled trial to compare the outcomes after LAGB using PF and PG pathways .  202 patients ( mean age 40 years , mean weight 123 kg , mean BMI 45 ) were r and omly allocated to the PF or PG pathway and followed for 2 years . Results : At 24 months , there have been 16 revisional procedures for prolapse , 4 in the PF group ( all anterior prolapse ) and 15 in the PG group ( 12 posterior and 3 anterior ) . This difference is significant ( P<0.001 ) . The mean % excess weight lost was 53 % for the PF group and 46 % for the PG group . There was equally significant improvements in the metabolic syndrome in both groups ( 59 % preoperatively and 19 % at 2 years ) . All 8 paired domain scores of the SF-36 measures of quality of life were improved significantly in both group ( P<0.001 ) . Conclusions : The PF pathway is as effective as the PG pathway in generating substantial weight loss , improved health and improved quality of life and is significantly less likely to be associated with prolapse ( slippage ) . It is recommended as the primary dissection pathway Objective To compare outcomes , quality of life ( QOL ) , and costs of laparoscopic and open gastric bypass ( GBP ) .  Summary Background Data Laparoscopic GBP has been reported to be a safe and effective approach for the treatment of morbid obesity . The authors performed a prospect i ve r and omized trial to compare outcomes , QOL , and costs of laparoscopic GBP with those of open GBP . Methods From May 1999 to March 2001 , 155 patients with a body mass index ( BMI ) of 40 to 60 kg/m2 were r and omly assigned to undergo laparoscopic ( n = 79 ) or open ( n = 76 ) GBP .  The two groups were similar in age , sex ratio , mean BMI , and comorbidities . Main outcome measures included operative time , estimated blood loss , length of hospital stay , operative complications , percentage of excess body weight loss , and time to return to activities of daily living and work . Changes in QOL were assessed using the SF-36 Health Survey and the bariatric analysis of reporting outcome system ( BAROS ) . Operative and hospital costs of the two operations were also compared . Results There were no deaths in either group . Mean operative time was longer for laparoscopic GBP than for open GBP , but operative blood loss was less . Two ( 2.5 % ) of the 79 patients in the laparoscopic group required conversion to laparotomy . Median length of hospital stay was shorter for laparoscopic GBP patients ( 3 vs 4 days ) . The rate of postoperative anastomotic leak was similar between groups . Wound-related complications such as infection ( 10.5 vs 1.3 % ) and incisional hernia ( 7.9 vs 0 % ) were more common after open GBP ; late anastomotic stricture was less frequent after open GBP ( 2.6 vs 11.4 % ) . Time to return to activities of daily living and work were shorter after laparoscopic GBP than after open GBP .  Weight loss at 1 year was similar between groups . Preoperative SF-36 scores were similar between groups ; however , at 1 month after surgery , laparoscopic patients had better physical conditioning , social functioning , general health , and less body pain than open GBP patients . At 6 months , the BAROS outcome was classified as good or better in 97 % of laparoscopic GBP patients compared with 82 % of open GBP patients . Operative costs were higher for laparoscopic GBP patients , but hospital costs were lower . Conclusions Laparoscopic GBP is a safe and cost-effective alternative to open GBP . Despite a longer operative time , patients undergoing laparoscopic GBP benefited from less blood loss , a shorter hospital stay , and faster convalescence .  Laparoscopic GBP patients had comparable weight loss at 1 year but a more rapid improvement in QOL than open GBP patients . The higher initial operative costs for laparoscopic GBP were adequately offset by the lower hospital costs 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 Background This study examined the prognostic significance of depressive symptoms in bariatric surgery patients over 24 months of follow-ups . Methods Three hundred fifty-seven patients completed a battery of assessment s before and at 6 , 12 , and 24 months following gastric bypass surgery .  In addition to weight loss and depressive symptoms , the assessment s targeted eating disorder psychopathology and quality of life . Results Clinical ly significant depressive symptoms , defined as a score of 15 or greater on the Beck Depression Inventory , characterized 45 % of patients prior to surgery , and 12 % at 6-month follow-up , 13 % at 12-month follow-up , and 18 % at 24-month follow-up . Preoperative depressive symptoms did not predict postoperative weight outcomes . In contrast , postsurgery depressive symptoms were predictive of weight loss outcomes . Higher postsurgery depressive symptoms at each time point predicted a greater degree of concurrent and subsequent eating disorder psychopathology and lower quality of life . Conclusions The frequency of elevated depressive symptoms decreases substantially following gastric bypass surgery but increases gradually over 24 months . Postoperative depressive symptoms are significantly associated with poorer weight outcomes at 6 and 12 months following surgery but do not predict longer-term weight outcomes at 24 months . Postoperative depressive symptoms prospect ively predict greater eating disorder psychopathology and poorer quality of life through 24 months . Elevated depressive symptoms , readily assessed by self-report , may signal a need for clinical attention after surgery IMPORTANCE There is no consensus as to which bariatric procedure is preferred to reduce weight and improve health in patients with a body mass index higher than 50 . OBJECTIVE To compare 5-year outcomes after Roux-en-Y gastric bypass ( gastric bypass ) and biliopancreatic diversion with duodenal switch ( duodenal switch ) . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical open-label trial at Oslo University Hospital , Oslo , Norway , and Sahlgrenska University Hospital , Gothenburg , Sweden . Participants were recruited between March 17 , 2006 , and August 20 , 2007 , and included 60 patients aged 20 to 50 years with a body mass index of 50 to 60 . The current study provides the 5-year follow-up analyses by intent to treat , excluding one participant accepted for inclusion who declined being operated on prior to knowing to what group he was r and omized . INTERVENTIONS Laparoscopic gastric bypass and laparoscopic duodenal switch . MAIN OUTCOMES AND MEASURES Body mass index and secondary outcomes including anthropometric measures , cardiometabolic risk factors , pulmonary function , vitamin status , gastrointestinal symptoms , health-related quality of life , and adverse events . RESULTS Sixty patients were r and omly assigned and operated on with gastric bypass ( n = 31 ) and duodenal switch ( n = 29 ) . Fifty-five patients ( 92 % ) completed the study . Five years after surgery , the mean reductions in body mass index were 13.6 ( 95 % CI , 11.0 - 16.1 ) and 22.1 ( 95 % CI , 19.5 - 24.7 ) after gastric bypass and duodenal switch , respectively . The mean between-group difference was 8.5 ( 95 % CI , 4.9 - 12.2 ; P < .001 ) . Remission rates of type 2 diabetes mellitus and metabolic syndrome and changes in blood pressure and lung function were similar between groups . Reductions in total cholesterol , low-density lipoprotein cholesterol , triglycerides , and fasting glucose were significantly greater after duodenal switch compared with gastric bypass . Serum concentrations of vitamin A and 25-hydroxyvitamin D were significantly reduced after duodenal switch compared with gastric bypass . Duodenal switch was associated with more gastrointestinal adverse effects . Health-related quality of life was similar between groups . Patients with  duodenal switch underwent more surgical procedures related to the initial procedure ( 13 [ 44.8 % ] vs 3 [ 9.7 % ] patients ; P = .002 ) and had significantly more hospital admissions compared with patients with gastric bypass . CONCLUSIONS AND RELEVANCE In patients with a body mass index of 50 to 60 , duodenal switch result ed in greater weight loss and greater improvements in low-density lipoprotein cholesterol , triglyceride , and glucose levels 5 years after surgery compared with gastric bypass while improvements in health-related quality of life were similar . However , duodenal switch was associated with more surgical , nutritional , and gastrointestinal adverse effects . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00327912 CONTEXT Extreme obesity is associated with health and cardiovascular disease risks . Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term , long-term outcomes are uncertain . OBJECTIVE To examine the association of  Roux-en-Y gastric bypass ( RYGB ) surgery  with weight loss , diabetes mellitus , and other health risks 6 years after surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese ( body mass index [ BMI ] ≥ 35 ) participants aged 18 to 72 years ( 82 % women ; mean BMI , 45.9 ; 95 % CI , 31.2 - 60.6 ) who sought and received RYGB surgery ( n = 418 ) , sought but did not have surgery ( n = 417 ; control group 1 ) , or who were r and omly selected from a population -based sample not seeking weight loss surgery ( n = 321 ; control group 2 ) . MAIN OUTCOME MEASURES Weight loss , diabetes , hypertension , dyslipidemia , and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment . RESULTS Six years after surgery , patients who received RYGB surgery ( with 92.6 % follow-up ) lost 27.7 % ( 95 % CI , 26.6%-28.9 % ) of their initial body weight compared with 0.2 % ( 95 % CI , -1.1 % to 1.4 % ) gain in control group 1 and 0 % ( 95 % CI , -1.2 % to 1.2 % ) in control group 2 . Weight loss maintenance was superior in patients who received RYGB surgery , with 94 % ( 95 % CI , 92%-96 % ) and 76 % ( 95 % CI , 72%-81 % ) of patients receiving RYGB surgery maintaining at least 20 % weight loss 2 and 6 years after surgery , respectively . Diabetes remission rates 6 years after surgery were 62 % ( 95 % CI , 49%-75 % ) in the RYGB surgery group , 8 % ( 95 % CI , 0%-16 % ) in control group 1 , and 6 % ( 95 % CI , 0%-13 % ) in control group 2 , with remission odds ratios ( ORs ) of 16.5 ( 95 % CI , 4.7 - 57.6 ; P < .001 ) vs control group 1 and 21.5 ( 95 % CI , 5.4 - 85.6 ; P < .001 ) vs control group 2 . The incidence of diabetes throughout the course of the study was reduced after RYGB surgery ( 2 % ; 95 % CI , 0%-4 % ; vs 17 % ; 95 % CI , 10%-24 % ; OR , 0.11 ; 95 % CI , 0.04 - 0.34 compared with control group 1 and 15 % ; 95 % CI , 9%-21 % ; OR , 0.21 ; 95 % CI , 0.06 - 0.67 compared with control group 2 ; both P < .001 ) . The numbers of participants with bariatric surgery-related hospitalizations were 33 ( 7.9 % ) , 13 ( 3.9 % ) , and 6 ( 2.0 % ) for the RYGB surgery group and 2 control groups , respectively . CONCLUSION Among severely obese patients , compared with nonsurgical control patients , the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years Few studies have investigated changes in health-related quality of life ( HRQOL ) in surgical patients who have undergone a laparoscopic sleeve gastrectomy .  Prospect i ve data were obtained from 78 consecutive patients undergoing laparoscopic sleeve gastrectomy ( LSG ; mean age , 42.4 years ; mean body weight , 131 kg ; mean body mass index ( BMI ) , 47 kg/m2 ( 24.4 % of superobese patients ) ) . Two HRQOL question naires were administered preoperatively and 12 months postsurgery : the generic Medical Outcomes Study Short Form-36 and the weight-specific IWQOL-Lite question  naire . Excess weight loss at 12 months was 57.18 % . No mortality was recorded . HRQOL scores revealed a significant improvement in all areas of both question naires . However , changes in HRQOL were not associated consistently with amount of weight loss .  Laparoscopic sleeve gastrectomy is an effective and safe procedure , with positive changes in health-related quality of life as well as weight reduction . A fruitful area for future research is the investigation of long-term changes in HRQOL after LSG In a prospect i ve study of 188 patients with morbid obesity , the time-dependent changes in the quality of life of individual patients were analyzed following laparoscopic gastric b and ing ( LGB ) . These 188 patients ( 148 females and 40 males ; age 19 to 59 years ; body mass index 33 to 72 kg/m(2 ) ) underwent evaluation  of  the LGB according to a strict protocol that included psychological testing using st and ardized instruments , detailed medical evaluation , upper gastrointestinal function studies , and evaluation of quality of life using the Gastrointestinal Quality of Life Index ( GIQLI ) . Following this evaluation , 73 patients ( 57 females and 16 males ; age 37 years [ range 19 to 59 years ] ; body mass index 48 kg/m(2 ) [ range 37 to 72 kg/m(2 ) ] ) underwent  LGB and were followed up for 2 years focusing on weight loss , postoperative morbidity , weight-related comorbidity , and quality of life . The results demonstrate that LGB is well able to allow for a significant loss of excess weight and a significant improvement in patients ' quality of life , both after a rather short period of time after surgery and at a continuous rate throughout the follow-up . The price for this success that was found in approximately 90 % of patients is a complication rate of 38 % ; 85 % of these patients , almost one third of all patients , must undergo some type of revision surgery . However , once the complications are resolved , these patients achieve the same level of weight loss and improvement in quality of life as patients with an uncomplicated postoperative course Many surgeons support some sort of restriction of the gastric pouch outlet by placing a ring around the gastric reservoir . Previous studies have shown positive results of b and ed gastric bypass ( BGBP ) ; however , there are not many comparative long-term studies to assess the real advantage of placing a ring during gastric bypass ( GBP ) surgery . This study aims to evaluate the long-term outcome of patients subjected to BGBP and nonb and ed GBP procedures .  We studied 260 retrospective , nonr and omized obese patients who underwent BGBP and 218 patients without the ring ( i.e. , GBP ) . They were followed up for 10 years , and the following parameters were evaluated : excess weight loss ( EWL ) , quality of life ( QOL ) , food tolerance , and correction of comorbidities . The study was approved by the Committee on Ethics , and all the patients gave their informed consent . There is a significant difference in % EWL from the third year until the tenth year of observation , with the proportion being 82 % in BGBP versus 63 % in nonb and ed GBP patients at the end of the study . Although there was some increased intolerance to food intake in the BGBP patients , this was not felt to reduce the QOL . The outcome in terms of comorbidities was not conclusive . There is a clear advantage in terms of % EWL in the BGBP patients . No differences in QOL were found in both groups . Further , selecting the right type of material and the right size of the ring is important to improve results and avoid complications 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 The quality of life in adult patients with chronic liver disease who were considered for transplantation  was assessed prospect ively over a 2 year period , for both those who did and did not subsequently receive transplants . The main outcome measures were the Nottingham Health Profile and survival . Of the 109 patients who completed an entry profile , 27 were transplanted , 71 not transplanted during the study period , and 11 rejected for transplant . Quality of life and severity of liver disease at entry was worse for the transplant group , whose survival at 15 months from entry was 81 % compared with 78 % for those not transplanted . Among transplant survivors there were marked improvements in quality of life , whilst amongst those not receiving transplants there was little change . In conclusion , liver transplantation was effective in improving quality of life in patients with chronic liver disease , but comparison between transplant and non-transplant patients is difficult because of differences between the groups Background : Quality of life ( QoL ) was tested in a 2- year postoperative study using the Medical Outcome Study Short Form 36 ( MOS SF-36 ) to assess preoperative and 1 and 2 year postoperative QoL among one group of female patients ( group 1 , n = 42 ) and a 2 year postoperative QoL study in a second group of female patients ( group 2 , n = 9 ) who underwent a stomach reduction operation involving open surgical placement of a Lap-B and during the year 1997 . Methods : The QoL of 42 patients ( group 1 ) was assessed at most 20 hours before surgery and 1 and 2 years ( 12 and 24 months ) postoperatively using a r and omized pre-test/post-test design . The QoL of 9 patients ( group 2 ) was assessed 2 years ( 24 months ) postoperatively using a r and omized post-test design only . The results were compared with the st and ardized Dutch norm data scale . Statistical data were analyzed with SPSS versions 10.0 . Results : The placement of a Lap-B and in group 1 result ed in a significant reduction in Body Mass Index ( BMI ) in the first and second-year follow-up . Mean BMI declined significantly from 40.7 kg/m2 preoperatively to 33.1 kg/m2 at the 1-year follow-up , to 31.3 kg/m2 at 2-year follow-up . In group 2 BMI also declined significantly from 43.0 kg/m2 preoperatively to 34.2 kg/m2 at 1-year follow-up to 32.1 kg/m2 at the 2-year follow-up . Compared to the MOS SF-36 st and ardized Dutch norm data , a significant improvement in the QoL was seen on the effect variable bodily pain , mental health and general health perceptions in group 1 . Although the bodily pain , general health and mental health perceptions increased significantly 2 years postoperatively ( group 1 ) com pared with the Dutch st and ardized norm data , the preoperative general health and mental health perceptions of morbidly obese patients were , like all other preoperative effect variables , not significantly different from the scores on the Dutch st and ardized norm scale . Conclusion : Although other authors found that QoL improves after surgical-induced weight loss , showing significant improvements on patients ' perception of their health status , these findings were not confirmed in the present study . The findings show only a significant difference in bodily pain , general health and mental health perception before and after surgical intervention and preoperatively in group 1 compared to the Dutch st and ardized norm data . Because of small sample size ( n = 9 ) , no significant results were found in group 2 compared to the Dutch St and ardized norm data . Based on earlier and present findings , further study is recommended to ascertain whether the MOS SF-36 is valid in morbidly obese patients and whether the response set has an influence on QoL studies of these patients 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 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 / 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 The main associations of body-mass index ( BMI ) with overall and cause-specific mortality can best be assessed by long-term prospect i ve follow-up of large numbers of people . The Prospect i ve Studies Collaboration aim ed to investigate these associations by sharing data from many studies . METHODS Collaborative analyses were undertaken of baseline BMI  versus  mortality  in 57 prospect i ve studies with 894 576 participants , mostly in western Europe and North America ( 61 % [ n=541 452 ] male , mean recruitment age 46 [ SD 11 ] years , median recruitment year 1979 [ IQR 1975 - 85 ] , mean BMI 25 [ SD 4 ] kg/m(2 ) ) . The analyses were adjusted for age , sex , smoking status , and study . To limit reverse causality , the first 5 years of follow-up were excluded , leaving 66 552 deaths of known cause during a mean of 8 ( SD 6 ) further years of follow-up ( mean age at death 67 [ SD 10 ] years ) : 30 416 vascular ; 2070 diabetic , renal or hepatic ; 22 592 neoplastic ; 3770 respiratory ; 7704 other . FINDINGS In both sexes , mortality was lowest at about 22.5 - 25 kg/m(2 ) . Above this range , positive associations were recorded for several specific causes and inverse associations for none , the absolute excess risks for higher BMI and smoking were roughly additive , and each 5 kg/m(2 ) higher BMI was on average associated with about 30 % higher overall mortality ( hazard ratio per 5 kg/m(2 ) [ HR ] 1.29 [ 95 % CI 1.27 - 1.32 ] ) : 40 % for vascular mortality ( HR 1.41 [ 1.37 - 1.45 ] ) ; 60 - 120 % for diabetic , renal , and hepatic mortality ( HRs 2.16 [ 1.89 - 2.46 ] , 1.59 [ 1.27 - 1.99 ] , and 1.82 [ 1.59 - 2.09 ] , respectively ) ; 10 % for neoplastic mortality ( HR 1.10 [ 1.06 - 1.15 ] ) ; and 20 % for respiratory and for all other mortality ( HRs 1.20 [ 1.07 - 1.34 ] and 1.20 [ 1.16 - 1.25 ] , respectively ) . Below the range 22.5 - 25 kg/m(2 ) , BMI was associated inversely with overall mortality , mainly because of strong inverse associations with respiratory disease and lung cancer . These inverse associations were much stronger for smokers than for non-smokers , despite cigarette consumption per smoker varying little with BMI . INTERPRETATION Although other anthropometric measures ( eg , waist circumference , waist-to-hip ratio ) could well add extra information to BMI , and BMI to them , BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5 - 25 kg/m(2 ) . The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal . At 30 - 35 kg/m(2 ) , median survival is reduced by 2 - 4 years ; at 40 - 45 kg/m(2 ) , it is reduced by 8 - 10 years ( which is comparable with the effects of smoking ) . The definite excess mortality below 22.5 kg/m(2 ) is due mainly to smoking-related diseases , and is not fully explained Background Negative consequences of the obesity epidemic include decreased physical , psychological , and sexual health .  Bariatric surgery is a well-tolerated and effective treatment for morbid obesity . This study aim ed to determine the effect of bariatric surgery on health-related quality of life ( HRQOL ) and sexual functioning and to identify potential predictors of this effect . Methods Eighty morbidly obese patients ( 50 women ) completed the study .  HRQOL was measured using the Short Form 36 question naire ( SF-36 ) . Sexual functioning was assessed using the Female Sexual Functioning Index ( FSFI ) and the International Index of Erectile Function ( IIEF ) . All participants were evaluated four times as follows : presurgery ( T1 ) , 1 month ( T2 ) , 6 months ( T3 ) , and 1 year ( T4 ) after surgery . Results Body mass index ( BMI ) significantly decreased over time ( p < 0.001 ) . Apart from male orgasm , all sexual functioning components as well as all SF-36 sub-scales improved between T1 and T4 . The maximum improvement was observed between T2 and T3 . Baseline HRQOL scores correlated with postoperative improvement in all HRQOL components . BMI improvement was correlated with improvement in role physical , bodily pain , and mental health scores . Baseline total sexual satisfaction score independently predicted total satisfaction improvement in both genders . Conclusions The present findings indicate that bariatric surgery represents an effective obesity treatment , leading to significant BMI reduction and improvement in HRQOL and sexual functioning , especially in the first 6 months postoperatively
target: 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 .
background: 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 .