title: Activities and sources of income after a period of long-term sick leave - a population-based prospective cohort study Swedish obese subjects (SOS) – an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. A study on the economic impact of bariatric surgery. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Obesity and sickness absence: results from the CHAP study. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Identifying employees at risk for job loss during sick leave Employment Outcomes One Year after Bariatric Surgery: the Role of Patient and Psychosocial Factors
abstract: Background There is limited knowledge about what happens to people after long-term sick leave . The aim of this report was to conduct a prospect i ve study of individuals who were on prolonged sick leave during a particular year , considering their activities and sources of income during subsequent years . To enable comparison of different time periods , we used three cohorts of individuals with different starting years . Methods Using data from national registers , three separate cohorts were constructed that included all people living in Sweden who were 20 - 64 years of age ( > 5 million ) in the years 1995 , 2000 and 2005 , respectively . The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995 - 2008 : on long-term sick leave , employed , old-age pensioner , long-term unemployed , disability pensioner , on parental leave , social assistance recipient , student allowance recipient , deceased , or emigrated . Results Most individuals on long-term ( > 6 months ) sick leave in 1995 were not employed 13 years later . Only 11 % of the women and 13 % of the men were primarily in employment after 13 years . Instead , a wide range of alternatives existed , for example , many had been granted disability pension , and about 10 % of the women and 17 % of the men had died during the follow-up period . A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up . Conclusions The low future employment rates for people on long-term sick leave may seem surprising . There are several possible explanations for the finding : The disorders these people may have , might have entailed longst and ing difficulties on the labor market . Besides , long-term absence from work , no matter what its causes were , might have worsen the chances of further employment . The economic cycles may also have been of importance . The improving labor market during later years seems to have improved the chances for employment among those earlier on long-term sick leave OBJECTIVE : To examine the effects of weight loss on health-related quality of life ( HRQL ) in subjects with severe obesity . DESIGN : Controlled clinical trial of the outcomes of surgical vs conventional weight reduction treatment . SUBJECTS : The first 487 surgical cases and their conventionally treated , matched controls were followed for two years in the Swedish Obese Subjects ( SOS ) intervention study . MEASUREMENTS : A battery of generic and study -specific self- assessment instruments or subscales was used to characterize HRQL in the severely obese ( BMI ) ≥34 kg/m2 for males and BMI ≥38 kg/m2 for females ) . Measures of general health perceptions ( general health rating index ; current health ) , mental well-being ( mood adjective check list ; pleasantness , activation and calmness ) , mood disorders ( hospital anxiety and depression scale ; anxiety and depression ) and social interaction ( sickness impact profile ) , were supplemented by obesity-specific modules on obesity-related psychosocial problems and eating behavior ( three-factor eating question naire ; restrained eating , disinhibition and perceived hunger ) . Assessment s were conducted prior to treatment and repeated after 6 , 12 and 24 months . RESULTS : Poor HRQL before intervention was dramatically improved after gastric restriction surgery , while only minor fluctuations in HRQL scores were observed in the conventionally treated controls . Peak values were observed in the surgical group at 6 or 12 months after intervention with a slight to moderate decrease at the two-year follow-up . The positive changes in HRQL after two years were related to the magnitude of weight loss , that is , the greater the weight reduction , the greater the HRQL improvements . Eating behavior improved accordingly . CONCLUSION : Quality of life in the severely obese is improved by substantial weight loss . Most patients benefit from weight reduction surgery , while HRQL in surgical patients with minor reduction in overweight is less positive . Further research is needed to determine outcome predictors of the surgical management of severe obesity and to ensure that HRQL improvements are maintained BACKGROUND Few long-term reports with high rates of follow-up are available after  gastric bypass .  We report changes in weight , co-morbidity , cardiovascular risk , and health-related quality of life ( HRQoL ) 5 years after gastric bypass .  METHODS Patients who had gastric bypass ( 2004 - 2006 ) were included . Prospect i ve data were review ed . Long-term complications , cardiovascular risk factors , and HRQoL were evaluated , and the 10-year risk for coronary heart disease was estimated ( Framingham risk score ) . Outcomes were compared in patients with body mass index ( BMI ) < 50 and ≥50 kg/m(2 ) . RESULTS A total of 184 of 203 patients ( 91 % ) met to follow-up . The mean ± SD preoperative BMI was 46 ± 5 kg/m(2 ) , and the mean ± SD age was 38 ± 9 years ; 75 % were women . Thirty-two percent of the patients had a BMI ≥50 kg/m(2 ) , and 30 % had type 2 diabetes . Follow-up was 63 ± 5 months . After 5 years , total weight loss was 27 % ± 11 % . Remission of type 2 diabetes had occurred in 67 % . The prevalence of hypertension , dyslipidemia , sleep apnea , and metabolic syndrome had decreased . HRQoL was improved . The Framingham risk score was reduced ( 5.6 % versus 4.6 % ; P = .021 ) . Sixty-one patients ( 33 % ) had long-term complications , most commonly chronic abdominal pain ( 10 % ) . BMI was 33 ± 5 and 37 ± 7 kg/m(2 ) in patients with preoperative BMI < 50 and ≥50 kg/m(2 ) , but changes in metabolic , cardiovascular risk profile and HRQoL were broadly similar . CONCLUSIONS Beneficial effects on weight loss , cardiovascular risk , and HRQoL were documented 5 years after gastric bypass in morbidly and super-obese patients OBJECTIVE To evaluate the private third-party payer return on investment for  bariatric surgery the United States . STUDY DESIGN Morbidly obese patients aged 18 years or older were identified in an employer cl aims data base of more than 5 million beneficiaries ( 1999 - 2005 ) using International Classification of Diseases , Ninth Revision , Clinical Modification code 278.01 . Each of 3651 patients who underwent bariatric surgery during this period was matched to a control subject who was morbidly obese and never underwent bariatric surgery . Bariatric surgery patients and controls were matched based on patient demographics , selected comorbidities , and costs . METHODS Total healthcare costs for bariatric surgery patients and their controls were recorded for 6 months before surgery through the end their continuous enrollment . To account for potential differences in patient characteristics , we calculated the cost differential by estimating a Tobit model . A return on investment was estimated from the result ing coefficients . Costs were inflation adjusted to 2005 US dollars using the Consumer Price Index for Medical Care , and the cost savings were discounted by 3.07 % , the month Treasury bill rate during the same period . RESULTS The mean bariatric surgery investment ranged from approximately $ 17,000 to $ 26,000 . After controlling for observable patient characteristics , we estimated all costs to have been recouped within 2 years for laparoscopic surgery patients and within 4 years for open surgery patients . CONCLUSIONS Downstream savings associated with bariatric surgery are estimated to offset the initial costs in 2 to 4 years . R and omized or quasiexperimental studies would be useful to confirm this conclusion , as unobserved characteristics may influence the decision to undergo surgery and can not be controlled for in this analysis BACKGROUND Physical , emotional , and social functioning are impaired in obesity . It is unknown whether and , if so , to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels . Our objective was to compare the health-related quality -of-life ( HRQL ) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric b and ing . METHODS An HRQL question naire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy , normal-weight subjects , matched for age , gender , education , and vocational training . In addition to weight loss and health gain , the influences of achieved weight loss goals , satisfaction with outcome and operative approach ( laparoscopy/laparotomy ) were assessed . RESULTS Quality -of-life was significantly impaired in obese subjects . With a substantial weight loss of 35 kg and 42 % loss of excessive weight , and correction of disturbed metabolic parameters , they significantly improved in general well-being , health distress , and perceived attractiveness , approaching halfway the values of a normal-weight reference group . Improvement in values for depression and self-regard lagged behind . In physical activity , they bypassed the reference group . Days of sick leave decreased to the level of the reference group . Improvements in HRQL paralleled the rate of weight loss . Personal satisfaction and surgical approach were of minor influence . CONCLUSIONS The obese subjects ' impaired physical and social functioning improved considerably , catching up midway to normal-weight reference values after weight loss . Psychologic amelioration lagged behind . Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies 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 Obesity is an increasing public health problem . A small number of studies have examined the relationship between obesity and sickness absence , with mixed results , particularly regarding short-term sickness absence . AIMS To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association . METHODS  Cross-sectional ( n = 1489 ) and prospect i ve ( n = 625 ) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured , obesity-related medical problems being diagnosed and psychiatric disorders being identified . The number of days taken for short- ( < 10 days in an episode ) and  long-term sickness absence  were recorded by managers on an electronic data base . RESULTS There was a positive linear association between employees '  body mass index ( BMI ) and the number of days ' work missed due to sickness absence on both cross-sectional and prospect i ve analyses ( P < 0.001 ) . Obesity was a risk factor for both short- and long-term sickness absence . Obese individuals typically took an extra 4 days sick leave every year . The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions . The excess short-term sickness absence was not explained by obesity-related medical problems , psychiatric disorders or workplace factors . CONCLUSIONS Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight . There is growing evidence to support employers becoming more involved in tackling obesity BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline Abstract Purpose : To examine the associations between medical , work-related , organizational and sociodemographic factors and job loss during sick leave in a Dutch population of 4132 employees on sick leave . Methods : Data were assessed by occupational health physicians ( OHPs ) on sociodemographic , medical , work-related and organizational factors . Odds ratios for job loss were calculated in logistic regression models . Results : Job loss during sick leave is associated with mental disorder , a history of sick leave due to these disorders , lack of co-worker and supervisor support , job insecurity and working as a civil servant or a teacher . Associations vary for gender and for company size . Conclusions : Job loss during sick leave is associated with medical , work-related , organizational and socio-demographic factors . The findings of this study might help the OHP or other health professionals involved in the management of employees on sick leave to identify those employees who are at risk for job loss during sick leave , and might help policymakers to decide on priorities in prevention and treatment . Future studies should have a longitudinal , prospect i ve design and include information about the type of contract , possible causes for job loss , severity and treatment of the disorder causing the sick leave . Implication s for Rehabilitation The labor market moves to more and more flexible and temporary contracts . This leads to more precarious types of employment . The risk of job loss during sick leave is associated with medical , work-related , organizational and sociodemographic factors . Occupational health physicians and other professionals in the field of work rehabilitation should be aware of these associations to prevent job loss due to these factors 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
target: However , the existing evidence does suggest that bariatric surgery has a generally positive impact on occupational outcomes .
  This suggests that surgery may have wider economic , social and psychological benefits above and beyond its immediate health benefits
background: Introduction Obesity has been linked with reduced productivity in the workplace and is associated with higher levels of unemployment and absenteeism .
  Studies have shown improvement in functioning and enhanced activity levels in patients after bariatric surgery .
  Objectives We perform a systematic review and meta- analysis of the literature to assess the impact of bariatric surgery on occupational outcomes .