title: US general population norms for telephone administration of the SF-36v2. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Influence of Reoperations on Long-Term Quality of Life After Restrictive Procedures: A Prospective Study Laparoscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Life at One Year Two-year changes in generic and obesity-specific quality of life after gastric bypass Female Pelvic Floor Symptoms Before and After Bariatric Surgery The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial 3-Year Real-World Outcomes with the Swedish Adjustable Gastric Band™ in France The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol Health related quality of life after gastric bypass or intensive lifestyle intervention: a controlled clinical study Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Evaluation of Gastric Bypass Patients 1 Year After Surgery: Changes in Quality of Life and Obesity-Related Conditions 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 Quality of Life After Laparoscopic Gastric Banding: Prospective Study (152 Cases) With a Follow-up of 2 Years Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity: A Prospective Randomized Controlled Clinical Trial Gastrointestinal Quality of Life Following Laparoscopic Vertical Banded Gastroplasty The Laparoscopic Adjustable Gastric Band (Lap-Band®): A Prospective Study of Medium-Term Effects on Weight, Health and Quality of Life A Prospective Randomized Trial of Placement of the Laparoscopic Adjustable Gastric Band: Comparison of the Perigastric and Pars Flaccida Pathways Changes in Urinary and Fecal Incontinence Symptoms With Weight Loss Surgery in Morbidly Obese Women Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison Prospective Longitudinal Assessment of Change in Health-Related Quality of Life After Adjustable Gastric Banding Efficacy, Safety, and Tolerance of Two Types of Intragastric Balloons Placed in Obese Subjects: A Double-Blind Comparative Study 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. Does Surgically Induced Weight Loss Improve Daytime Sleepiness? Health‐related quality of life after gastric banding Gastrointestinal Quality of Life Following Laparoscopic Adjustable Gastric Banding in Asia Treating morbid obesity with laparoscopic adjustable gastric banding. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. Relationship between Quality of Life and Weight Loss 1 Year after Gastric Bypass LAP-BAND for lower BMI: 2-year results from the multicenter pivotal study. Laparoscopic Gastric Banding in Over 60s
abstract: OBJECTIVE US general population norms for mail administration of the Medical Outcomes Study 36-Item Short Form Version 2 ( SF-36v2 ) were established in 1998 . This article reports SF-36v2 telephone-administered norms collected in 2005 - 2006 for adults aged 35 - 89 years . STUDY DESIGN AND SETTING The SF-36v2  was administered to 3,844 adults in the National Health Measurement Study ( NHMS ) , a r and om-digit dial telephone survey . Scale scores and physical and mental component summary ( PCS and MCS ) scores were computed . RESULTS When compared with 1998 norms ( mean=50.00 , st and ard deviation [SD]=10.00 ) , SF-36v2 scores for the 2005 - 2006 general population tended to be higher : physical functioning ( mean=50.68 , SD=14.48 ) ; role limitations due to physical health problems ( mean=49.47 , SD=14.71 ) ; bodily pain ( mean=50.66 , SD=16.28 ) ; general health perceptions ( mean=50.10 , SD=16.87 ) ; vitality ( mean=53.71 , SD=15.35 ) ; social functioning ( mean=51.37 , SD=13.93 ) ; role limitations due to emotional problems ( mean=51.44 , SD=13.93 ) ; mental health ( mean=54.27 , SD=13.28 ) ; PCS ( mean=49.22 , SD=15.13 ) ; MCS ( mean=53.78 , SD=13.14 ) . PCS and MCS factor scoring coefficients were similar to those previously reported for the 1998 norms . SF-36v2 norms for telephone administration were created . CONCLUSION The higher scores for NHMS data are likely due to the effect of telephone administration . The 2005 - 2006 norms can be used as a reference to interpret scale and component summary scores for telephone-administered surveys with the SF-36v2 OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention 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 Quality of life improves after  bariatric surgery .  However , long-term results and the influence of reoperations are not well known . A prospect i ve quality of life assessment before , 1 and 7 years after  laparoscopic adjustable gastric b and ing ( LAGB ) and vertical b and ed gastroplasty ( VBG )  was performed in order to determine the influence of reoperations during follow-up . One hundred patients were included in the study . Fifty patients underwent VBG and 50 LAGB .  Patients completed the  quality of life question  naires prior to surgery and two times during follow-up . Health-related quality of life ( HRQoL ) question naires included the Nottingham Health Profile I and II and the Sickness Impact Profile 68 . Follow-up was 84 % with a mean duration of 84 months ( 7 years ) . During follow-up , 65 % of VBG patients underwent conversion to Roux-en-Y gastric bypass while 44 % of LAGB patients underwent a reoperation or conversion . One year after the procedure , nearly all quality -of-life parameters significantly improved . After 7 years , the Nottingham Health Profile (NHP)-I domain “ physical ability ” , the NHP-II and the SIP-68 domains “ mobility control ” , “ social behavior ” , and “ mobility range ” were still significantly improved in both groups . The domains “ emotional reaction ” , “ social isolation ” ( NHP-I ) , and “ emotional stability ” ( SIP-68 ) remained significantly improved in the VBG group while this was true for the domain “ energy level ” ( NHP-I ) in the LAGB group . Both the type of procedure and reoperations during follow-up were not of significant influence on the HRQoL results . Weight loss and decrease in comorbidities were the only significant factors influencing quality of life . Restrictive bariatric surgery improves quality of life . Although results are most impressive 1 year after surgery , the improvement remains significant after long-term follow-up . Postoperative quality of life is mainly dependent on weight loss and decrease in comorbidities and not on the type of procedure or surgical complications 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 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 Obesity is a risk factor for female pelvic floor disorders . The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery . Methods This was a prospect i ve cohort study of female patients that underwent bariatric surgery .  Patients completed a demographic question naire , the Pelvic Floor Distress Inventory-20 ( PFDI-20 ) , and the Pelvic Floor Impact Question naire-7 ( PFIQ-7 ) before surgery and at 6 and 12 months following surgery . Body mass index ( BMI ) was compared between time points using Student ’s t tests ( P < 0.05 significant ) . Symptom and impact on quality of life prevalence were compared using McNemar ’s test and question naire scores were compared using the Wilcoxon matched pairs test ( P < 0.025 significant ) . Results At 12 months after surgery , 63 patients had completed the study . Even with significant weight loss ( BMI , 43.7 kg/m2 to BMI , 29 kg/m2 ; P < 0.001 ) , there was no significant difference in the prevalence of pelvic floor symptoms before and after surgery ( 94 % to 81 % , P = 0.2 ) . Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery ( 56 % to 30 % ; P = 0.004 ) . Baseline PFDI-20 and PFIQ-7 scores were low ; however , there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery ( P < 0.001 ) . Conclusions Prevalence of pelvic floor symptoms did not vary greatly after surgery ; however , significant weight reduction did improve the degree of bother and quality of life related to these symptoms Background The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service ( BRS ) on  patient weight loss following bariatric surgery  at 1 year . Methods A single-site open-r and omised parallel group control trial based at St. Richard ’s Hospital in Chichester in the UK . Patients ( n = 162 ) were recruited immediately prior to Roux-en-Y gastric bypass  and r and omly allocated to receive either treatment as usual ( n = 80 ) or the BRS ( n = 82 ) . The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information , support and mentoring pre and post surgery addressing psychological issues such as dietary control , self esteem , coping and emotional eating . Weight loss was assessed at 1 year . The key outcome variable was BMI and change in BMI . Results Follow-up weight was available for 145 patients . Intention-to-treat analysis ( n = 162 ) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49 . There was no significant difference between the two groups ( control group = −16.37 , 95 % CI = 15.15–17.57 ; intervention = −16.6 , 95 % CI = 15.42–17.81 ; ηp2 = 0.001 ) . Similarly , explanatory analysis ( n = 145 ) showed a mean change in BMI of −17.17 . The difference between the two groups was not significant ( control group = −16.9 , 95 % CI = 15.78–18.18 ; intervention = −17.35 , 95 % CI = 18.5–16.16 ; ηp2 = 0.001 ) . Conclusions Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year . It is argued that psychological support should be targeted to patients who start to demonstrate  weight regain at a later stage . Trial registration : Clinical Trials.gov NCT01264120 The study objective was to ascertain outcomes with the  Swedish adjustable gastric b and ( SAGB ) on an intention-to-treat basis in multiple centers across the French social health insurance system .  SAGB results at 3-year follow-up are reported . The noncomparative , observational , prospect i ve , consecutive cohort study design sought a 500-patient minimum recruitment geographically representative of continental France .  Safety ( adverse events [ AEs ] , device-related morbidity , and mortality ) and effectiveness ( change in body mass index [ BMI , kilograms per square meter ] , percentage excess weight loss , comorbidities , quality of life [ QoL ] ) were assessed . Adjustable gastric b and survival was calculated . Thirty-one surgeons in 28 multidisciplinary teams/sites enrolled patients between September 2 , 2007 and April 30 , 2008 . SAGB was successfully implanted in 517 patients : 88.0 % female ; mean age , 37.5 years ; obesity duration , 15.3 years ( baseline : mean BMI , 41.0 ; comorbidities , 773 in 74.3 % of patients ; Bariatric Analysis and Reporting Outcome System ( BAROS ) , 1.4 ; EuroQoL 5-Dimensions ( EQ-5D ) , 0.61 ; EuroQoL – visual analog scale ( EQ – VAS ) , 52.3 ) . At 3 years : BMI , 32.2 ( mean change , −9.0 ; p < 0.0001 ) ; excess weight loss , 47.4 % ; comorbidities , 161 in 27.2 % ; BAROS , 3.6 ( + 2.2 , p < 0.0001 ) ; EQ-5D , 0.84 ( + 0.22 , p < 0.0001 ) ; EQ – VAS , 73.4 ( + 21.4 , p < 0.0001 ) . SAGB-induced weight loss was associated with substantially improved QoL. One death occurred and was unrelated to the treatment . No AE was reported in 68.3 % of patients , and no confirmed device-related AE in 77.0 % . Overall AE rate was 0.19 per patient year . Device retention was 87.0 % . Analysis of patients lost to follow-up showed a nonsignificant effect on overall study results . In a prospect i ve , consecutive cohort , “ real-world ” , nationwide study , the Swedish Adjustable Gastric B and was found safe and effective at 3-year follow-up Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 ( or 35 with co morbidities ) . A minority of patients , however , either do not show the desired loss of excess weight or show weight regain by follow up . Research highlights some of the reasons for this variability , most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body , psychological issues relating to dietary control , self esteem , coping and emotional eating remain neglected . The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service ( BRS ) on patient health outcomes . The bariatric rehabilitation service will provide information , support and mentoring pre and post surgery and will address psychological issues such as dietary control , self esteem , coping and emotional eating . The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes . Methods / Design The study is a r and omised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery . Follow up measures of weight loss and psychological issues will be taken at baseline ( 2 weeks preoperatively ) , 3 , 6 and 12 months postoperatively . The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups ( BOSPA & WLSinfo ) . This study will take place in St Richard 's Hospital in Chichester in the UK . Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life , dietary control , self esteem , coping and emotional eating . This also has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term . Trial registration Clinical Trials.gov NCT01264120 Background 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 BACKGROUND  Gastric restrictive surgery  induces a marked change in eating behavior . However , the relationship between preoperative and postoperative eating behavior and weight loss outcome has received limited attention . OBJECTIVE This study assessed a range of eating behaviors before and 1 year after laparoscopic adjustable gastric b and ing ( LAGB )  and explored the nature and extent of change in eating patterns , their clinical associates , and impact on weight loss . METHODS AND PROCEDURES A 12-month observational study assessed presurgical and postsurgical binge eating disorder ( BED ) , uncontrolled eating , night eating syndrome ( NES ) , grazing , nutrient intake and eating-related behaviors , and markers of psychological distress .  A total of 129 subjects ( 26 male and 103 female , mean age 45.2 + /- 11.5 and BMI 44.3 + /- 6.8 ) participated in this study . RESULTS Presurgical BED , uncontrolled eating , and NES occurred in 14 % , 31 % , and 17.1 % of subjects , which reduced after surgery to 3.1 % , 22.5 % , and 7.8 % , respectively ( P = 0.05 for all ) . Grazing was prevalent before ( 26.3 % ) and after surgery ( 38.0 % ) . Preoperative BED most frequently became grazers ( P = 0.029 ) . The average percentage weight loss ( % WL ) was 20.8 + /- 8.5 % ; range -0.67 to 50.0 % and percentage of excess weight loss ( % EWL ) 50.0 + /- 20.7 % ; range -1.44 to 106.9 % ( P < 0.001 ) . Uncontrolled eating and grazing after surgery showed high overlap and were associated with poorer % WL ( P = 0.008 and P < 0.001 , respectively ) and elevated psychological distress . DISCUSSION Consistent with recent studies , uncontrolled eating and grazing were identified as two high-risk eating patterns after surgery . Clearer characterization of favorable and unfavorable postsurgical eating behaviors , reliable methods to assess their presence , and empirically tested postsurgical intervention strategies are required to optimize weight loss outcomes and facilitate psychological well-being in at-risk groups Background Obesity has recently been cited as the number one killer in the USA . This problem is both a national and regional epidemic . The health care costs of obesity and obesity-related illnesses are ever increasing , and gastric bypass surgery is becoming a popular treatment strategy . Recently , reports describe not only surgical outcomes , but also quality of life outcomes . The bigger issue of obesity-related illness resolution is still evolving . Our institution has performed well over 500 gastric bypasses since 2002 . We evaluated over 100 patients prior to and 1 year after gastric bypass surgery .  Methods A prospect i ve study was design ed in order to systematic ally examine quality of life in  gastric bypass patients and couple the results with both objective and subjective assessment of bariatric surgery outcomes . One hundred nineteen patients undergoing gastric bypass at our institution from January 2005 to December of 2005 were enrolled in the study . In addition to routine preprocedural and postprocedural follow-up , completion of  quality of life  forms and anthropometric measurements were performed . Using these data , we then correlated the change in quality of life scores with social factors , weight loss success , and status of obesity-related conditions . We also examined the impact of alcohol intake and other demographic factors on both quality of life and obesity related conditions . Results A total of 119 patients were enrolled in the study during the calendar year 2005 . Follow-up at approximately 1 year ( average 12.86 months ) postsurgery was obtained in 75 patients . A significant reduction in weight ( 144.4 ± 34.4 vs. 91.5 ± 28.8 ; p < 0.0001 ) , body mass index ( 52.4 ± 12.2 vs. 32.3 ± 8.6 ; p < 0.0001 ) , mean systolic blood pressure ( 140.4 ± 14.7 vs. 130.0 ± 21.7 ; p < 0.001 ) , and lipids ( 194.3 ± 33.8 vs. 165.7 ± 32.1 ; p < 0.0001 ) was noted . Quality of life scores 1 year after gastric bypass surgery were also significantly improved ( 35.9 ± 19.5 vs. 82.2 ± 23.5 ; p < 0.0001 ) . There was also a significant reduction in the reported usage of medications for obesity related conditions . Various measures of success ( change in BMI , change in quality of life scores , and follow up health ranking ) were compared across demographic and social factors and no significant associations were identified . Conclusions Gastric bypass is associated with a reduction in weight , BMI , mean systolic blood pressure , cholesterol , and the usage of medications for obesity-related conditions . A significant improvement in quality of life was also noted 1 year after surgery 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 To evaluate influence of laparoscopic gastric b and ing ( LGB ) on quality of life ( QOL ) in patients with morbid obesity .  Laparoscopic adjustable gastric b and ing is a popular bariatric operation in Europe . The objectives of surgical therapy in patients with morbid obesity are reduction of body weight , and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients . In a prospect i ve clinical trial , development of the individual patient QOL was analyzed , after LGB in patients with morbid obesity . From October 1999 to January 2001 , 152 patients [ 119 women , 33 men , mean age 38.4 y ( range 24 to 62 ) , mean body mass index 44.3 ( range 38 to 63 ) ] underwent evaluation for LGB  according the following protocol : history of obesity ; concise counseling of patients and relative on nonsurgical treatment alternatives , risk of surgery , psychologic testing , question naire for eating habits , necessity of lifestyle change after surgery ; medical evaluation including endocrinologic and nutritionist work-up , upper GI endoscopy , evaluation of QOL using the Gastro Intestinal Quality of Life Index ( GIQLI ) . Decision for surgery was a multidisciplinay consensus . This group was follow-up at least 2 years , focusing on weight loss and QOL . Mean operative time was 82 minutes ; mean hospital stay was 2.3 days and the mean follow-up period was 34 months . The BMI dropped from 44.3 to 29.6 kg/m2 and all comorbid conditions improved markedly : diabetes melitus resolved in 71 % of the patients , hypertension in 33 % , and sleep apnea in 90 % . However , 26 patients ( 17 % ) had late complications requiring reoperation . Preoperative global GIQLI score was 95 ( range 56 to 140 ) , significant different of the healthy volonteers score ( 120 ) ( 70 to 140 ) P<0.001 . Correlated with weight loss ( percentage loss of overweight and BMI ) , the global score of the group increased to 100 at 3 months , 104 at 6 , 111 at 1 year to reach 119 at 2 years which is no significant different of healthy patients . Analyzing the subscale , physical condition , emotional status , and social integration increased significantly ( P<0.001 ) from preoperative to end of follow-up . Digestive symptoms were not modified . In case of failure of the procedure ( 10.5 % ) global Giqli score is not modified . Patients who have required successfull revisional surgery for late complications ( 6.5 % ) have an excellent QOL outcome that are not different from the whole group . Together with a satisfactory reduction of the excess overweight , laparoscopic gastric b and ing may lead in a carefully selected population of patients with morbid obesity to a significant improvment of patient QOL , in at least 2 years follow-up Background Laparoscopic sleeve gastrectomy ( LSG ) is a promising procedure for the surgical treatment of morbid obesity . We report our 2-year experience with LSG and specifically evaluate the importance of staple-line protection to prevent leakage after the laparoscopic procedure . Methods One hundred eighteen consecutive patients with BMI > 30 who underwent LSG from January 2006 to February 2009 were included in our study . There were 88 women and 30 men with a mean age of 33.2 ± 9.6 years and a mean BMI of 38.0 ± 6.4 kg/m2 . The first 40 patients ( group 1 ) underwent the operation without any reinforcement procedure and the other 78 patients received reinforcement of the staple-line ( group 2 ) . Data including demographics , hospital stay , blood loss , operative time , complications , excess weight loss percentage ( EWL% ) , and gastrointestinal quality of life index ( GIQLI ) were collected prospect ively for evaluation . Results The overall mean operative time was 118.5 ± 37.0 min , mean blood loss was 56.8 ± 56.7 ml , mean hospital stay was 5 ± 3 days . The mean EWL% at 12 and 24 months was 81.5 and 76.0 % , respectively . The overall leakage rate was 3.39 % ( 4/118 ) . All leakage occurred in group 1 patients , with a leakage rate of 10 % ( 4/40 ) . Mean preoperative GIQLI was 98.7 , and the postoperative GIQLI were 116.4 , 115 , 112.4 , and 97.6 at 3 , 6 , 12 , and 24 months , respectively . Conclusions LSG is an effective obesity treatment to achieve significant weight loss after 24 months . Staple-line reinforcement is strongly recommended for laparoscopic sleeve gastrectomy to decrease complications Objectives : This prospect i ve , r and omized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) and laparoscopic mini-gastric bypass ( LMGBP ) in the treatment of morbid obesity . Summary Background Data : LRYGBP has been the gold st and ard for the treatment of morbid obesity . While LMGBP has been reported to be a simple and effective treatment , data from a r and omized trial are lacking . Methods : Eighty patients who met the NIH criteria were recruited and r and omized to receive either LRYGBP ( n = 40 ) or LMGBP ( n = 40 ) . The minimum postoperative follow-up was 2 years ( mean , 31.3 months ) . Perioperative data were assessed . Late complication , excess weight loss , BMI , quality of life , and comorbidities were determined . Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index ( GIQLI ) . Results : There was one conversion ( 2.5 % ) in the LRYGBP group . Operation time was shorter in LMGBP group ( 205 versus 148 , P < 0.05 ) . There was no mortality in each group . The operative morbidity rate was higher in the LRYGBP group ( 20 % versus 7.5 % , P < 0.05 ) . The late complications rate was the same in the 2 groups ( 7.5 % ) with no reoperation . The percentage of excess weight loss was 58.7 % and 60.0 % at 1 and 2 years , respectively , in the LPYGBP group , and 64.9 % and 64.4 % in the LMGBP group . The residual excess weight < 50 % at 2 years postoperatively was achieved in 75 % of patients in the LRYGBP group and 95 % in the LMGBP group ( P < 0.05 ) . A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted . Both gastrointestinal quality of life increased significantly without any significant difference between the groups . Conclusion : Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life .  LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up 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 : Obesity is now one of our major public health problems . Effective and acceptable treatment options are needed . The Lap-B and ® system is placed laparoscopically and allows adjustment of the level of gastric restriction . Methods : A prospect i ve study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center . After extensive preoperative evaluation , patients with a body mass index > 35 were treated by  LapB and ® placement . Close follow-up with progressive adjustment of gastric restriction continued permanently . Medical co-morbidities were monitored as part of comprehensive prospect i ve data collection . Results : There have been no deaths perioperatively or during follow-up . Significant perioperative adverse events occurred in 1.2 % only . Reoperation has been needed for prolapse ( slippage ) in 12.5 % , erosion of the b and into the stomach in 2.8 % and for tubing breaks in 3.6 % . A steady progression of weight loss has occurred through the duration of the study with 52 ± 19 % EWL at 24 months ( n=333 ) , 53±22 % EWL at 36 months ( n=264 ) , 52 ± 24 % EWL at 48 months ( n=108 ) , 54 ± 24 % EWL at 60 months ( n=30 ) , and 57 ± 15 % EWL at 72 months ( n=10 ) . Major improvements have occurred in diabetes , asthma , gastroesophageal reflux , dyslipidemia , sleep apnea and depression . Quality of life as measured by R and SF-36 shows highly significant improvement . Conclusions : Placement of the Lap-B and ® system provides safe and effective control of severe obesity . The effect on weight loss is durable and is associated with major improvement in health and quality of life . It has the potential to provide a broadly acceptable option for this common and serious disease 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 examine changes in the prevalence and severity of urinary incontinence ( UI ) and fecal incontinence in morbidly obese women undergoing laparoscopic weight loss surgery .  METHODS : In a prospect i ve cohort study , 101 women ( aged 20–55 years ) with body mass index ( BMI ) of 40 or more underwent laparoscopic Roux-en-Y gastric bypass  and were followed to 6 and 12 months . Presence , severity , and effect of UI were assessed using the Medical , Epidemiological , and Social Aspects of Aging Question naire , Urogenital Distress Inventory , and Incontinence Impact Question naire . Fecal incontinence was assessed by self-report of anal leakage . RESULTS : Mean BMI decreased from 48.9±7.2 presurgery to 35.3±6.5 at 6 months and 30.2±5.7 at 12 months postsurgery . Prevalence of UI decreased from 66.7 % presurgery to 41.0 % at 6 months and 37.0 % at 12 months ( P<.001 ; 95 % confidence interval [ CI ] for change 18.6–40.0 % ) . Reduction in prevalence of UI was significantly associated with decreases in BMI ( P=.01 ) . Among incontinent women who lost 18 or more BMI points , 71 % regained urinary continence at 12 months . Medical , Epidemiological , and Social Aspects of Aging Question naire urge and stress scores decreased ( both P<.001 ; 95 % CI 0.5–1.85 and 2.71–5.34 , respectively ) , as did scores on the Urogenital Distress Inventory ( P<.001 ; 95 % CI 8.31–16.21 ) and Incontinence Impact Question naire ( P<.001 ; 95 % CI 4.71–14.60 ) , indicating reduction in severity . Prevalence of fecal incontinence ( solid or liquid stool ) decreased from 19.4 % to 9.1 % at 6 months and 8.6 % at 12 months ( P=.018 ; 95 % CI 2.1–19.4 % ) . CONCLUSION : Prevalence of UI and fecal incontinence decreased after bariatric surgery . Magnitude of weight loss was associated with reduction in UI prevalence , strengthening the inference that improvements are attributable to weight loss . LEVEL OF EVIDENCE : Background : Vertical b and ed gastroplasty ( VBG ) and gastric bypass ( GBP ) are the two bariatric procedures recommended by NIH consensus conference . Recent advancement in laparoscopic ( L ) techniques has made LVBG and LGBP alternatives for the conventional open approach . Methods : From December 2000 to February 2002 , 80 patients ( 24 men and 56 women ; mean age 32 years , range 18 - 57 ) with morbid obesity ( mean BMI 43.2 kg/m2 , range 36 - 59.8 ) were enrolled in a prospect i ve trial and r and omly assigned to LVBG or LGBP .  Changes in quality of life were assessed using the Gastro-intestinal quality of life index ( GIQLI ) . Results : The conversion rate was zero for LVBG and 2.5 % ( 1/40 ) for LGBP . There has been no mortality . Surgical time was significantly longer for LGBP ( 209 minvs 126 min for LVBG , P<0.001).Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP ( P<0.001 ) . Postoperative analgesic usage was also less for LVBG patients ( mean dose 1.4 vs 2.4 , P<0.05 ) . Early complication rate was higher in the LGBP group ( 17.8 % vs 2.5 % , P<0.001 ) . All 3 major complications were in the LGBP group , of which 2 were related to anastomotic leakage ( 5 % ) . Late complications consisted of upper GI bleeding , stenosis and others observed in 4 LGBP patients ( 10 % ) and 2 LVBG patients ( 5 % ) . Mean follow-up was 20 months ( range 18 to 30 ) . BMI fell significantly in both groups , with significant improvement of obesity-related co-morbidities . LGBP had significantly better excess weight loss than LVBG ( 62.9 % vs 55.4 % at 1 year and 71.4 % vs 53.1 % at 2 years ) , as well as lower BMI than LVBG ( 29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years ) . There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP ( 11.8 vs 13.8 , P<0.05 ) . Preoperative GIQLI scores were similar between the groups ; however , at 1 year , LGBP patients had better GIOLI scores than LVBG patients ( 121 vs 106 , P<0.01 ) . LVBG had improvement in physical condition , social function and emotional conditioning but deterioration in GI symptoms which result ed in no increase in total GIQLI score . Conclusion : LGBP was a time-consuming dem and ing technique with a higher early complication rate compared with LVBG . Although both operations result ed in significant weight reduction and decrease in obesity-related co-morbidities , LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state . Each patient should be individualized for the operations according to the patient 's decision Background Gastric b and ing remains a common procedure worldwide . Improving health-related quality of life ( HRQOL ) has become a major goal in the treatment of patients with chronic diseases , yet there are few comprehensive data regarding the effect of gastric b and ing on HRQOL . The aim of this study was to evaluate the impact of laparoscopic gastric b and ing on HRQOL with particular regard to change over time . Methods The 262 consecutive patients included between May 2005 and September 2006 in a French multicenter prospect i ve study design ed to assess the safety and efficacy of a  gastric b and were asked to complete the SF36 question naire preoperatively and each 6 months during 3 years . The HRQOL scores were compared with community norms , and their longitudinal change was assessed using cross-sectional analysis and mixed-effects linear modeling ( individual growth model ) . Results One hundred sixty-four patients ( 63 % ) provided a preoperative and at least one postoperative SF-36 question naire from 12 to 36 months and form the basis of the present study . In all dimensions , the scores of HRQOL were significantly impaired preoperatively and were significantly improved at 3 years . The increase in HRQOL scores was most marked during the first postoperative months ; it continued more slowly after 6 months and stabilized after 1 year . The improvement in HRQOL was associated with the decrease in BMI , in all dimensions . Conclusion Gastric b and ing results in a significant improvement in HRQOL . A return to normal can be expected at 1 year and persists at 3 years . The postoperative improvement in HRQOL is strongly related to weight loss The intragastric balloon is a temporary treatment for obese patients . Fluid-filled devices have shown efficacy and safety , and are widely used . Recently , although there are no comparative studies between them , an air-filled balloon , Heliosphere ® bag , has been proposed . Prospect i ve , double-blind study in 33 patients with morbid and type 2 obesity : 23 female , 43.9 ± 10 years , 120.3 ± 17 kg , and body mass index ( BMI ) of 44.2 ± 5 kg/m2 , placing 18 gastric balloons filled with 960 cm3 of air ( Heliosphere ® bag ) or 15 balloons filled with 700 ml of saline ( Bioenterics-BIB ® ) . Both balloons were placed with conscious sedation and removed under general anesthesia 6 months later . Intravenous drugs were given to control symptoms for 48 h. Patients were sent home on a 1000-kcal diet , multivitamin supplements , and oral proton pump inhibitors , and were followed monthly . Complications , symptoms , weight , and quality of life evaluated by the Gastrointestinal Quality of Life Index ( GIQLI ) scale were recorded . At 6 months , mean weight loss ( 12.8 ± 8 vs 14.1 ± 8 kg ) , BMI loss ( 4.6 ± 3 vs 5.5 ± 3 kg/m2 ) and percent excess weight loss ( 27 ± 16 vs.30.2 ± 17 ) showed no significant differences between both groups . At removal , two Heliosphere ® bags were not found in the stomach , and four patients required extraction of the balloon by rigid esophagoscopy or surgery ( p = 0.02 ) . Tolerance was good in both groups , but early removal occurred in three BIB ® ( 20 % ) due to vomits and dehydration . The GIQLI total scores remained unchanged . Both balloons achieve a significant weight loss with good tolerance in obese patients .  Nevertheless , Heliosphere ® bag has severe technical problems that need to be solved before recommending it 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 Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life . We prospect ively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale ( ESS ) and the Short Form-12 . Participants ( n = 223 ; 79 % women ) with a mean body mass index ( BMI ) and ESS of 44.8 ± 7.9 kg/m2 and 7.9 ± 4.5 , respectively , received a vertical gastrectomy ( 76 % ) or Roux-en-Y gastric bypass ( 12 % ) . Preoperatively , 30 % of patients complained of excessive daytime sleepiness ( ESS > 10 ) . Patients with preoperative excessive daytime sleepiness were more obese ( p = 0.002 ) , had higher fasting glucose levels ( p = 0.02 ) , more likely to have a diagnosis of sleep-disordered breathing ( p < 0.001 ) , report snoring ( p < 0.001 ) , and had lower health-related quality of life measures particularly physical function ( p < 0.001 ) , depression ( p = 0.006 ) , and sexual satisfaction ( p = 0.04 ) than non-sleepy patients . At 12-months postoperatively , most patients experienced a significant reduction in BMI ( 28.6 ± 5.5 kg/m2 , p < 0.001 ) and excessive daytime sleepiness ( mean ESS 5.3 ± 3.3 , p < 0.001 ) . Patients with a clinical ly relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function ( p = 0.009 ) and snoring ( p = 0.010 ) and were more likely still using positive airway pressure therapy ( p = 0.032 ) than patients without a clinical ly relevant improvement . Statistically and clinical ly significant improvements in all health-related quality of life measures were noted at 24 months . Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness Bariatric surgery ameliorates  obesity‐associated diseases  , result ing in psychological and social benefits . Long‐term studies of its effects on quality of life ( QOL ) assessed with well established instruments are lacking . This prospect i ve study investigated the long‐term effects of  gastric b and ing  on health‐related QOL using an obesity‐specific vali date d measure Background : Laparoscopic adjustable gastric b and ing ( LAGB ) is a safe and effective treatment for morbid obesity . Previous studies in Western countries disclosed a significant improvement in co-morbidities and health-related quality of life . Data from Asia and regarding the specific GI quality of life following LAGB are lacking . Methods : From May 2002 to May 2005 , 107 consecutive patients – 48 men and 59 women , with mean age 31.4 years ( range 17 - 57 years ) with morbid obesity ( mean weight 115.8 kg , range 81 - 174 kg ; mean BMI 41.3 kg/m2 , range 32.0 - 59.8 kg/m2 ) underwent LAGB in a prospect i ve trial . All b and s were placed via the pars flaccida technique .  Quality of life was measured by the Gastrointestinal Quality of Life Index ( GIQLI ) , a 36item question naire before LAGB , and at 3 , 6 , 12 and 24 months after surgery . Results : All procedures were performed laparoscopically with no conversions . There was neither intra-operative complications nor major postoperative complications . Minor complications occurred in 3 patients ( 2.8 % ) ; all were transient stoma obstruction . At follow-up , only one b and ( 0.94 % ) was removed at 3 months postoperatively because of the patient 's intolerance . No gastric slippage occurred . 4 patients ( 3.7 % ) had tubing problems and required revision surgery for port adjustment . Mean BMI decreased from 41.3 to 33.1 after 2 years . Percent excess BMI loss averaged 48.1 % at 2 years ( range 6.7 - 139.2 ) . All co-morbidities were eliminated significantly . 80 % of patients were satisfied with the results at 2 years . However , the GIQLI score remained similar before and after surgery . Preoperative score was 110.8 + 15 points . The score became 116.2 + 13 , 114.7 + 13 , 108.5 + 14 and 107.2 + 17 at 3 , 6 , 12 and 24 months . The patients had improvement in 3 domains of general health ( social , physical and emotional functions ) , but decrease in the domain of symptoms . Conclusion : Although LAGB was successful in weight loss and resolution of co-morbidities in morbidly obese patients , the GIQLI did not improve . This feature will be the major disadvantage of LAGB BACKGROUND Morbid obesity results in multiple comorbidities and an increased mortality rate . The National Institutes of Health has stated that surgery is the most effective long-term therapy ; therefore , we evaluated a laparoscopically implantable adjustable gastric b and . METHODS We review ed 2 multicenter prospect i ve , open-label , single-arm surgical trials -- trial A ( 3 years ) and trial B ( 1 year)--with ongoing safety follow-up . These trials were conducted in United States community and university hospitals ( trial A = 8 sites and trial B = 12 sites ) . Trial A comprised 292 subjects ( mean + /- SD preoperative weight : 133 kg + /- 24.4 ) , and trial B comprised 193 subjects ( 129 kg + /- 20.8 ) . Intervention included placement of a constrictive , adjustable b and around the upper stomach to limit food intake and induce weight loss . Main outcome measures were the primary efficacy end point of weight loss . Secondary end-points were change in quality -of-life , safety parameters , and complications , including b and slippage , reoperation , and device explantation . RESULTS In the 2 trials , 485 devices were implanted ( 92 % laparoscopically ) , and no deaths occurred . Of the patients in trial A , 206 ( 70.5 % ) completed the 3-year follow-up , and 142 ( 73.6 % ) of patients in trial B completed the 1-year follow-up . Weight-loss results , using the last value carried forward , for all 292 patients in trial A and all 193 patients in trial B demonstrated a change in mean body mass index ( kg/m2 ) + /- SD from 47.4 + /- 7.0 to 39.0 + /- 7.3 in trial A and from 46.7 + /- 7.8 to 38.4 + /- 7.6 in trial B subjects at 1 year ( P < .001 for both trials A and B ) , with minimal further change at 3 years ( 39.0 + /- 8.5 ) in trial A subjects . The percentage of initial body weight lost at 1 year was 17.7 % + /- 9.4 % for trial A subjects and 18.2 % + /- 8.9 % for trial B subjects , whereas the 3-year total for trial A subjects was 18.3 % + /- 13.1 % . At 1 year , 76 % of patients in trial A and 66 % of patients in trial B had complications , mostly related to upper gastrointestinal symptoms . By 9 years after surgery , 33 % ( 96 of 292 ) of trial A subjects had their devices explanted because of complications or inadequate weight loss . CONCLUSIONS These first-generation implantable adjustable gastric b and results suggest that this is a viable bariatric surgery therapeutic option for the treatment of obesity OBJECTIVE This study examined the clinical significance of  loss of control ( LOC ) over eating in bariatric surgery patients over 24 months of prospect i ve , multiwave follow-ups . METHOD Three hundred sixty-one gastric bypass surgery patients completed a battery of assessment s before surgery and at 6 , 12 , and 24 months following surgery . In addition to weight loss and LOC over eating , the assessment s targeted eating disorder psychopathology , depression levels , and quality of life . The study was conducted between January 2002 and February 2008 . RESULTS Prior to surgery , 61 % of patients reported general LOC ; postsurgery , 31 % reported LOC at 6-month follow-up , 36 % reported LOC at 12-month follow-up , and 39 % reported LOC at 24-month follow-up . Preoperative LOC did not predict postoperative outcomes . In contrast , mixed models analyses revealed that postsurgery LOC was predictive of weight loss outcomes : patients with LOC postsurgery lost significantly less weight at 12-month ( 34.6 % vs 37.2 % BMI loss ) and 24-month ( 35.8 % vs 39.1 % BMI loss ) postsurgery follow-ups . Postsurgery LOC also significantly predicted eating disorder psychopathology , depression , and quality of life at 12- and 24-month postsurgery follow-ups . CONCLUSIONS Preoperative LOC does not appear to be a negative prognostic indicator for postsurgical outcomes . Postoperative LOC , however , significantly predicts poorer postsurgical weight loss and psychosocial outcomes at 12 and 24 months following surgery . Since LOC following bariatric surgery significantly predicts attenuated postsurgical improvements , it may signal a need for clinical attention 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 OBJECTIVE The goal of this study was to examine the safety and effectiveness of the LAP-B AND System for patients with 30 - 39.9 BMI and associated comorbidities . DESIGN AND METHODS In this prospect i ve , multicenter , interventional cohort study , subjects with a BMI between 30 and 39.9 who had failed prior weight loss attempts were recruited from 7 surgical centers . The primary effectiveness endpoint required that > 40 % of subjects achieve ≥30 % excess weight loss ( EWL ) at 1 year . Secondary endpoints included assessment of comorbidities and quality -of-life . RESULTS Of 149 subjects , 90.6 % were female , with mean BMI of 35.3 kg/m2 . At 1 year , 84.6 % of subjects achieved ≥30 % EWL ( P < 0.0001 ) , with 65.0 % mean EWL ; 66.4 % of subjects were no longer obese ( BMI < 30 ) . Baseline comorbidities improved at 1 year for 64.4 % with dyslipidemia , 59.6 % with hypertension , and 85.7 % with diabetes . Quality -of-life ( IWQOL-Lite ) also improved ( P < 0.0001 ) . The Year 1 results were maintained or improved at 2 years . Regression analysis indicates that each additional 10 % weight loss at Year 2 was associated with an increase in IWQOL-Lite by 7.1 points and a decrease in triglycerides by 13.7 mg/dL , fasting glucose by 3.5 mg/dL , and systolic blood pressure by 3.3 mmHg . Most adverse events were mild to moderate and resolved without sequelae within 1 month . Five subjects ( 3.4 % ) had explantations . CONCLUSION LAGB is safe and effective for people with 30 - 39.9 BMI , with weight loss and comorbidity improvement through at least 2 years Background The aggressive pursuit of weight loss in the elderly remains a controversial objective . In this series of 113 patients over 60 years of age who underwent laparoscopic gastric b and ing surgery  , we report on complications , co-morbidity change , quality -of-life improvement and changes in medication use over a median follow-up period of 25.5 months . Methods A prospect ively kept data base was review ed from January 1999 to September 2008 identifying patients over 60 who underwent gastric b and ing surgery .  Baseline and follow-up SF-36 ® survey scores were compared longitudinally . Co-morbidity change and medication use were assessed by question naire and electronic record review . Results Major complications were experienced by 7.1 % over the follow-up period with a re-operation rate of 15.0 % . Excess BMI loss was 44.1 % after 5 years and combined mean SF-36 ® quality -of-life scores ( out of 100 ) improved 22.1 points , achieving parity with age-matched norms for the general population . Diabetes improved in 74.2 % with hypertension , hyperlipidaemia and depression improving in 57.1 , 51.1 and 35.9 % of cases . A significant drop in medication use was not seen , and cancer was responsible for three deaths over the follow-up period . No surgical mortality was incurred . Conclusion Laparoscopic gastric b and ing can markedly improve quality of life for morbidly obese over 60s . Health gains are significant , but medication use is not substantially altered . Gastric b and ing is an ideal weight loss operation for this age group due to its safety and efficacy , and the primary goal should be quality -of-life improvement
target: The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 ( 95 % CI : 0.80 - 0.96 ) , indicating that bariatric surgery has a significant positive influence on quality of life in general .
  The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life .
  Bariatric surgery is effective in improving quality of life , especially when looking at physical well-being .
  Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people
background: This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between- study variation by examining the st and ardized mean magnitude of effect in change in the levels of quality of life .