Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Enhanced recovery after liver surgery. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Musculoskeletal function following bariatric surgery. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Improved memory function two years after bariatric surgery. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review Gender effect on vascular inflammation following bariatric surgery. Consequences of Small Intestinal Bacterial Overgrowth in Obese Patients Before and After Bariatric Surgery A comparison of functional brain changes associated with surgical versus behavioral weight loss Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity Changes in Testosterone Levels and Sex Hormone-Binding Globulin Levels in Extremely Obese Men after Bariatric Surgery Employment Outcomes One Year after Bariatric Surgery: the Role of Patient and Psychosocial Factors Inhibition of C-Reactive Protein in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol Decreased serum hepcidin and improved functional iron status 6 months after restrictive bariatric surgery. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4.
OBJECTIVE It is of vital importance to eluci date the triggering factors of obesity and type 2 diabetes to improve patient care . Bariatric surgery has been shown to prevent and even cure diabetes , but the mechanism is unknown . Elevated levels of lipopolysaccharide ( LPS ) predict incident diabetes , but the sources of LPS are not clarified . The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery .  RESEARCH DESIGN AND METHODS This was a prospect i ve observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls .  Main assessment s were plasma LPS , HbA1c , adipose tissue volumes ( computed tomography ) , and quantified bacterial DNA in adipose tissue compartments . RESULTS Plasma levels of LPS were elevated in obese individuals compared with controls ( P < 0.001 ) and were reduced after bariatric surgery ( P = 0.010 ) . LPS levels were closely correlated with HbA1c ( r = 0.56 ; P = 0.001 ) and intra-abdominal fat volumes ( r = 0.61 ; P < 0.001 ) , but only moderately correlated with subcutaneous fat volumes ( r = 0.33 ; P = 0.038 ) . Moreover , there was a decreasing gradient ( twofold ) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments ( P = 0.041 ) . Finally , reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c ( r = 0.85 ; P < 0.001 ) . CONCLUSIONS Our findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes , and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to , and even the result of , a reduction in plasma levels of LPS BACKGROUND Increased adipokine production and hyperfiltration may explain the links between obesity and chronic kidney disease . Indeed , hyperfiltration may precede a subsequent accelerated decline of kidney function in these patients . Glomerular filtration rate decreases after bariatric surgery in young obese patients with hyperfiltration . OBJECTIVE Our aim was to identify the factors associated with this decrease 1 year after bariatric surgery . SETTING We used data from a prospect i ve cohort of severely obese patients who underwent bariatric surgery in Nice University Hospital . METHODS We analyzed 175 patients before and 1 year after bariatric surgery .  Low- grade inflammation was evaluated by serum C-reactive protein levels . Lean body mass and fat body mass were estimated by bioelectric impedance analysis . Body surface area was assessed by the Du Bois formula . Serum creatinine levels were used to estimate glomerular filtration rate by the chronic kidney disease-epidemiology collaboration ( CKD-EPI ) equation . Glomerular filtration rate was de-adjusted from st and ard body surface area and then divided by lean body mass to calculate the decrease in hyperfiltration and to separate the patients into 2 groups : above or below the median decrease of hyperfiltration after bariatric surgery . RESULTS The factors associated with a large correction of hyperfiltration were baseline C-reactive protein levels ( 10.0 ± 5.8 mg/L versus 12.7 ± 7.4 mg/L , P = .01 ) and brachial circumference ( 41 ± 4 cm versus 44 ± 5 cm , P = .006 ) . A high fat mass reduction rate was significantly associated with a substantial hyperfiltration reduction after bariatric surgery ( P<.001 ) independently of sex and surgical procedure . CONCLUSIONS The correction of hyperfiltration is associated with a high reduction rate of fat mass after bariatric surgery but may be limited by low- grade inflammation INTRODUCTION In a majority of cases , enhanced recovery after surgery program ( ERP ) leads to a reduced rate of postoperative complications and shortened hospital stays following digestive surgery . The program 's preoperative , perioperative and postoperative measures are implemented by the members of a motivated multidisciplinary team . Having shown its merits in digestive surgery , ERP would be particularly useful in liver surgery due to the elevated rates of morbidity and mortality this type of operation continues to entail . The objective of this review was to evaluate the efficacy of ERP  in liver surgery . METHOD This is a systematic narrative review of the literature on the efficacy of ERP  in liver surgery by laparotomy or laparoscopy . RESULTS Notwithst and ing a number of studies ( n=30 : 5 r and omized trials , 14 cohort studies and 11 meta-analyses ) less sizable than with regard to digestive surgery in general and colorectal surgery in particular , analysis of the literature confirms that in liver surgery , ERP is associated with an overall decrease in complications by 30 to 60 % , but without improvement in the rates of hospital readmission and postoperative mortality . All of the studies report a reduction in average length of stay ( ALOS ) by 2.3 days and in functional recovery , a more objective indicator than ALOS , by 2.5 days . As of now , the economic impact of the ERP programs in liver surgery is neither positive nor negative , the above-mentioned savings being counterbalanced by heightened costs for material and equipment . Laparoscopic surgery is independently associated with better outcomes in terms of complications , functional recovery and ALOS ; that is why it is important to incorporate this surgical approach in ERP as often as possible . Given a lack of robust evidence , Prehabilitation , which is a preoperative optimization process leading to improved functional reserve , has yet to be assigned a place in ERP programs pertaining to liver surgery . Possible roadblocks to application of an ERP program can be overcome through coordination by a team leader , a motivated multidisciplinary team , training courses and dedicated teaching sessions . CONCLUSION ERP is a care improvement process that has a major play to play in organization of liver surgery , and its large-scale application is to be recommended Introduction Morbid obesity and obstructive sleep apnea ( OSA ) interact at an inflammatory level . Bariatric surgery reduces inflammatory responses associated with obesity . Heme oxygenase-1 ( HO-1 ) is an enzyme with anti-inflammatory properties , which might be increased in morbid obesity or OSA . We studied morbidly obese patients with OSA to determine : ( a ) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and ( b ) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation . Material and Methods We analyzed the homeostasis model insulin resistance index ( HOMA ) and plasma concentrations of HO-1 , tumor necrosis factor alpha , interleukin-6 , interleukin-1-beta , C reactive protein ( CRP ) , and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery  and 12 months after surgery . Results Before surgery , HO-1 plasma concentrations were similar in three groups of patients with mild , moderate , and severe OSA , and correlated with HOMA ( r = 0.27 , p = 0.02 ) . Twelve months after surgery , low- grade inflammation and insulin resistance had decreased in all the groups , but HO-1 plasma concentration had decreased only in the severe OSA group ( p = 0.02 ) . In this group , the reduction in HO-1 correlated with a reduction in CRP concentrations ( r = 0.43 , p = 0.04 ) and with improved HOMA score ( r = 0.37 , p = 0.03 ) . Conclusions Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA , and this decrease is associated with decreases in insulin resistance and in inflammation BACKGROUND Asthma in obese subjects is poorly understood , and these patients are often refractory to st and ard therapy . OBJECTIVES We sought to gain insights into the pathogenesis and treatment of asthma in obese subjects by determining how obesity and bariatric surgery affect asthma control , airway hyperresponsiveness ( AHR ) , and markers of asthmatic inflammation . METHODS We performed a prospect i ve study of ( 1 ) asthmatic and nonasthmatic patients undergoing bariatric surgery compared at baseline and ( 2 ) asthmatic patients followed for 12 months after bariatric surgery .  RESULTS We studied 23 asthmatic and 21 nonasthmatic patients undergoing bariatric surgery .  At baseline , asthmatic patients had lower FEV(1 ) and forced vital capacity and lower numbers of lymphocytes in bronchoalveolar lavage fluid . After surgery , asthmatic participants experienced significant improvements in asthma control ( asthma control score , 1.55 to 0.74 ; P < .0001 ) and asthma quality of life ( 4.87 to 5.87 , P < .0001 ) . Airways responsiveness to methacholine improved significantly ( methacholine PC(20 ) , 3.9 to 7.28 , P = .03 ) . There was a statistically significant interaction between IgE status and change in airways responsiveness ( P for interaction = .01 ) . The proportion of lymphocytes in bronchoalveolar lavage fluid and the production of cytokines from activated peripheral blood CD4(+ ) T cells increased significantly . CONCLUSIONS Bariatric surgery improves AHR in obese asthmatic patients with normal serum IgE levels . Weight loss has dichotomous effects on airway physiology and T-cell function typically involved in the pathogenesis of asthma , suggesting that obesity produces a unique phenotype of asthma that will require a distinct therapeutic approach 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 OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential BACKGROUND & AIMS Severe obesity is implicated in development of nonalcoholic fatty liver disease ( NAFLD ) . Bariatric surgery induces weight loss and increases survival time of obese patients , but little is known about its effects on liver damage . We performed a 5-year prospect i ve study to evaluate fibrosis and nonalcoholic steatosis ( NASH ) in severely obese patients after bariatric surgery .  METHODS  Bariatric surgery was performed on 381 patients . Clinical and biological data , along with liver biopsies , were collected before and at 1 and 5 years after surgery . RESULTS Five years after surgery , levels of fibrosis increased significantly , but 95.7 % of patients maintained a fibrosis score < or= F1 . The percentage of patients with steatosis decreased from 37.4 % before surgery to 16 % , the NAFLD score from 1.97 to 1 , ballooning from 0.2 to 0.1 . Inflammation remained unchanged . The percentage of patients with probable or definite NASH decreased significantly over 5 years , from 27.4 % to 14.2 % . The kinetics of insulin resistance ( IR ) paralleled that of steatosis and ballooning ; the greatest improvements occurred within the first year and were sustained 5 years later . Steatosis and ballooning occurred more frequently in patients with a refractory IR profile . In multivariate analysis , the refractory IR profile independently predicted the persistence of steatosis and ballooning 5 years later . CONCLUSIONS Five years after bariatric surgery for severe obesity , almost all patients had low levels of NAFLD , whereas fibrosis slightly increased . Steatosis and ballooning were closely linked to IR ; long-term effects could be predicted by early improvement in IR OBJECTIVE Obesity is as an independent risk factor for poor neurocognitive outcomes , including Alzheimer 's disease .  Bariatric surgery has recently been shown to result in improved memory at 12-weeks postoperatively . However , the long-term effects of bariatric surgery on cognitive function remain unclear . DESIGN AND METHODS Eighty-six individuals ( 63 bariatric surgery patients , 23 obese controls ) were recruited from a prospect i ve study examining the neurocognitive effects of bariatric surgery .  All participants completed  self-report measurements and a computerized cognitive test battery  prior to surgery and at 12-week and 24-month follow-up ; obese controls completed measures at equivalent time points . RESULTS Bariatric surgery patients exhibited high rates of pre-operative cognitive impairments in attention , executive function , memory , and language . Relative to obese controls , repeated measures ANOVA showed improvements in memory from baseline to 12-weeks and 24-months postoperatively ( P < 0.05 ) . Regression analyses controlling for baseline factors revealed that a lower BMI at 24-months demonstrated a trend toward significance for improved memory ( β = -.30 , P = 0.075 ) . CONCLUSION These findings suggest that cognitive benefits of bariatric surgery may extend to 24-months postoperatively . Larger prospect i ve studies with extended follow-up periods are needed to eluci date whether bariatric surgery decreases risk for cognitive decline and possibly the development of dementia ABSTRACT Introduction : Established risk factors for gestational diabetes mellitus ( GDM ) include ethnicity , obesity , and family history of diabetes . Untreated GDM patients have higher rates of maternal and perinatal morbidity . GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus ( T2DM ) , metabolic syndrome , cardiovascular morbidity , malignancies , ophthalmic , psychiatric , and renal disease in the mother . Offspring risk long-term adverse health outcomes , including T2DM , subsequent obesity , impacted neurodevelopmental outcome , increased neuropsychiatric morbidity , and ophthalmic disease . Areas covered : We critically review data from retrospective , prospect i ve , and meta- analysis studies pertaining to established GDM risk factors , complications during pregnancy and birth ( both mother and offspring ) , and long-term consequences ( both mother and offspring ) . Expert commentary : Many of the adverse consequences of GDM might be avoided with proper management and treatment . Patients belonging to high-risk ethnic groups , and /or with body mass index ≥ 25 kg/m2 , and /or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group ( IADPSG ) . The IADPSG one-step method has several advantages , including simplicity of execution , greater patient-friendliness , and higher diagnostic accuracy . Additionally , evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years . Similarly , metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients Studies have shown that mortality was reduced by 31.6 % in patients that underwent bariatric surgery  compared with the non-operative control group . However , in most surgical series the majority of patients were women , and men had higher post-operative mortality rates and a higher postoperative morbidity , regardless of weight . Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss . Methods . A prospect i ve study evaluated vascular inflammation in obese patients before and three months after bariatric surgery .  Markers of vascular inflammation were measured - before surgery and three months afterwards . Results . One hundred and two patients ( 73 women and 29 men , 40.5 ± 12.3 years old ) underwent bariatric surgery .  Correlation was found between BMI change and waist circumference change ( r = 0.658 , P<0.001 ) . Three months post-surgery , BMI was significantly decreased ( p<0.001 ) ( a decrease of 8.82 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 17.33 cm ) . ICAM-1 levels and hs-CRP levels were decreased ( both P = 0.0001 ) . Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus ( men > women ; P = 0.05 ) and hypertension ( men > women ; P = 0.06 ) . In women , following bariatric surgery  , BMI was decreased ( p<0.001 ) ( a decrease of 9.25 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 18.8 cm ) . ICAM-1 levels were decreased ( p = 0.002 ) and hs-CRP levels were also decreased ( P = 0.0001 ) . In men , following bariatric surgery  , BMI was decreased ( p = 0.001 ) ( a decrease of 8.1 ) , waist circumference was reduced ( p<0.005 ) ( a decrease of 14.6 cm ) ; however , although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant ( both P = 0.09 ) . Discussion . Our study examined gender effects of bariatric surgery  on vascular inflammation  . Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients , while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation . These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing  bariatric operation for  weight loss .  This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome , and cardiovascular morbidity and mortality Background and Aims Small intestinal bacterial overgrowth ( SIBO ) has been described in obese patients . The aim of this study was to prospect ively evaluate the prevalence and consequences of SIBO in obese patients before and after bariatric surgery . Patients and Methods From October 2001 to July 2009 , in obese patients referred for bariatric surgery ( BMI > 40 kg/m2 or > 35 in association with comorbidities ) , a glucose hydrogen ( H2 ) breath test ( BT ) was performed before and /or after either Roux-en-Y gastric bypass ( RYGBP ) or adjustable gastric b and ing ( AGB ) to assess the presence of SIBO . Weight loss and serum vitamin concentrations were measured after bariatric surgery while a multivitamin supplement was systematic ally given . Results Three hundred seventy-eight ( mean ± SD ) patients who performed a BT before and /or after surgery were included : before surgery , BT was positive in 15.4 % ( 55/357 ) . After surgery , BT was positive in 10 % ( 2/20 ) of AGB and 40 % ( 26/65 ) of RYGBP ( p < 0.001 compared to preoperative situation ) . After RYGBP , patients with positive BT had similar vitamin levels , a lower caloric intake ( 983 ± 337 vs. 1271 ± 404 kcal/day , p = 0.014 ) but a significant lower weight loss ( 29.7 ± 5.6 vs. 37.7 ± 12.9 kg , p = 0.002 ) and lower percent of total weight loss ( 25.6 ± 6.0 vs. 29.2 ± 6.9 % , p = 0.044 ) . Conclusion In this study , SIBO is present in 15 % of obese patients before bariatric surgery . This prevalence does not increase after AGB while it rises up to 40 % of patients after RYGBP and it is associated with lower weight loss Objective Few studies have examined brain changes in response to effective weight loss ; none have compared different methods of weight-loss intervention . We compared functional brain changes associated with a behavioral weight loss intervention to those associated with bariatric surgery . Methods 15 obese participants were recruited prior to adjustable gastric b and ing surgery and 16 obese participants were recruited prior to a behavioral diet intervention .  Groups were matched for demographics and amount of weight lost . fMRI scans ( visual food motivation paradigm while hungry and following a meal ) were conducted before , and 12 weeks after surgery/behavioral intervention . Results When compared to bariatric patients in the pre-meal analyses , behavioral dieters showed increased activation to food images in right medial PFC and left precuneus following weight loss . When compared to behavioral dieters , bariatric patients showed increased activation in in bilateral temporal cortex following the weight loss . Conclusions Behavioral dieters showed increased responses to food cues in medial PFC – a region associated with valuation and processing of self-referent information – when compared to bariatric patients . Bariatric patients showed increased responses to food cues in brain regions associated with higher level perception — when compared to behavioral dieters . The method of weight loss determines unique changes in brain function Background and aim : Male hypogonadism has been linked to obesity and diabetes . We aim ed to study the association of changes in insulin sensitivity and testosterone levels in severe obese patients su bmi tted to bariatric surgery .  Subjects and methods : Prospect i ve intervention study with twenty consecutive patients who underwent bariatric surgery studied before and after significant weight loss .  Serum testosterone , SHBG , fasting glucose , and insulin were measured among others . Free testosterone was calculated with the Vermeulen formula and insulin sensitivity with the homeostatic model assessment ( HOMA ) . Results : At baseline , thirteen patients had low total testosterone levels  , whereas eight of these patients also had free testosterone levels below the reference range obtained from the control group . After bariatric surgery  total testosterone , SHBG , and free testosterone significantly increased and achieved normal values in all evaluated patients . Insulin sensitivity improved in all of them . Multivariate linear regression showed that changes in fasting glucose ( β=−1.868 , p= 0.001 ) , insulin ( β=−3.782 , p= 0.001 ) , weight ( β=−0.622 , p= 0.002 ) , and SHBG ( β=−0.635 , p= 0.022 ) were associated with changes in free testosterone ( adjusted R2 = 0.936 , F=26.613 , p= 0.001 ) . When insulin resistance calculated by HOMA was in the model instead of insulin and glucose , it also was associated ( β=−3.488 , p= 0.008 ) with free testosterone ( adjusted R2 = 0.821 , F=11.111 , p= 0.005 ) . Conclusion : Circulating testosterone in obese men increases after bariatric surgery in parallel with an improvement in insulin sensitivity Objective . Obesity is a risk factor for hypogonadotropic hypogonadism in men . Weight loss has been shown to improve hypogonadism in obese men . This study evaluated the early changes in sex hormones profile after bariatric surgery . Methods . This is a prospect i ve study including 29 morbidly obese men . Main outcomes were changes in serum levels of total testosterone ( TT ) , free testosterone ( cFT ) , SHBG , estradiol , adiponectin , and leptin at 1 and 6 months after surgery . Results . The mean age of patients was 31 ± 8 years and the mean BMI was 56.8 ± 11.7 kg/m2 . Fifteen patients underwent Roux-en-Y gastric bypass and 14 patients underwent sleeve gastrectomy .  At baseline , 22 patients ( 75.9 % ) had either low TT levels ( < 10.4 nmol/L ) or low cFT levels ( < 225 pmol/L ) . Total testosterone and SHBG levels increased significantly at 1 month after surgery ( p ≤ 0.001 ) . At 6 months after surgery , TT and cFT increased significantly ( p ≤ 0.001 ) and 22 patients ( 75.9 % ) had normalized TT and cFT levels . There were no changes in estradiol levels at either 1 month or 6 months after surgery . Conclusions . Increases in TT and SHBG levels occurred early at 1 month after bariatric surgery while improvements in cFT levels were observed at 6 months after bariatric surgery 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 Background Obesity is considered a low- grade chronic inflammatory condition as reflected by increased C-reactive protein ( CRP ) levels . Inflammation is emerging as a predictor of cardiovascular disease and it may be a precursor of the metabolic syndrome . Bariatric surgery is commonly performed as a treatment for morbid obesity offering significant reductions in premature myocardial infa rct ion . Laparoscopic sleeve gastrectomy ( LSG ) is a relatively new bariatric procedure that is currently used as a definitive procedure for weight loss . The aim of this study is to assess the impact of sleeve gastrectomy on CRP levels . Methods This study is part of an ongoing , prospect i ve , cohort study to evaluate LSG impact on iron indices . CRP levels were compared preoperatively and 6 months after surgery . Similarly , demographics including body mass index and excess weight were also compared at these same study points . Data were analyzed using Student paired t test and Pearson product moment correlation analysis . Results Twenty-nine morbidly obese patients were included . There was significant decrease in body mass index ( BMI ) between the preoperative and 6-month period ( 50.9 ± 13.2 and 35.1 ± 6.85 , respectively ; P < 0.001 ) . Also CRP levels were statistically significantly lower at 6 months after surgery ( preoperative 12.3 ± 7.53 mg/L and postoperative 5.6 ± 4.2 mg/L. P < 0.0001 ) . The significant weight loss as reflected by change in BMI was correlated with the difference between preoperative and postoperative CRP levels . Conclusions Massive weight loss in morbidly obese patients induced by LSG causes a significant decrease in CRP levels , which could reduce the risk of cardiovascular diseases in these patients Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity 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 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 Excess adiposity is associated with low- grade inflammation and decreased iron status . Iron depletion in obesity is thought to be mediated by an inflammation-induced increase in the body 's main regulator of iron homeostasis , hepcidin . Elevated hepcidin can result in iron depletion as it prevents the release of dietary iron absorbed into the enterocytes , limiting replenishment of body iron losses . Weight reduction is associated with decreased inflammation ; however , the impact of reduced inflammation on iron status and systemic hepcidin in obese individuals remains unknown . We determined prospect ively the impact of weight loss on iron status parameters , serum hepcidin , inflammation , and dietary iron  in 20 obese premenopausal females 6 months after restrictive bariatric surgery .  At baseline , the presence of iron depletion was high with 45 % of the women having serum transferrin receptor ( sTfR ) > 28.1 nmol/l . Differences between baseline and 6 months after surgery for BMI ( 47.56 vs. 39.55 kg/m(2 ) ; P < 0.0001 ) , C-reactive protein ( CRP ) ( 10.83 vs. 5.71 mg/l ; P < 0.0001 ) , sTfR ( 29.97 vs. 23.08 nmol/l ; P = 0.001 ) , and serum hepcidin ( 111.25 vs. 31.35 ng/ml ; P < 0.0001 ) were significantly lower , whereas hemoglobin ( Hb ) ( 12.10 vs. 13.30 g/dl ; P < 0.0001 ) and hematocrit ( Hct ) ( 36.58 vs. 38.78 % ; P = 0.001 ) were significantly higher . Ferritin and transferrin saturation ( Tsat ) showed minimal improvement at follow-up . At baseline , hepcidin was not correlated with sTfR ( r = 0.02 ) ; however , at follow-up , significant correlations were found ( r = -0.58 ) . Change in interleukin-6 ( IL-6 ) from baseline was marginally associated with decreased log serum hepcidin ( Δ IL-6 : β = -0.22 ; P = 0.15 ) , whereas change in BMI or weight was not . No significant difference in dietary iron was noted after surgery . Weight loss in obese premenopausal women is associated with reduced serum hepcidin and inflammation . Reduction in inflammation and hepcidin likely allow for enhanced dietary iron absorption result ing in an improved functional iron profile CONTEXT The polycystic ovary syndrome ( PCOS ) is frequently associated with obesity . However , there are very few data about PCOS in morbid obesity , especially with regard to its evolution after bariatric surgery . OBJECTIVE The objective of this study was to evaluate the response of PCOS to the sustained and marked weight loss achieved by  bariatric surgery in morbidly obese women . DESIGN This was a longitudinal prospect i ve nonr and omized evaluation . SETTING S The study was performed at an academic hospital . PATIENTS Thirty-six consecutive premenopausal women su bmi tted to bariatric surgery were screened for PCOS , which was present in 17 . INTERVENTIONS Bariatric surgery was performed . MAIN OUTCOME MEASURES Hyper and rogenism , menstrual function , and insulin resistance were estimated before and at least 6 months after bariatric surgery in 12 patients with PCOS . RESULTS Weight loss ( 41 + /- 9 kg after 12 + /- 5 months ) was paralleled by decreases in the hirsutism score ( from 9.5 + /- 6.8 to 4.9 + /- 4.2 ; P = 0.001 ) , total ( 69 + /- 32 to 42 + /- 19 ng/dl ; P < 0.02 ) and free testosterone ( from 1.6 + /- 0.7 to 0.6 + /- 0.3 ng/dl ; P < 0.005 ) , and rostenedione ( from 4.1 + /- 1.5 to 3.0 + /- 0.9 ng/ml ; P < 0.02 ) , and dehydroepi and rosterone sulfate ( from 2000 + /- 1125 to 1353 + /- 759 ng/ml ; P < 0.005 ) ; amelioration of insulin resistance estimated by homeostasis model assessment ( from 6.0 + /- 3.0 to 1.6 + /- 1.0 ; P < 0.001 ) ; and restoration of regular menstrual cycles and /or ovulation in all patients . CONCLUSIONS The PCOS is a frequent finding in women with morbid obesity and may resolve after weight loss induced by bariatric surgery BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery
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
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 .