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ImportanceAmong women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.ObjectivesTo examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.Design, setting, and participantsThe Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).InterventionParticipants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.Main outcomes and measuresThe frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.ResultsOf 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Gui delines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated., In the past decade, our growing knowledge of the genetic, physiological, psychological, metabolic, and environmental influences on body weight has increased our awareness of the complexities of weight management. New [...]

Objective To assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular (IMAT) adipose tissue by whole-body MRI before surgery and at 12 months and 24 months post-surgery in a subset of participants of the Longitudinal Assessment of Bariatric Surgery-2. Methods From 0 to 12 months, n = 20 females and 3 males; from 12 to 24 months, n = 42 females and 7 males. Paired t-tests and GLM repeated measures examined changes in TAT, SAT, VAT, and IMAT at 12 and 24 months, with sex and age as covariates. Results Changes from 0 to 12 months included weight (−41.9 ± 12.1 kg; −36%), TAT (−33.5 ± 9.6 kg; −56%), SAT (−29.2 ± 8.2 kg; −55%), VAT (−3.3 ± 1.6 kg; −73%), and IMAT (−0.99 ± 0.68 kg; −50%), all P < 0.001. In females, from 12 to 24 months, despite relative weight stability (−1.8 ± 6.5 kg, −2%; P = 0.085), VAT (−0.5 ± 0.7 kg; −30%; P < 0.001) and IMAT (−0.2 ± 0.4 kg; −14%; P = 0.012) decreased further. In males, from 12 to 24 months, weight increased (5.1 ± 5.2 kg; 6%; P = 0.04) with no significant changes in TAT or sub-depots. Conclusions Bariatric surgery continues to induce favorable changes in body composition, i.e., persistent adipose tissue loss at 24 months in the absence of further significant weight loss. [ABSTRACT FROM AUTHOR]

Abstract: Background: Differences in excess weight loss, body mass index (BMI) change, and body composition have been related to different types of bariatric procedures. Our objective was to explore these alterations related to body mass in superobese (SO) and morbidly obese (MO) patients in a university hospital setting. Methods: Patients provided written informed consent and had their body composition measured before and after surgery using bioimpedance (Tanita 310). The t test was used to compare MO and SO. Pearson''s correlations were used to examine the BMI, excessive BMI loss, percentage of body fat (BF) change, and fat-free mass. Results: A total of 133 MO patients had a BMI of 43.3 kg/m2 and 88 SO patients had a BMI of 59.4 kg/m2. The percentage of BF was 46.7% and 51.9% (P < .0001). The differences in the follow-up period after surgery (21.5 and 20.6 months; P = .62) and patient age (43.4 and 42.5 yr) were not significant, but the gender distribution was significant (P = .003). After surgery, the MO patients had a BMI of 30.9 ± 5.7 kg/m2 and the SO patients had a BMI of 37.3 ± 9.0 kg/m2. The percentage of BF was not different between the 2 groups (MO, 33.1% ± 9.6% and SO, 35.0% ± 12.4%; P = .21). Gender differences in the percentage of BF were present before surgery; however, after surgery, these were absent for the men in the 2 groups (24.8% and 26.6%; P = .51). The change in the BMI and the change in the BF had a stronger correlation for the MO patients (r = .83 versus r = .53) than for the SO patients. The fat-free mass loss correlated with the change in BMI without regard to procedure. The percentage of excessive BMI loss was 65.1% for the MO and 63.4% for the SO patients (P = .64). Conclusions: The SO patients achieved excessive BMI loss similar to that of the MO patients, with more SO men choosing biliopancreatic diversion/duodenal switch. At a BMI of 37.3 kg/m2, the SO patients had a percentage of BF that was not different from that of the MO patients at 30.9 kg/m2. The fat-free mass losses correlated with the change in BMI. [Copyright &y& Elsevier]

Objective: To describe the reproductive health history and characteristics of women having bariatric surgery and to determine whether this differs by age of onset of obesity.Design: Retrospective and cross-sectional analyses of self-reported survey data.Setting: Six sites of the Longitudinal Assessment of Bariatric Surgery-2 study.Patient(s): The study included 1,538 females having bariatric surgery.Intervention(s): None.Main Outcome Measure(s): Reported polycystic ovary syndrome (PCOS), pregnancy and fertility history, contraceptive use, and plans for pregnancies.Result(s): Mean age was 44.8 years (range, 18-78 years); mean body mass index was 47.2 kg/m2 (range, 33.8-87.3 kg/m2). PCOS had been diagnosed by a health care provider in 13.1% of subjects. Of women who had tried to conceive, 41.9% experienced infertility and 61.4% had a live birth after experiencing infertility. In the whole group, prior live birth was reported by 72.5%. Women who were obese by 18 years old were more likely to report PCOS and infertility and less likely to have ever been pregnant, compared with women who became obese later in life. Future pregnancy was important to 30.3% of women younger than 45 years, whereas 48.6% did not plan to become pregnant in the future. In the year before surgery, 51.8% used contraception.Conclusion(s): Self-reporting of obesity by age 18 appears to be related to reproductive morbidity. Women undergoing bariatric surgery have important reproductive health care needs, including reliable contraception and counseling about plans for postoperative pregnancy. [ABSTRACT FROM AUTHOR]