Executive Summary of the Recommendations of the American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic &amp; Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient: Complete guidelines are available at www.aace.com

Mechanick, Jeffrey I.; Kushner, Robert F.; Sugerman, Harvey; González-Campoy, J. Michael; Collazo–Clavell, Maria L.; Guven, Safak; Spitz, Adam F.; Apovian, Caroline M.; Livingston, Edward H.; Brolin, Robert E.; Sarwer, David B.; Anderson, Wendy; Dixon, John

doi:10.4158/ep.14.3.318

Cited by 48 publications

(6 citation statements)

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“…The current preoperative recommendations from the American Association of Clinical Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery include chest radiography for all patients. Patients “with intrinsic lung disease or disordered sleep patterns should have a formal pulmonary evaluation, including arterial blood gas measurement and sleep polysomnography, when knowledge of the results would alter patient care” [41]. Our current clinical practice is to obtain full lung function tests for patients with known lung disease (i.e., asthma or COPD) or pulmonary symptoms.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function in the morbidly obese

Saliman

Benditt

Flum

et al. 2008

Surgery for Obesity and Related Diseases

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Background Only limited data exist on the relationship of lung function to patients with extreme obesity. To assess the relationship between lung function tests and clinical characteristics in a cohort of morbidly obese patients undergoing evaluation for bariatric procedures in a university hospital in the United States. Methods Consecutive patients undergoing clinical evaluation were reviewed. The variables included demographic, anthropometric, clinical, and pulmonary function data. Results A total of 229 patients underwent a standardized preoperative evaluation. Of these 229 patients, 136 (59%) had evaluable data and 102 (75%) were women. The mean ± standard deviation age was 45 ± 10 years, the mean weight was 164 ± 42 kg, and the mean body mass index was 57 ± 13 kg/m2. Smoking or asthma was reported in 38% and 24% of patients, respectively. The mean forced vital capacity and forced expiratory volume in 1 s was 80% ± 17% of predicted and 76% ± 19% of predicted, respectively. Of the 136 patients, 29% had a measured forced expiratory volume in 1 s/forced vital capacity of ≥.08 below the predicted ratio. The mean total lung capacity was 86% ± 14% of predicted; 26% of subjects had a total lung capacity < 80% of predicted. Multivariate logistic regression analysis demonstrated an association of obstructive ventilatory defects with male gender (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.00–5.50) and current or previous smoking (OR 2.41, 95% CI 1.10–5.30), but not body mass index. Restrictive defects were associated with body mass index (OR 1.06, 95% CI 1.01–1.10), in particular, obesity hypoventilation syndrome (OR 3.7, 95% CI 1.2–11.1). Conclusion The mean preoperative spirometry, lung volumes, and gas exchange values were within the established reference ranges. Restrictive ventilatory defects were less common than obstructive ventilatory patterns and were most prominently associated with obesity hypoventilation syndrome.

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Section: Discussionmentioning

confidence: 99%

Pulmonary function in the morbidly obese

Saliman

Benditt

Flum

et al. 2008

Surgery for Obesity and Related Diseases

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“…Thus, life expectancy and quality of life are significantly higher in gastric bypass patients compared to untreated control populations (3). This has led to a boom in bariatric surgery, with about 200,000 surgeries per year in the USA, which is limited only by the number of surgeons (4). Roux-en-Y gastric bypass (RYGB) is the most effective surgery for body weight loss and remission of T2DM.…”

Section: Introductionmentioning

confidence: 99%

Roux-en-Y gastric bypass surgery changes food reward in rats

et al. 2010

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Context Roux-en-Y gastric bypass surgery (RYGB) is currently the most effective treatment for morbid obesity and clinical studies suggest that RYGB patients change food preferences and the desire to eat. Objective To examine hedonic reactions to palatable foods and food choice behavior in an established rat model of Roux-en-Y gastric bypass surgery (RYGB). Methods and Design Male Sprague-Dawley rats and selected line obesity-prone rats that were rendered obese on a high-fat diet underwent RYGB or sham surgery and were tested for ‘liking’ and ‘wanting’ of palatable foods at different caloric densities 4 – 6 months after surgery. Results Compared with sham-operated (obese) and age-matched lean control rats, RYGB rats of both models exhibited more positive orofacial responses to low concentrations of sucrose but fewer to high concentrations. These changes in ‘liking’ by RYGB rats were translated into a shift of the concentration-response curve in the brief access test, with more vigorous licking of low concentrations of sucrose and corn oil, but less licking of the highest concentrations. The changes in hedonic evaluation also resulted in lower long-term preference/acceptance of high-fat diets compared with sham-operated (obese) rats. Furthermore, the reduced ‘wanting’ of a palatable reward in the incentive runway seen in sham-operated obese SD rats was fully restored after RYGB to the level found in lean control rats. Conclusions The results suggest that RYGB leads to a shift in hedonic evaluation, favoring low over high calorie foods and restores obesity-induced alterations in ‘liking’ and ‘wanting’. It remains to be determined whether these effects are simply due to weight loss or specific changes in gut-brain communication. Given the emerging evidence for modulation of cortico-limbic brain structures involved in reward mechanisms by gut hormones, RYGB-induced changes in the secretion of these hormones could potentially be mediating these effects.

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“…The American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic & Bariatric Surgery (AACE/TOS/ASBMS) guidelines initially published in 2008 [22] and updated in 2013 [23]. …”

Section: Resultsmentioning

confidence: 99%

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

et al. 2016

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Introduction Bariatric surgery is the most effective therapeutic option to reduce weight in morbidly obese individuals, but it results in a number of mineral and vitamin deficiencies. Clinical Practice Guidelines (CPGs) attempt to balance those benefits and harms to provide guidance to physicians and patients. Objectives We compare and evaluate the quality of the evidence and of the development process of current CPGs that provide recommendations on vitamin D replacement in patients undergoing bariatric surgery, using a validated tool. Methods We searched 4 databases, with no time restriction, to identify relevant and current CPGs. Two reviewers assessed eligibility and abstracted data, in duplicate. They evaluated the quality of CPGs development process using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) tool that consists of 6 domains. A content expert verified those assessments. Results We identified 3 eligible CPGs: (1) the Endocrine Society (ES) guidelines (2010); (2) the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASBMS) guidelines (update 2013); and (3) the Interdisciplinary European (IE) guidelines on Metabolic and Bariatric Surgery (latest update 2014). The ES and the AACE/TOS/ASBMS guidelines recommended high doses of vitamin D, varying from 3,000 IU daily to 50,000 IU 1-3 times weekly. Vitamin D doses were not mentioned in the IE guidelines. The recommendations were based on a low quality of evidence, if any, or limited to a single high quality trial, for some outcomes. In terms of quality, only the IE guidelines described their search methodology but none of the CPGs provided details on evidence selection and appraisal. None of the three CPGs rigorously assessed the preferences of the target population, resource implications, and the applicability of these guidelines. According to the AGREE II tool, we rated the ES guidelines as average in quality, and the other two as low in quality. Conclusion Current CPGs recommendations on vitamin D supplementation in bariatric surgery differ between societies. They do not fulfill criteria for optimal guideline development, in part possibly due to limited resources, and are based on expert opinion. Thus, the pressing need for high quality randomized trials to inform CPGs, to be developed based on recommended standards.

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Cited by 48 publications

References 0 publications

Pulmonary function in the morbidly obese

Pulmonary function in the morbidly obese

Roux-en-Y gastric bypass surgery changes food reward in rats

Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal

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