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Purpose: Metabolic and bariatric surgery (MBS) is presently the most evidence-based, effective treatment of obesity. Nevertheless, only half of the eligible individuals who are referred for this procedure complete it. This study aims to investigate the association between social support and MBS completion, considering race and ethnicity. Methods: In this prospective cohort study, 413 participants were enrolled between 2019 and 2022. Using the 19-item Brief Family Relationship Scale, which comprises three subscales (eight-item Cohesion subscale, four-item Expressiveness subscale, and seven-item Conflict subscale), the quality of family relationship functioning was assessed. Multivariable logistic regression models were used to determine the association between MBS completion and social support status, adjusting for variables including race, ethnicity, age, gender, body mass index, and insurance. Results: The mean age of the sample was 47.55 years (SD 11.57), with 87% of the participants being female and 39% non-Hispanic White. Nearly 35% of participants (n = 145) completed MBS. Multivariable logistic regression analysis showed overall cohesion (adjusted odds ratio [aOR], 1.52 [95% CI, 1.15–2.00]; p =.003) and overall expressiveness (aOR, 1.58 [95% CI, 1.22–2.05]; p <.001) were associated with higher odds of pursuing MBS. There was no significant interaction between overall cohesion, expressiveness, conflict, and race/ethnicity (p =.61, p =.63, p =.25, respectively). Conclusion: The findings indicated that there is a link between family-based social support and MBS completion, regardless of race and ethnicity. Future research should continue to explore the complex interplay between family dynamics and MBS outcomes, considering cultural variations to enhance the effectiveness of obesity interventions within diverse communities. [ABSTRACT FROM AUTHOR]

Background: Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. Methods: This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. Results: A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation. Conclusion: These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a complex condition that often requires the simultaneous employment of diverse approaches for prevention and treatment. Mindful eating may be a beneficial complementary approach. This narrative review analyzes potential mechanisms of action through which mindful eating may regulate blood glucose and thereby aid in diabetes prevention and management. Findings from this review may serve to inform both clinical practice and new research in the field. Method: We conducted a narrative review focusing on the meditation-independent mechanisms by which mindful eating could improve blood glucose regulation. Specifically, we analyzed the effects of mindful eating practices on eating behavior, calorie intake, weight control, and/or glucose control. Results: Evidence suggests that mindful eating can improve eating behaviors by decreasing automatic and disordered eating which, in turn, may regulate blood glucose levels. Moreover, by eating slowly, attentively, and according to hunger and satiety cues, mindful eating may help align energy intake to energy needs, thereby improving weight and glycemic management. Conclusion: Key mindful eating practices that may directly or indirectly improve glycemic management include eating slowly, eating with deliberate attention to the sensory properties of food, cultivating acceptance of thoughts and feelings concerning food and eating, decentering from food-related thoughts, and relying on hunger and satiety cues to guide eating. Future research may improve our knowledge of these interventions and their application to the prevention and treatment of diabetes. [ABSTRACT FROM AUTHOR]

Background: Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia. Methods: This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change. Results: A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125 days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12 months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms. Conclusion: TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is a complex, chronic disease that is strongly associated with complications which cost the US healthcare system billions of dollars per year. Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective procedure for treatment of obesity, but without practice guidelines there are likely to be variations practice. We sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development. Methods: We conducted an anonymous cross-sectional survey to examine practice patterns related to ESG. The survey was organized in 5 sections: Endoscopic Practice, Training, and Resources; Pre-ESG Evaluation and Payment Model; Perioperative/Operative Period; Post-operative Period; and Endobariatric Practice Other Than ESG. Results: A variety of exclusion criteria were reported by physicians performing ESG. Most respondents (n = 21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n = 13/32) would not perform ESG on patients with BMI over 50. The majority of respondents (74.2%, n = 23/31) reported ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n = 21/31). Conclusions: We found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation, and medication use. Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costs. Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs. [ABSTRACT FROM AUTHOR]

Background: Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. Methods: This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. Results: The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30–0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64–19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39–6.79, p = 0.005) compared to men. Conclusions: Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion. [ABSTRACT FROM AUTHOR]

Purpose: Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity. Methods: This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers. Results: The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37–124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82–86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55–71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96). Conclusion: Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients. [ABSTRACT FROM AUTHOR]

Purpose: The impact of the COVID-19 pandemic on behavioral issues among those who have completed bariatric surgery (BS) is not well described in ethnically diverse populations. The aim of this study was to compare the impact of COVID-19 lockdown orders and after lockdown orders were lifted on substance use, mental health, and weight-related behaviors among a sample of post-BS adults. Materials and Methods: A retrospective medical chart review identified BS patients from one university-based obesity medicine clinic and two BS practices. An online non-anonymous survey was implemented in two phases: during lockdown (April 1–May 31, 2020) and after lockdown orders were lifted (June 1, 2020–September 30, 2020) to obtain information about the COVID-19 pandemic's impact on BS patients. Results: A total of 189 (during lockdown=39, post-lockdown=150) participants (90.4% female, mean age 52.4 years, SD 11.1, 49.8% non-Hispanic White, 30.6% non-Hispanic Black, 16.1% Hispanic) participated. Lockdown participants were more likely to have sleep problems (74.3% vs. 56.1%, P=.039) and feel anxious (82.0% vs. 63.0%, P=.024) versus post-lockdown participants. A majority (83.4%) reported depression in both lockdown/post-lockdown. Post-lockdown participants were more than 20 times more likely to report substance use compared those in lockdown (aOR 20.56, 95% CI 2.66–158.4). Conclusions and Relevance: The COVID-19 pandemic is having a substantial negative impact on substance use, mental health, and weight-related health behaviors in diverse BS patients. These findings have important implications for post-BS patient care teams and may suggest the integration of screening tools to identify those at high risk for behavioral health issues. [ABSTRACT FROM AUTHOR]

Caregivers of youth with behavioral health conditions often experience significant and chronic caregiving strain. Caregiving strain is thought to consist of three dimensions: objective strain (observable negative events), subjective internalized strain (negative feelings directed inwardly), and subjective externalized strain (negative feelings directed outwardly). Based on a modified stress process model, the aims of this study were to: (1) examine whether the association between youth emotional-behavioral problem severity (measured with the Child Behavior Checklist/6-18) and subjective internalized and subjective externalized caregiving strain is mediated by objective strain for caregivers, and; (2) identify other predictors of subjective internalized and subjective externalized strain, particularly related to youth emotional-behavioral strengths as measured by the Behavioral and Emotional Rating Scale-Parent Rating Scale. We also explored the extent to which the association between youth emotional-behavioral problem severity and subjective internalized and subjective externalized strain may be moderated by perceived youth emotional-behavioral strengths. One-hundred and eighty-five ( N = 185) caregivers of youth served by a community-based system of care participated in structured survey interviews at program enrollment. Regression analyses indicated that objective strain was found to fully mediate the association between youth emotional-behavioral problem severity and subjective externalized strain. Greater youth strengths related to family involvement were also associated with lower subjective externalized strain. Higher caregiver age, lower education, biological parent relationship to youth, greater youth emotional-behavioral problem severity, higher objective strain, and lower youth strengths related to school functioning were associated with higher subjective internalized strain. A significant interaction was found between youth problem severity, youth affective strengths, and subjective internalized strain such that caregivers who reported higher levels of youth affective strengths experienced stronger effects from youth emotional-behavioral problem severity on subjective internalized strain. These findings shed light upon the complex set of circumstances that may lead caregivers of youth with behavioral health conditions to experience subjective internalized and subjective externalized strain. [ABSTRACT FROM AUTHOR]

The Drosophila Ncc69 gene encodes a Na+-K+-2Cl−-cotransporter (NKCC) that is critical for regulating intra- and extracellular ionic conditions in different tissues. Here, we show that the Ncc69 transporter is necessary for fly vision and that its expression is required non-autonomously in glia to maintain visual synaptic transmission. Flies mutant for Ncc69 exhibit normal photoreceptor depolarization in response to a light pulse but lack the ON and OFF-transients characteristic of postsynaptic responses of lamina neurons, indicating a failure in synaptic transmission. We also find that synaptic transmission requires the Ncc69 regulatory kinases WNK and Fray in glia. The ERG phenotype is associated with a defect in the recycling of the histamine neurotransmitter. Ncc69 mutants exhibit higher levels of the transport metabolite carcinine in lamina cartridges, with its accumulation most intense in the extracellular space. Our work reveals a novel role of glial NKCC transporters in synaptic transmission, possibly through regulating extracellular ionic conditions. [ABSTRACT FROM AUTHOR]