Dr. Jon O. Ebbert

A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.

When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.

Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.

So, what predicts success – and can we facilitate it?

Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.

In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.

The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).

I was left wondering how I can best help my patients using this information.

First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.

Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.

When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.

Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.

So, what predicts success – and can we facilitate it?

Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.

In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.

The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).

I was left wondering how I can best help my patients using this information.

First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.

Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.

When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again.

Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm.

So, what predicts success – and can we facilitate it?

Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss.

In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery.

The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either).

I was left wondering how I can best help my patients using this information.

First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support.

Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.

Data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Center Survey reveal benzodiazepine prescriptions grew by 12.5% per year between 2002 and 2009. Data from the National Health and Nutrition Examination Survey suggest that prescriptions for sleep aids (sedatives and hypnotics) tripled between 1998 and 2006. Four percent of U.S. adults age 20 years or older and 7% of adults age 80 years or older report using a prescription sleep aid in the past month.

Aside from the addictive potential and their limited long-term effectiveness, they may be associated with an increased risk of death.

Dr. Scott Weich and his colleagues at University of Warwick, Coventry, England, analyzed data from a retrospective matched cohort study involving 34,727 patients aged at least 16 years who received prescriptions for anxiolytics or hypnotics and 69,418 patients who did not (BMJ 2014;348:g1996). To reduce the likelihood that patients received a prescription that they did not fill, only patients receiving at least two prescriptions were included. The average follow-up period was 7.6 years. The most commonly prescribed drugs were diazepam (48%), temazepam (35%), zopiclone (34%), and zolpidem (8%).

Significantly higher ratios for mortality were observed with the use of these drugs. Adjusting for potential confounders, the hazard ratio for mortality during the whole follow-up period was significantly elevated for the group receiving any sedative or hypnotic in the first year of recruitment (hazard ratio, 3.32; 95% confidence interval: 3.19-3.45).

Dose responses were observed for study drugs. For example, the HR for patients receiving more than 90 doses during the first year was 4.51 (95% CI: 4.22-4.82). Patients who did not receive study drugs beyond 1 year were less likely to die than those who continued to take them. The authors point out that these data translate into four excess deaths linked to use of these drugs per 100 people over 7.6 years after the initial prescription.

The biggest challenge will be to figure out how best to incorporate this information into our counseling of patients without sounding like we are "fear-mongering." Fear-mongering doesn’t work – it just makes our patients more anxious, when what we really need to do is calm them down.

Cognitive-behavioral therapy works for insomnia, but patients report not having the time. I always start the discussion by telling patients to read the book "No More Sleepless Nights" and to start a sleep log. Amazing what we can learn from this. This as least gets the ball rolling.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. Dr. Ebbert does not receive royalties from the sale of "No More Sleepless Nights."

Data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Center Survey reveal benzodiazepine prescriptions grew by 12.5% per year between 2002 and 2009. Data from the National Health and Nutrition Examination Survey suggest that prescriptions for sleep aids (sedatives and hypnotics) tripled between 1998 and 2006. Four percent of U.S. adults age 20 years or older and 7% of adults age 80 years or older report using a prescription sleep aid in the past month.

Aside from the addictive potential and their limited long-term effectiveness, they may be associated with an increased risk of death.

Dr. Scott Weich and his colleagues at University of Warwick, Coventry, England, analyzed data from a retrospective matched cohort study involving 34,727 patients aged at least 16 years who received prescriptions for anxiolytics or hypnotics and 69,418 patients who did not (BMJ 2014;348:g1996). To reduce the likelihood that patients received a prescription that they did not fill, only patients receiving at least two prescriptions were included. The average follow-up period was 7.6 years. The most commonly prescribed drugs were diazepam (48%), temazepam (35%), zopiclone (34%), and zolpidem (8%).

Significantly higher ratios for mortality were observed with the use of these drugs. Adjusting for potential confounders, the hazard ratio for mortality during the whole follow-up period was significantly elevated for the group receiving any sedative or hypnotic in the first year of recruitment (hazard ratio, 3.32; 95% confidence interval: 3.19-3.45).

Dose responses were observed for study drugs. For example, the HR for patients receiving more than 90 doses during the first year was 4.51 (95% CI: 4.22-4.82). Patients who did not receive study drugs beyond 1 year were less likely to die than those who continued to take them. The authors point out that these data translate into four excess deaths linked to use of these drugs per 100 people over 7.6 years after the initial prescription.

The biggest challenge will be to figure out how best to incorporate this information into our counseling of patients without sounding like we are "fear-mongering." Fear-mongering doesn’t work – it just makes our patients more anxious, when what we really need to do is calm them down.

Cognitive-behavioral therapy works for insomnia, but patients report not having the time. I always start the discussion by telling patients to read the book "No More Sleepless Nights" and to start a sleep log. Amazing what we can learn from this. This as least gets the ball rolling.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. Dr. Ebbert does not receive royalties from the sale of "No More Sleepless Nights."

Data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Center Survey reveal benzodiazepine prescriptions grew by 12.5% per year between 2002 and 2009. Data from the National Health and Nutrition Examination Survey suggest that prescriptions for sleep aids (sedatives and hypnotics) tripled between 1998 and 2006. Four percent of U.S. adults age 20 years or older and 7% of adults age 80 years or older report using a prescription sleep aid in the past month.

Aside from the addictive potential and their limited long-term effectiveness, they may be associated with an increased risk of death.

Dr. Scott Weich and his colleagues at University of Warwick, Coventry, England, analyzed data from a retrospective matched cohort study involving 34,727 patients aged at least 16 years who received prescriptions for anxiolytics or hypnotics and 69,418 patients who did not (BMJ 2014;348:g1996). To reduce the likelihood that patients received a prescription that they did not fill, only patients receiving at least two prescriptions were included. The average follow-up period was 7.6 years. The most commonly prescribed drugs were diazepam (48%), temazepam (35%), zopiclone (34%), and zolpidem (8%).

Significantly higher ratios for mortality were observed with the use of these drugs. Adjusting for potential confounders, the hazard ratio for mortality during the whole follow-up period was significantly elevated for the group receiving any sedative or hypnotic in the first year of recruitment (hazard ratio, 3.32; 95% confidence interval: 3.19-3.45).

Dose responses were observed for study drugs. For example, the HR for patients receiving more than 90 doses during the first year was 4.51 (95% CI: 4.22-4.82). Patients who did not receive study drugs beyond 1 year were less likely to die than those who continued to take them. The authors point out that these data translate into four excess deaths linked to use of these drugs per 100 people over 7.6 years after the initial prescription.

The biggest challenge will be to figure out how best to incorporate this information into our counseling of patients without sounding like we are "fear-mongering." Fear-mongering doesn’t work – it just makes our patients more anxious, when what we really need to do is calm them down.

Cognitive-behavioral therapy works for insomnia, but patients report not having the time. I always start the discussion by telling patients to read the book "No More Sleepless Nights" and to start a sleep log. Amazing what we can learn from this. This as least gets the ball rolling.

Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author. Dr. Ebbert does not receive royalties from the sale of "No More Sleepless Nights."