| 1. |
- Biörserud, Christina, et al.
(författare)
-
Sahlgrenska Excess Skin Questionnaire (SESQ): A reliable questionnaire to assess the experience of excessive skin after weight loss.
- 2013
-
Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 47:1, s. 50-59
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract There is a lack of knowledge and reliable measurement instruments to assess excess skin after massive weight loss. The purpose of this study was to test the reliability of a new self-administered questionnaire. A self-administered questionnaire, the Sahlgrenska Excess Skin Questionnaire (SESQ) was designed to assess excess skin after weight loss. The questionnaire includes 30 questions about demographic data, activity and daily life and excess skin on specific body parts and the body as a whole. Forward and backward translations were made by two independent professional translators, from Swedish to English and then back to Swedish. The questionnaire was tested on 10 patients from Sweden and England and was followed by an interview with each patient. Minor corrections were made. A test-retest was carried out to evaluate the reliability by sending the Swedish questionnaire to 46 subjects with weight loss after obesity surgery, dieting, or medication. The test-retest reliability of questions concerning activity and daily life between the two occasions had a Percentage Of Agreement (POA) of 49%-76% and a weighted Kappa of 0.44-0.78. The questions about the degree of excess skin on specific body parts had a POA of 50%-76% and a weighted Kappa of 0.53-0.81. Excess skin perceived as causing problems had a POA of 32%-57 %, an adjusted POA of 63%-87%, and an Intra-Class Correlation of 0.72-0.92. The SESQ is reliable for evaluating patients' experience of excess skin after massive weight loss.
|
|
| 2. |
- Biörserud, Christina
(författare)
-
Excess skin after bariatric surgery - patients' perspective and objective measurements
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Most of the world's population lives in countries where overweight and obesity kills more people than underweight. The only effective treatment is found to be bariatric surgery. Excess skin is an undervalued, negative effect following the massive weight loss after the procedure. Aim: The general aim of this thesis was to investigate the experience and the development of excess skin after massive weight loss following bariatric surgery. Materials and method: Super obese patients filled in a questionnaire concerning experience and discomfort from excess skin after massive weight loss following bariatric surgery. Their experiences were correlated to circumference measurements of hip and waist. The questionnaire was developed further and test – retest was performed to test the reliability. Sahlgrenska Excess Skin Questionnaire, SESQ, aims to investigate excess skin on different body parts from the patients’ perspective. In a longitudinal follow up, patients filled in SESQ and objective measurements of excess skin were made. Excess skin, ptosis and circumference were measured in a standardized way. Correlations were made between patients’ subjective experiences and the objective measurements. The measuring protocol, designed to measure excess skin in massive weight loss patients, was evaluated regarding inter rater reliability by two testers. Results: The SESQ consists of three different parts, I: demographic data, II: symptoms of excess skin and III: assessment and discomfort of excess skin on different body parts. The test-retest reliability of SESQ showed a kappa coefficient of 0.44 to 0.81 concerning parts I and II, and an ICC of 0.72 to 0.92 for part III. In addition, face validity was performed with ten post bariatric patients. Weight loss after bariatric surgery in super obese and obese patients is associated with substantial experience and discomfort from excess skin. The excess skin is most commonly located on the abdomen, upper arms and thighs, and women experience more discomfort on several body parts than men. The excess skin causes intertriginous problems, such as fungus and eczema. It is heavy, which causes pain and hinders physical activity and is also a severe psychocosmetic problem. Repeated, objective, measurements of obese patients demonstrate that all ptosis and excess skin measurements decreased after weight reduction due to surgery except for the ptosis on the thighs, which had increased significantly. Comparison of objective measurements with the patients’ subjective reports of experience and discomfort from excess skin gave little or low correlation for both obese and super obese patients. The prediction analysis indicates that, for every centimeter of ptosis on the abdomen preoperatively, there is a twofold higher odds of having a postoperative ptosis on the abdomen > 3 cm (OR=2.32). Measurements of ptosis and excess skin had high or good reliability even though the size of the ptosis varied by several centimetres and the majority of the measurements had an ICC > 0.9 despite the fact that the measurers were from different professions. In summary: The SESQ is a reliable questionnaire for assessing excess skin from the patients’ perspective and the measuring protocol represents a useful instrument for providing a consistent and objective assessment of excess skin. While the extent of excess skin that was measured is reduced in comparison with before the operation, patients seem to become more aware, inconvenienced and discomforted by it on several body parts after weight loss. Discomfort from excess skin correlates fairly well to the extent of excess skin or circumference measurements in super obese or obese patients.
|
|
| 3. |
- Biörserud, Christina, et al.
(författare)
-
Experience of excess skin after gastric bypass or duodenal switch in patients with super obesity.
- 2014
-
Ingår i: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - : Elsevier BV. - 1878-7533. ; 10:5, s. 891-896
-
Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about the patient's experience of excess skin after bariatric surgery in patients with body mass index, (BMI)>50 kg/m(2). The objective of this study was to evaluate experience of excess skin after laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) or laparoscopic Roux-en-Y gastric bypass (LRYGB) and explore possible gender differences. Another aim was to analyze possible correlation between the reported experiences of excess skin with changes in weight, BMI, and hip and waist circumference after surgery.
|
|
| 4. |
- Biörserud, Christina, et al.
(författare)
-
Objective measurements of excess skin in post bariatric patients - inter-rater reliability.
- 2016
-
Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 50:2, s. 68-73
-
Tidskriftsartikel (refereegranskat)abstract
- An ability to reliably assess excess skin after massive weight loss using well-described and transferrable methods is important. The aim of this trial was to evaluate inter-rater reliability of ptosis and circumference measurements in patients with excess skin after bariatric surgery.
|
|
| 5. |
- Biörserud, Christina, et al.
(författare)
-
Patients' Experience of Surplus Skin After Laparoscopic Gastric Bypass.
- 2011
-
Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428.
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have described that many obese patients who undergo bariatric surgery develop surplus skin. However, there is a lack of knowledge about where on the body the problems are located and to what extent surplus skin affects the person. The aim of this study was to examine whether and where patients develop surplus skin after laparoscopic gastric bypass and if there is any relation between surplus skin and the patient's sex, age, weight loss, or activity level. MATERIALS AND METHODS: A questionnaire was constructed which included questions about surplus skin. The questionnaire was sent to 148 patients who had been operated with laparoscopic gastric bypass. One hundred and twelve (76%) responded of whom 77 were women and 35 men. RESULTS: At follow-up, 94 persons (84%) reported problems with surplus skin. The surplus skin was situated most commonly on the abdomen, the upper arms, and the inside of the thighs, but also on the back, the cheek and over the knees. Significantly, more women than men reported complications with surplus skin (p = 0.018), distributed over more body parts, specifically on the upper arms, medial thigh, and lateral back (p < 0.05). The surplus skin caused problems with fungal infections and itching, physical unpleasantness and complicated physical activity. There was no correlation between degree of problems with surplus skin and age, weight loss, or activity rate. DISCUSSION: Weight loss after gastric bypass reduces the medical risks of obesity but the psychosocial problems remain in many patients due to problems with surplus skin.
|
|
| 6. |
- Biörserud, Christina, et al.
(författare)
-
Self-image after bariatric surgery and its relationship to gender, excess skin and health-related quality of life
- 2018
-
Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 52:5, s. 288-293
-
Tidskriftsartikel (refereegranskat)abstract
- © 2018 Acta Chirurgica Scandinavica Society Introduction: There is limited knowledge about self-image in relation to excess skin after bariatric surgery. The aim of this study was therefore to explore self-image after massive weight loss and its relationship to gender, weight loss, discomfort regarding excess skin and health-related quality of life. Methods: Eighteen months after obesity surgery, 131 patients filled in questionnaires about self-image (Som jag ser mig själv), excess skin (Sahlgrenska Excess Skin Questionnaire, SESQ) and quality of life (EQ-5D and SF-36). In addition, maximal ptosis was measured on their abdomen, arms and thighs. Results: There were no differences in self-image or quality of life between the genders. Participants who scored low discomfort on SESQ had a significantly better overall self-image, in all subscales, compared to those with high discomfort scores (p<.05). They also had a significantly higher quality of life on the EQ-5D VAS (p=.045). Correlations were low, if any, between self-image, excess skin, quality of life and ptosis. There were moderate correlations between the SESQ score and the self-image subscore ‘physical well-being’, and in self-image and quality-of-life scores. Conclusions: Self-image is lower among those who experience a high degree of discomfort of excess skin after bariatric surgery. Its correlation to weight loss, measured excess skin and quality of life is weak.
|
|
| 7. |
- Biörserud, Christina, et al.
(författare)
-
SESQ, a patient-reported outcome instrument addressing excess skin; report on the updated version and the validation process
- 2023
-
Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 57:1-6, s. 360-364
-
Tidskriftsartikel (refereegranskat)abstract
- Excess skin after weight loss is perceived as a major problem for the majority of the bariatric patients, between 68 and 90% desire additional reconstructive surgery. However, only about 20% of the patients actually have the possibility to undergo these procedures. Reliable and valid patient-reported outcome instruments, PROM, are required in order to consider the patients' perspective of excess skin when discussing reconstructive surgery. The aim of this study was to present the updated version of Sahlgrenska Excess Skin Questionnaire, SESQ and to report on the validation process. The material for the process to evaluate internal consistency and known group validity was based on four different studies conducted at the Department of Plastic Surgery at Sahlgrenska University Hospital, Sweden. Internal consistency was high in all four groups examined; the normal population, the obese patients, the post-bariatric patients and the post-abdominoplasty patients. Values for Cronbach's alpha were >0.86 in all groups, and the highest value was seen in the obese patients (0.92). Furthermore, regarding known group validity, there were strong significant differences between the answers from the normal population in comparison with most of the other studies. In conclusion, patients thought that the questions in SESQ were easy to understand, that they covered all appropriate aspects of excess skin and the patients did not think that SESQ overlooked any questions or aspects concerning excess skin. SESQ is a valid questionnaire addressing excess skin in post-bariatric patients. The updated version of the SESQ is both accurate and user-friendly.
|
|
| 8. |
- Biörserud, Christina, et al.
(författare)
-
Understanding excess skin in postbariatric patients: objective measurements and subjective experiences
- 2016
-
Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 12:7, s. 1410-1417
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Excess skin is a well-known side effect of massive weight loss after bariatric surgery. However, there is a lack of longitudinal follow-ups. Objectives: The primary aims of this study were to investigate the development and amount of excess skin after laparoscopic Roux-en-Y gastric bypass and to relate objective results to subjective experiences. Methods: From 2009 to 2012, 200 patients were included and assessed with respect to excess skin before and 18 months after bariatric surgery. Patients were measured according to a standardized protocol and completed a questionnaire regarding their subjective experience of excess skin. Results: A follow-up visit was completed in 149 patients (78%). All ptosis measurements decreased after weight reduction except for ptosis on the thighs. When comparing objective measurements with patients' subjective experience and discomfort from excess skin, we found little or low correlation in most body parts (r(s).03-.67). The prediction analysis indicated that, for every centimeter of ptosis on the abdomen preoperatively, there was a 2-fold greater probability of having a postoperative ptosis on the abdomen of >3 cm (OR = 2.32, 1.76-3.07). Conclusion: The objective measurement of excess skin provides unique information in postbariatric patients' body habitus. Although the measured excess skin decreased compared with preoperative measurements, patients seem to become more aware of and disturbed and discomforted by it after the weight loss. Importantly, the objectively assessed measurements of excess skin correlated fairly with the perceived discomfort. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
|
|
| 9. |
|
|
| 10. |
- Börgeson, Emma, et al.
(författare)
-
AICAR ameliorates high-fat diet-associated pathophysiology in mouse and ex vivo models, independent of adiponectin.
- 2017
-
Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 60:4, s. 729-739
-
Tidskriftsartikel (refereegranskat)abstract
- In this study, we aimed to evaluate the therapeutic potential of 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR), an activator of AMP-activated protein kinase, for ameliorating high-fat diet (HFD)-induced pathophysiology in mice. We also aimed to determine whether the beneficial effects of AICAR were dependent on adiponectin. Furthermore, human adipose tissue was used to examine the effect of AICAR ex vivo.Six-week-old male C57BL/6J wild-type and Adipoq (-/-) mice were fed a standard-fat diet (10% fat) or an HFD (60% fat) for 12weeks and given vehicle or AICAR (500μg/g) three times/week from weeks 4-12. Diet-induced pathophysiology was examined in mice after 11 weeks by IPGTT and after 12 weeks by flow cytometry and western blotting. Human adipose tissue biopsies from obese (BMI 35-50kg/m(2)) individuals were incubated with vehicle or AICAR (1mmol/l) for 6h at 37°C, after which inflammation was characterised by ELISA (TNF-α) and flow cytometry.AICAR attenuated adipose inflammation in mice fed an HFD, promoting an M1-to-M2 macrophage phenotype switch, while reducing infiltration of CD8(+) T cells. AICAR treatment of mice fed an HFD partially restored glucose tolerance and attenuated hepatic steatosis and kidney disease, as evidenced by reduced albuminuria (p<0.05), urinary H2O2 (p<0.05) and renal superoxide levels (p<0.01) in both wild-type and Adipoq (-/-) mice. AICAR-mediated protection occurred independently of adiponectin, as similar protection was observed in wild-type and Adipoq (-/-) mice. In addition, AICAR promoted an M1-to-M2 macrophage phenotype switch and reduced TNF-α production in tissue explants from obese human patients.AICAR may promote metabolic health and protect against obesity-induced systemic diseases in an adiponectin-independent manner. Furthermore, AICAR reduced inflammation in human adipose tissue explants, suggesting by proof-of-principle that the drug may reduce obesity-induced complications in humans.ClinicalTrials.gov NCT02322073.
|
|
