Skip to main content

Advertisement

SpringerLink
Log in

4-Year Changes in Sex Hormones, Sexual Functioning, and Psychosocial Status in Women Who Underwent Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Initial weight loss after bariatric surgery has been associated with improvements in reproductive hormones and sexual functioning in women. Few studies have investigated the durability of these changes.

Objectives

The objective of this paper is to investigate changes in sex hormones, sexual functioning, and relevant psychosocial constructs over 4 years in women who underwent bariatric surgery.

Setting

The setting is a prospective cohort of 106 women from the Longitudinal Assessment of Bariatric Surgery consortium.

Methods

Changes in sex hormones were assessed by blood assay. Sexual functioning, quality of life (QOL), body image, depressive symptoms, and marital adjustment were assessed by psychometric measures.

Results

Women lost on average (95% confidence interval) 32.3% (30.4%, 34.3%) at postoperative year 3 and 30.6% (28.5%, 32.8%) at postoperative year 4. Compared to baseline, women experienced significant changes at 4 years in all hormones assessed, except estradiol. Women reported significant improvements in sexual functioning (i.e., arousal, desire, and satisfaction) through year 3, but these changes were not maintained through year 4. Changes in relationship quality followed a similar pattern. Improvements in physical aspects of QOL, body image, and depressive symptoms were maintained through 4 years.

Conclusions

Improvements in reproductive hormones and physical aspects of QOL, body image, and depressive symptoms were maintained 4 years after bariatric surgery. Improvements in sexual functioning, relationship satisfaction, and mental components of QOL eroded over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Adams TD, Davidson LE, Litwin SE, et al. Gastrointestinal surgery: cardiovascular risk reduction and improved long-term survival in patients with obesity and diabetes. Curr Atheroscler Rep. 2012 Dec;14(6):606–15. https://doi.org/10.1007/s11883-012-0286-4.

    Article  CAS  PubMed  Google Scholar 

  2. Courcoulas AP, Christian NJ, Belle SH, et al. Three year weight and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium. JAMA. 2013 Dec 11;310(22):2416–25. https://doi.org/10.1001/jama.2013.280928.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639–48. https://doi.org/10.1038/oby.2005.71.

    Article  PubMed  Google Scholar 

  4. Sarwer DB, Lavery M, Spitzer JC. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012;22(4):668–76. https://doi.org/10.1007/s11695-012-0588-1.

    Article  PubMed  Google Scholar 

  5. Kolotkin RL, Davidson LE, Crosby RD, et al. Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surg Obes Relat Dis. 2012;8(5):625–33. https://doi.org/10.1016/j.soard.2012.01.011.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Karlsson J, Taft C, Rydén A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61. https://doi.org/10.1038/sj.ijo.0803573.

    Article  CAS  Google Scholar 

  7. Moore RH, Sarwer DB, Lavenberg J, et al. Relationship between sexual function and quality of life in persons seeking weight reduction. Obesity. 2013;21(10):1966–74. https://doi.org/10.1002/oby.20398.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sarwer DB, Spitzer JC, Wadden TA, et al. Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and non-surgical weight loss. Surg Obes Relat Dis. 2013;9(6):997–1007. https://doi.org/10.1016/j.soard.2013.07.003.

    Article  PubMed  Google Scholar 

  9. Sarwer DB, Spitzer JC, Wadden TA, et al. Changes in sexual functioning and sex hormone levels in women following bariatric surgery. JAMA Surg. 2014;149(1):26–33. https://doi.org/10.1001/jamasurg.2013.5022.

    Article  PubMed  Google Scholar 

  10. Leenen R, van der Kooy K, Seidell JC, et al. Visceral fat accumulation in relation to sex hormones in obese men and women undergoing weight loss therapy. J Clin Endocrinol Metab. 1994;78(6):1515–20. https://doi.org/10.1210/jcem.78.6.8200956.

    CAS  PubMed  Google Scholar 

  11. Legro RS, Dodson WC, Gnatuk CL, et al. Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab. 2013;97(12):4540–8.

    Article  Google Scholar 

  12. Turcato E, Zamboni M, De Pergola G, et al. Interrelationships between weight loss, body fat distribution and sex hormones in pre- and postmenopausal obese women. J Intern Med. 1997;241(5):363–72. https://doi.org/10.1046/j.1365-2796.1997.120129000.x.

    Article  CAS  PubMed  Google Scholar 

  13. Bastounis EA, Karayiannakis AJ, Syrigos K, et al. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res. 1998;30(1):43–7. https://doi.org/10.1159/000008556.

    Article  CAS  PubMed  Google Scholar 

  14. Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery. Surg Obes Relat Dis. 2007;3(2):116–26. https://doi.org/10.1016/j.soard.2007.01.006.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Belle SH, Berk PD, Chapman WH, et al. Baseline characteristics of participants in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Surg Obes Relat Dis.[published online ahead of print March 7, 2013]. https://doi.org/10.1016/j.soard.2013.01.023.

  16. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. NEJM. 2009;361(5):445–54.

    Article  Google Scholar 

  17. Sarwer DB, Spitzer JC, Wadden TA, et al. Sexual functioning and sex hormones in men who underwent bariatric surgery. Surg Obes Relat Dis. 2014;11(3):643–51. https://doi.org/10.1016/j.soard.2014.12.014.

    Article  PubMed  Google Scholar 

  18. Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208. https://doi.org/10.1080/009262300278597.

    Article  CAS  PubMed  Google Scholar 

  19. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–33. https://doi.org/10.1080/00926230590475206.

    Article  PubMed  Google Scholar 

  20. Ware JE, Snow KK, Kosinski M, et al. SF-36 health survey manual and interpretation guide. Boston: New England Medical Center, The Health Institute; 1993.

    Google Scholar 

  21. Kolotkin RL, Head S, Hamilton M, et al. Assessing the impact of weight on the quality of life. Obes Res. 1995;3(1):49–56. https://doi.org/10.1002/j.1550-8528.1995.tb00120.x.

    Article  CAS  PubMed  Google Scholar 

  22. Kolotkin RL, Crosby RD, Kosloski KD, et al. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11. https://doi.org/10.1038/oby.2001.13.

    Article  CAS  PubMed  Google Scholar 

  23. Kolotkin RL, Crosby RD. Manual for the Impact of Weight on Quality of Life Measure (IWQOL and IWQOL-Lite). Durham: Obesity and Quality of Life Consulting; 2011.

    Google Scholar 

  24. Cash TF, Fleming EC. The impact of body-image experiences: development of the Body Image Quality of Life Inventory. Int J Eat Disord. 2002;31(4):455–60. https://doi.org/10.1002/eat.10033.

    Article  PubMed  Google Scholar 

  25. Cooper PJ, Taylor MJ, Cooper Z, et al. The development and validation of the body shape questionnaire. Int J Eat Disord. 1987;6(4):485–94. https://doi.org/10.1002/1098-108X(198707)6:4<485::AID-EAT2260060405>3.0.CO;2-O.

    Article  Google Scholar 

  26. Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marital Fam Ther. 1976;38(2):15–38.

    Google Scholar 

  27. Beck AT, Steer RA, Brown GK. Beck depression inventory II (BDI-II) manual. San Antonio: Harcourt Brace; 1993.

    Google Scholar 

  28. Herpertz S, Kielmann R, Wolf AM, et al. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res. 2004 Oct;12(10):1554–69. https://doi.org/10.1038/oby.2004.195.

    Article  CAS  PubMed  Google Scholar 

  29. van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg. 2006 Jun;16(6):787–94. https://doi.org/10.1381/096089206777346808.

    Article  PubMed  Google Scholar 

Download references

Funding

This ancillary study to the Longitudinal Assessment of Bariatric Surgery-2 was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant no. R01DK072452.

Author information

Authors and Affiliations

  1. Center for Obesity Research and Education, College of Public Health, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA, 19140, USA

    David B. Sarwer & Jacqueline C. Spitzer

  2. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Thomas A. Wadden

  3. Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA

    James E. Mitchell & Kathy Lancaster

  4. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Anita Courcoulas & William Gourash

  5. New England Research Institutes, Watertown, MA, USA

    Raymond C. Rosen

  6. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Nicholas J. Christian

Authors
  1. David B. Sarwer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas A. Wadden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacqueline C. Spitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James E. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kathy Lancaster
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anita Courcoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. William Gourash
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raymond C. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nicholas J. Christian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David B. Sarwer.

Ethics declarations

Conflict of Interest

During the time of the study, Dr. Sarwer served as a paid consultant for Allergan, BariMD, BAROnova, EnteroMedics, and Ethicon Endo-Surgery, which are manufacturers of products for non-surgical weight loss treatment and bariatric surgery. At the time of the conduct of the study, he also was on the board of directors of the Surgical Review Corporation, which created the International Center of Excellence for Bariatric Surgery program to evaluate bariatric surgeons and hospitals around the world. Dr. Wadden serves on advisory boards for Novo Nordisk, Nutrisystem, and Orexigen Pharmaceuticals. Dr. Courcoulas has received research grants from Allergan, Pfizer, Covidien, EndoGastric Solutions, and Nutrisystem and is on the Scientific Advisory Board of Ethicon J & J Healthcare System. Dr. Mitchell, Ms. Spitzer, Ms. Lancaster, Mr. Gourash, and Dr. Christian have no relationships to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Electronic Supplementary Material

ESM 1

(DOCX 23 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarwer, D.B., Wadden, T.A., Spitzer, J.C. et al. 4-Year Changes in Sex Hormones, Sexual Functioning, and Psychosocial Status in Women Who Underwent Bariatric Surgery. OBES SURG 28, 892–899 (2018). https://doi.org/10.1007/s11695-017-3025-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-3025-7

Keywords

Search

Navigation