Evaluación de la calidad de vida en pacientes mexicanos con obesidad severa antes y después de cirugía bariátrica / Quality of life evaluation in Mexican patients with severe obesity before and after bariatric surgery

Resumen Introducción: En México no se han utilizado los instrumentos Shorth Form 36 Items (SF-36) ni Baryatric Assesment Reporting Outcomes System (BAROS) para evaluar la calidad de vida (CV) antes y después de la cirugía bariátrica (CB). Objetivo: Describir los cambios en la CV con los cuestionarios SF-36 y BAROS, en pacientes con obesidad severa antes y después de la CB. Métodos: Se recolectaron los datos clínicos y antropométricos de pacientes sometidos a cirugía baríatrica entre 2015 y 2016. Se consideró con significación estadística una p < 0.05. Resultados: Se analizaron 230 pacientes, 98 y 132 antes y después de la CB; la mayoría fue del sexo femenino (81 %). El índice de masa corporal inicial fue de 48 kg/m2 (44-53). La CV medida con el SF-36 demostró un incremento en la puntuación del componente físico de 43 a 54.2 (p < 0.001) y en el componente mental, de 53.3 a 56.6 después de la CB. Con BAROS, en 98.5 % se registraron resultados buenos a excelentes en la CV en los primeros tres meses. Conclusión: Al ser medida con los cuestionarios SF-36 y BAROS se definió que la CV de los pacientes mexicanos con obesidad severa mejora después de la CB.

Abstract Introduction: In Mexico, neither the 36-item Short Form Health Survey (SF-36) nor the Bariatric Analysis and Reporting Outcome System (BAROS) instruments have been used to assess quality of life (QoL) before and after bariatric surgery (BS). Objective: To describe changes in QoL using the SF-36 and BAROS questionnaires in patients with severe obesity before and after BS. Methods: Clinical and anthropometric data of patients undergoing bariatric surgery between 2015 and 2016 were collected. Statistical significance was considered with a p-value < 0.05. Results: 230 patients were analyzed, 98 before and 132 and after BS; most were females (81 %). Initial body mass index was 48 kg/m2 (44-53). SF-36-measured QoL showed an increase in the physical component score from 43 to 54.2 points (p < 0.001), and in the mental component, from 53.3 to 56.6 points after BS. With BAROS, 98.5 % showed good to excellent QoL results within the first three months after BS. Conclusion: When measured with the SF-36 and BAROS questionnaires, QoL of Mexican patients with severe obesity was found to improve after BS.

Path taken by morbidly obese people in search of bariatric surgery in the public health system / Caminho percorrido por obesos mórbidos em busca da cirurgia bariátrica no sistema público de saúde / Camino recorrido por obesos mórbidos en la búsqueda de la cirugía bariátrica en el sistema público de salud

Objective: to understand the path taken in the public health system by people with morbid obesity in the search for bariatric surgery. Method: qualitative research based on the social phenomenology of Alfred Schütz, with 17 hospitalized morbidly obese people, with a scheduled date for bariatric surgery. The phenomenological interview with open questions was used and the statements were analyzed in the light of the theoretical-methodological framework and literature related to the theme. Results: the participants were able to schedule bariatric surgery by referring friends, family and public people. The waiting list for the procedure generated anguish and anxiety due to fear of surgery, weight gain, risk of worsening health and physical limitations, but it helped prepare for its performance. The experience lived in the search for bariatric surgery led these people to want continuity of care in the Basic Health Unit, after the surgery, by professionals trained to meet their needs. Conclusion: the aspects inscribed in the path of people in search of bariatric surgery signal the need to strengthen the assistance-related flows of the public health system and to invest in professional training to reduce the social inequalities in access to bariatric surgery and increased quality of services.(AU)

Objetivo: compreender o caminho percorrido no sistema público de saúde pela pessoa com obesidade mórbida em busca da cirurgia bariátrica. Método: pesquisa qualitativa fundamentada na fenomenologia social de Alfred Schütz, com 17 pessoas obesas mórbidas hospitalizadas, com data agendada para a cirurgia bariátrica. Utilizou-se a entrevista fenomenológica com questões abertas e os depoimentos foram analisados à luz do referencial teórico-metodológico e literatura referente ao tema. Resultados: os participantes conseguiram agendamento para a cirurgia bariátrica por meio da indicação de amigos, familiares e pessoas públicas. A fila de espera pelo procedimento gerou angústia e ansiedade devido ao medo da cirurgia, aumento do peso, risco de agravamento da saúde e das limitações físicas, mas auxiliou na preparação para sua realização. A experiência vivida na busca pela cirurgia bariátrica levou essas pessoas a desejarem a continuidade da assistência na Unidade Básica de Saúde, após a cirurgia, por profissionais capacitados para atender as suas necessidades. Conclusão: os aspectos inscritos no caminho de pessoas em busca de cirurgia bariátrica sinalizam a necessidade de fortalecimento dos fluxos assistenciais do sistema público de saúde e de investimento na capacitação profissional para redução das desigualdades no acesso à cirurgia bariátrica e incremento da qualidade dos serviços.(AU)

Objetivo: comprender el camino que recorre la persona con obesidad mórbida en el sistema de salud pública en la búsqueda de cirugía bariátrica. Método: investigación cualitativa basada en la fenomenología social de Alfred Schütz, con 17 personas internadas con obesidad mórbida, con fecha programada para cirugía bariátrica. Se utilizó la entrevista fenomenológica con preguntas abiertas y las declaraciones se analizaron a la luz del marco teórico-metodológico y la literatura relacionada con el tema. Resultados: los participantes pudieron programar la cirugía bariátrica gracias a la recomendación de amigos, familiares y personas públicas. La lista de espera para el procedimiento generó angustia y ansiedad debido a factores como el miedo a la cirugía, aumento de peso, riesgo de empeorar el estado de salud y limitaciones físicas, pero ayudó a los participantes a prepararse para su realización. La experiencia vivida en la búsqueda de cirugía bariátrica llevó a estas personas a pretender la continuidad de la atención por profesionales capacitados para satisfacer sus necesidades en la Unidad Básica de Salud, después de la cirugía. Conclusión: los vaivenes que se suscitan en el camino de las personas en búsqueda de cirugía bariátrica señalan la necesidad de fortalecer los flujos de atención del sistema de salud pública e invertir en capacitación profesional para reducir las desigualdades en el acceso a la cirugía bariátrica y aumentar la calidad de los servicios prestados.(AU)

Recuperación de peso perdido en pacientes que han tenido cirugía bariátrica: Una mirada psicológica / Psychological factors influencing weight regain after bariatric surgery

Background Approximately 15 to 40% of bariatric patients regain a significant percentage of their weight lost after surgery. Among psychological variables, control and self-efficacy loci are associated with behaviors related to weight loss. Also, family support can be a risk or protection factor for the maintenance of weight loss. Aim To evaluate the association between psychological variables with weight maintenance or regain after bariatric surgery. Material and Methods We evaluated 97 patients at 4.1 ± 3.4 years after their bariatric surgery. They answered questionnaires about self-efficacy to lose weight, locus of weight control and family functioning style. Regain after surgery was also calculated, through self-report. Results Seventeen percent of patients gained weight. Locus of control (Z = -3.09, p < 0.01), family identity (Z = -3.71, p < 0.01) and self-efficacy (Z = -2.44, p = 0.01), differentiated patients who maintained weight loss from those who re-gained at least 15% of their lost weight. An inverse and significant relationship was observed between the percentage of weight regain and locus of control (r = -0.42, p < 0.01), family identity (r = -0.36, p < 0.01) and self-efficacy (r = -0.34, p <0.01). Conclusions The psychological variables "locus of weight control" and "family identity" are inversely and moderately associated with weight regain in patients subjected to bariatric surgery.

Cirurgia bariátrica e transtorno de compulsão alimentar: os cirurgiões devem se preocupar com isso? Uma revisão da literatura sobre a prevalência e os métodos de diagnóstico / Bariatric surgery and binge eating disorder: should surgeons care about it? a literature review of prevalence and assessment tools

ABSTRACT BACKGROUND: Eating pathologies among bariatric surgery candidates are common and associated with adverse surgical outcomes, including weight regain and low quality of life. However, their assessment is made difficult by the great variety and inconsistent use of standardized measures. OBJECTIVE: The purpose of this review was to synthesize current knowledge on the prevalence of binge eating disorder (BED) in presurgical patients and to make a critical appraisal of assessment tools for BED. METHODS: A search was conducted on PubMed, Scopus, and Web of Science databases from January 1994 to March 2017. Data were extracted, tabulated and summarized using a narrative approach. RESULTS: A total of 21 observational studies were reviewed for data extraction and analysis. Prevalence of BED in bariatric populations ranged from 2% to 53%. Considerable variation in patient characteristics and in BED assessment measures was evident among the studies. In addition, several methodological weaknesses were recognized in most of the studies. Ten different psychometric instruments were used to assess BED. Clinical interviews were used in only 12 studies, though this is the preferred tool to diagnose BED. CONCLUSION: Study heterogeneity accounted for the variability of the results from different centers and methodological flaws such as insufficient sample size and selection bias impaired the evidence on the magnitude of BED in surgical settings. For the sake of comparability and generalizability of the findings in future studies, researchers must recruit representative samples of treatment-seeking candidates for bariatric surgery and systematically apply standard instruments for the assessment of BED.

RESUMO CONTEXTO: Os transtornos alimentares entre os candidatos à cirurgia bariátrica são comuns e estão associados a resultados cirúrgicos adversos, incluindo recuperação de peso e baixa qualidade de vida. No entanto, sua avaliação é difícil pela grande variedade e uso inconsistente de métodos de avaliação padronizados. OBJETIVO: O objetivo desta revisão foi sintetizar o conhecimento atual sobre a prevalência do transtorno de compulsão alimentar (TCA) em pacientes pré-cirúrgicos e fazer uma avaliação crítica dos instrumentos de avaliação para TCA. MÉTODOS: A busca foi realizada nas bases de dados PubMed, Scopus e Web of Science de janeiro de 1994 a março de 2017. Os dados foram extraídos, tabulados e resumidos usando uma abordagem narrativa. RESULTADOS: Um total de 21 estudos observacionais foram revisados para extração e análise de dados. A prevalência de TCA nas populações bariátricas variou de 2% a 53%. Variações consideráveis nas características dos pacientes e nas medidas de avaliação do TCA foram evidentes entre os estudos. Além disso, várias fragilidades metodológicas na maioria dos estudos foram reconhecidas. Estudos utilizaram 10 diferentes instrumentos psicométricos para avaliar a TCA. Entrevistas clínicas foram utilizadas em 12 estudos, embora seja a ferramenta preferencial para diagnosticar o TCA. CONCLUSÃO: A heterogeneidade dos estudos foi responsável pela variabilidade dos resultados nos diferentes centros e falhas metodológicas, como tamanho insuficiente da amostra e viés de seleção, prejudicaram a estimativa da magnitude do TCA em cenários cirúrgicos. Para fins de comparabilidade e generalização dos achados em estudos futuros, os pesquisadores devem recrutar amostras representativas de candidatos à cirurgia bariátrica e fazer a aplicação sistemática de instrumentos padronizados para a avaliação do TCA.

Cirugía bariátrica en adolescentes / Bariatric surgery in adolescents

Resumen: La epidemia de obesidad afecta en forma transversal a todo el ciclo vital. En particular, en las últimas décadas se ha observado un incremento de la obesidad severa en adolescentes. En esta etapa de la vida caracterizada por profundos cambios físicos, emocionales y gran vulnerabilidad, la obesidad severa tiene pocas opciones efectivas de tratamiento. En adolescentes, los resultados del tratamiento centrado en modificaciones del estilo de vida son modestos y el arsenal farmacológico muy acotado y de poca efectividad. La Cirugía Bariátrica (CB) ha surgido como una opción terapéutica viable para un grupo seleccionado de adolescentes. El objetivo de esta revisión es presentar una visión actualizada respecto a indicaciones, contraindicaciones, complicaciones y resultados de estos procedimientos en población adolescente.

Abstract: The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.

Depression, anxiety, and binge eating before and after bariatric surgery: problems that remain / Depressão, ansiedade e compulsão alimentar antes e após cirurgia bariátrica: problemas que persistem

ABSTRACT Background: As the number of surgeries increases and the elapsed time of the realization increases as well, the postoperative evaluations would become increasingly necessary. Aim: To assess the psychological profile before and after surgery. Methods: Were evaluated 281 patients from the public service of bariatric surgery. In this study, 109 patients completed the evaluations before surgery (T0) and up to 23 months after surgery (T1); 128 completed the evaluations in T0 and between 24 months and 59 months after surgery (T2); and 44 completed the evaluations in T0 and 60 months after surgery (T3). A semi-structured interview, the Beck Depression Inventory (BDI), Beck Anxiety (BAI), and the Binge Eating Scale (BES) were used. Results: There was a higher prevalence of female (83%), patients with less than 12 years of education (83%), and patients who have a partner (64%). Analyzing all times of evaluation, regarding anxiety, depression, and binge eating, there was a reduction in all symptoms in T1, pointing to significant improvements in the first 23 months after surgery. Already, in T2 and T3, there was an increase in all indicators of anxiety, depression, and binge eating pointing to the transient impact of weight loss or bariatric surgery on these symptoms. Conclusions: This study shows the importance of the continuous psychological evaluation and needs for the appropriate interventions for these patients who have undergone bariatric surgery, even after weight loss.

RESUMO Racional: Avaliações pós-operatórias têm se tornado necessárias em ciruriga bariátrica considerando o grande número de operações e o tempo decorrido de sua realização. Objetivo: Avaliar o perfil psicológico de pacientes de um serviço público de cirurgia bariátrica antes e após o procedimento. Métodos: Foram avaliados no total 281 pacientes. Destes, 109 completaram as avaliações antes (T0) e até 23 meses após a operação (T1); 128 completaram as avaliações em T0 e entre 24 meses e 59 meses após a operação (T2); e 44 completaram as avaliações em T0 e 60 meses após a operação (T3). Foram utilizados entrevista semi-estruturada, Inventário Beck de Depressão (BDI), Inventário Beck de Ansiedade (BAI) e Escala de Compulsção Alimentar Periódica (ECAP). Resultados: Observou-se maior prevalência de mulheres (83%), pacientes com menos de 12 anos de escolaridade (83%) e pacientes que tinham um companheiro(a) (64%). Ao analisar todos os tempos de avaliação, observou-se que, com relação à ansiedade, depressão e compulsão alimentar, houve redução de todos os sintomas em T1, apontando para melhorias significativas nos primeiros 23 meses após a operação. Já em T2 e T3 observou-se aumento de todos os indicadores de ansiedade, depressão e compulsão alimentar, apontando para o impacto transitório da perda de peso alcançada pela cirurgia bariátrica nesses sintomas. Conclusões: Este estudo mostra a importância de avaliações psicológicas contínuas e a necessidade de intervenções multiprofissionais apropriadas para pacientes submetidos à cirurgia bariátrica, mesmo após a perda de peso.

Repercussões em longo prazo da derivação gástrica em Y de Roux em população de baixa renda: avaliação após dez anos de cirurgia / Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery

RESUMO Objetivo: avaliar a evolução ponderal, nutricional e a qualidade de vida de pacientes de baixa renda, após dez anos de derivação gástrica em Y de Roux (DGYR). Métodos: estudo longitudinal, retrospectivo e descritivo, que avaliou a perda do excesso de peso, o reganho de peso, a evolução da hipertensão arterial, do diabetes mellitus tipo 2, da anemia e da hipoalbuminemia em 42 pacientes de classes sociais D e E submetidos à DGYR. A qualidade de vida foi avaliada através do Bariatric Analysis and Reporting Outcome System (BAROS). Resultados: dos 42 pacientes, 68,3% se definiram como não praticantes de atividade física regular, e somente 44,4% e 11,9% tinham acompanhamento médico e nutricional regulares, respectivamente. Foi encontrada média da perda do excesso de peso de 75,6%±12 (IC=71,9-79,4) e perda ponderal insuficiente apenas em um paciente. O reganho ponderal médio foi de 22,3%±16,2 (IC=17,2-27,3), com 64,04% da amostra apresentando reganho maior do que 15% do peso mínimo. 52,3% da amostra apresentou anemia após dez anos de cirurgia e 47,6% deficiência de ferro. Hipoalbuminemia foi encontrada em 16,6% da amostra. Houve remissão da HAS em 66% e do diabetes mellitus tipo 2 em 50%. O BAROS demonstrou melhora na qualidade de vida em 85,8% dos pacientes. Conclusão: pudemos observar, em uma população com diversas limitações socioeconômicas, que a DGYR manteve resultados satisfatórios quanto à perda peso, mas o seguimento ineficiente pode comprometer o resultado final, especialmente no que diz respeito às deficiências nutricionais.

ABSTRACT Objective: to evaluate the weight, nutritional and quality of life of low-income patients after ten years of Roux-en-Y gastric bypass (RYGB). Methods: we conducted a longitudinal, retrospective and descriptive study evaluating the excess weight loss, weight regain, arterial hypertension, type 2 diabetes mellitus, anemia and hypoalbuminemia in 42 patients of social classes D and E submitted to RYGB. We assessed quality of life through the Bariatric Analysis and Reporting Outcome System (BAROS). Results: of the 42 patients, 68.3% defined themselves as doing non-regular physical activity, and only 44.4% and 11.9% had regular medical and nutritional follow-up, respectively. We found a mean excess weight loss of 75.6%±12 (CI=71.9-79.4), and in only one patient there was insufficient weight loss. The mean weight loss was 22.3%±16.2 (CI=17.2-27.3) with 64.04% of the sample presenting regain greater than 15% of the minimum weight; 52.3% of the sample presented anemia after ten years of surgery and 47.6%, iron deficiency. We found hypoalbuminemia in 16.6% of the sample. There was remission of hypertension in 66%, and of type 2 diabetes mellitus, in 50%. BAROS showed an improvement in the quality of life of 85.8% of the patients. Conclusion: in a population with different socioeconomic limitations, RYGB maintained satisfactory results regarding weight loss, but inefficient follow-up may compromise the final result, especially with regard to nutritional deficiencies.

Morbid Obesity and Motivation for Bariatric Surgery / Obesidad Mórbida y Motivación para la Cirugía Bariátrica

Morbid obesity is a disease affecting the health of thousands of people around the world, representing a great economic burden for health services. One of the most effective methods of weight reduction is bariatric surgery; however this procedure is commonly used only after other weight reduction methods have failed. This study explores the importance of certain elements as pre- and post-surgery motivators, as well as their relevance in the evolution of the bariatric patient. In this qualitative study we analyzed the discourse of 9 morbid obese people who had gone through bariatric surgery to lose weight, to identify their motivation to do the bariatric procedure, as well as doing and keeping changes to their lifestyle after surgery. We found that the most important motivating factors in pre-surgery period are fear of suffering diseases derived from their morbid obesity, and failure of other weight reduction methods; in postsurgery period, the main motivators to do and keep lifestyle changes are family support and desire to be able to do physical activities. We conclude that motivation should be considered in the treatment of bariatric patients, and treated by a psychologist as part of a multidisciplinary team of health experts.

La obesidad mórbida es una enfermedad que afecta la salud de miles de personas en el mundo, y representa una carga económica importante para los servicios de salud. Uno de los principales métodos para reducción de peso es la cirugía bariátrica, sin embargo, este procedimiento comúnmente es usado después del fracaso de otras alternativas. Este estudio explora la importancia de los motivadores en el periodo pre y post-cirugía, así como su relevancia en la evolución del paciente. En este estudio cualitativo se analizaron los discursos de 9 personas con obesidad mórbida que se sometieron a cirugía de reducción de peso, para identificar los motivadores que los llevaron a realizarse la cirugía y para cambiar su estilo de vida tras esta. Los principales motivadores en el periodo pre-cirugía son miedo a sufrir enfermedades derivadas de la obesidad y fracaso de otros métodos de reducción de peso; en el periodo postcirugía, los motivadores para hacer y mantener cambios en el estilo de vida fueron apoyo familiar y deseo de poder hacer actividad física. Concluimos que la motivación debe considerarse en el tratamiento de pacientes bariátricos, y tratada por un psicólogo como parte de un equipo multidisciplinario de expertos en salud.

Suicidio y cirugía bariátrica: un estudio de la evidencia / Suicide risk after bariatric surgery

Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a higher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed.

Short-Term Analysis of Food Tolerance and Quality of Life after Laparoscopic Greater Curvature Plication

PURPOSE: The aim of this study was to compare short-term outcomes [food tolerance scores (FTS) and quality of life] after three types of restrictive bariatric surgery: laparoscopic adjustable gastric banding (LAGB), laparoscopic greater curvature plication (LGCP), and laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: From January 2012 to December 2013, all patients that underwent primary surgery were included in one of the LAGB, LGCP, or LSG groups. These three groups were then compared with respect to FTS, gastrointestinal quality of life indices (GIQLI), and the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire. Questionnaires were sent to all patients both pre- and post-operatively. RESULTS: A total of 85 patients (LAGB=45, LGCP=22, and LSG=18) returned the questionnaires in full, and these patients constituted the study cohort. The cohort was predominately female (n=73, 85.9%). Mean percentage excess weight loss (%EWL) values after LAGB, LGCP, and LSG were 65.4+/-27.0%, 65.6+/-25.2%, and 82.7+/-21.7%, respectively (p=0.044). Mean postoperative FTSs and improvements in total GIQLIs after LAGB, LGCP, and LSG were 15.96, 20.95, and 21.33 and -3.40, 6.68, and 18.78, respectively (p<0.05). All procedures produced improvements in the three SF-36 domain scores. Subgroup analysis revealed significant differences between the three procedures in terms of improvements in general health and emotional well-being. CONCLUSION: LGCP is safe and effective at achieving significant weight loss. In terms of food tolerance and GI quality of life, LGCP was found to be comparable to gastric banding and sleeve gastrectomy.

IMPACT ON QUALITY OF LIFE, WEIGHT LOSS AND COMORBIDITIES: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass / Impacto na qualidade de vida, perda de peso e comorbidades: estudo comparativo entre as intervenções cirúrgicas derivação biliopancreática tipo “duodenal switch” e derivação gástrica em Y de Roux com anel

Context Few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS. The Roux-en-Y gastric bypass (RYGB) is the most common morbid obesity surgery worldwide. However, there is evidence indicating that a biliopancreatic diversion with duodenal switch (DS) is more effective than RYGB in weight loss terms. Objectives To evaluate the impact of different types of bariatric surgery on quality of life, comorbidities and weight loss. Methods Two groups of patients who underwent bariatric surgery conventional Banded Roux-en-Y gastric bypass (BRYGB) or DS were evaluated through monitoring at 12 to 36 months after surgery, as well as a control group of obese patients who had not undergone surgery. The tools used for this were SF-36, BAROS and M-A QoLQ II. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals. Results The mean age of the patients in the groups was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the control group, with no significant difference. There was no difference in the ratio of men to women in the groups. The patients that had surgery showed a significant improvement in all domains of quality of life vs the control group. Comparing the two groups that underwent surgery, the DS group achieved better quality of life results in terms of “general state of health” and “pain”, according to responses to the SF-36 tool, and in terms of “sexual interest”, according to responses to the M-A QoLQ II tool. There was no significant difference among the three groups regarding the ratio of occurrence of comorbidities. In the ...

Contexto Poucos estudos avaliaram os resultados de diferentes cirurgias bariátricas utilizando o questionário de qualidade de vida Medical Outcome Study 36 - Item Health Survey Short-Form (SF - 36), o Bariatric and Reporting Outcome System (BAROS) e o Moorehead-Ardelt Quality of Life II (M-A QoLQ II) revisado, que compõem o BAROS. A derivação gástrica em Y de Roux é a operação mais realizada em todo o mundo para tratamento da obesidade mórbida. Há evidencias sugerindo maior efetividade da operação derivação biliopancreática tipo “duodenal switch” (DS) em relação a derivação gástrica em Y de Roux quanto à perda de peso Objetivos Avaliar o impacto de diferentes intervenções cirúrgicas na qualidade de vida, comorbidades e perda de peso. Métodos Foram avaliados dois grupos de doentes submetidos à cirurgia bariátrica de derivação gástrica em Y-de-Roux com anel (BRYGB) ou “duodenal switch” após seguimento de 12 a 36 meses e, um grupo controle de doentes obesos não operados, utilizando o SF-36, o BAROS e o M-A QoLQ II. O grupo DS foi constituído por 17 doentes e, o BRYGB convencional, por 20. O grupo controle foi formado por 20 doentes obesos mórbidos independentes. Resultados A média de idade dos doentes nos grupos foi respectivamente 45,18 anos no grupo DS, 49,75 anos no grupo BRYGB e, 44,25 anos no grupo controle, sem diferença significante. Não foi observada diferença entre as proporções de sexo nos grupos. O grupo de pacientes operados apresentou melhora significante em todos os domínios de qualidade de vida, em relação ao grupo controle. Na comparação entre os grupos cirúrgicos, o grupo DS apresentou resultados de qualidade de vida melhores nos domínios “estado geral ...

Perception of quality of life of a group of individuals subjected to bariatric surgery / Percepción de calidad de vida de un grupo de personas operadas de cirugía bariátrica / Percepção de qualidade de vida de um grupo de pessoas operadas de cirurgia bariátrica

Objective. The study sought to identify the state of health and quality of life of post-bariatric surgery patients. Methodology. This was a cross-sectional study conducted in 2012 with the participation of 338 individuals attending the private practice of a bariatric surgeon from Medellín (Colombia). With prior signed informed consent, the survey was filled out by each patient. The information gathered was sociodemographic in nature along with the World Health Organization's Quality of Life Brief Questionnaire (WHOQoL-Bref). Results. It was found that 82.2% were women and mean age was 41±12 years. Gastric bypass was practiced on 79.6% of the cases. Mean weight before surgery was 106.3±17.5 Kg and after surgery it was 73.2±13.4 Kg. Nine of every 10 participants classified their quality of life and state of health between extremely well and quite well. Quality of life was better in men, in those younger than 40 years of age, in those from socio-economic levels 4 to 6, and in those with educational level above the secondary (high school). Conclusion. As a consequence of the important and rapid weight loss occurring during the first months after surgery, most of the participants perceived having a good quality of life and were satisfied with their health status. For nursing, it is a challenge to implement educational programs and projects, bearing in mind the sociocultural diversity of the individuals and communities, through interdisciplinary and inter-sector work, which contributes to the well-being of obese individuals subjected to bariatric surgery and their families.

Objetivo. Identificar el estado de salud y calidad de vida (CV) de los pacientes posoperados de cirugía bariátrica. Metodología. Estudio cross-sectional realizado en 2012 en el que participaron 338 personas que asistieron a la consulta particular de un cirujano bariátrico de Medellín (Colombia). Previo consentimiento informado firmado, se aplicó una encuesta que fue diligenciada por cada paciente. La información recolectada fue de tipo sociodemográfica y el cuestionario abreviado de calidad de vida de la Organización Mundial de la Salud (WHOQoL-Bref). Resultados. El 82.2% pertenecía al sexo femenino, la edad media fue 41±12 años. Les practicaron Bypass gástrico al 79.6% de los casos. El peso medio antes de la cirugía fue de 106.3±17.5 Kg y después de ella de 73.2±13.4 Kg. 9 de cada 10 participantes calificaron entre extremadamente bien y bastante bien su calidad de vida y el estado de salud. Aquella fue mejor en los hombres, en los menores de 40 años, en quienes pertenecían a estratos socioeconómicos 4 a 6 y en los que tenían estudios superiores a los secundarios. Conclusión. Como consecuencia de la rápida pérdida de peso ocurrida durante los primeros meses tras la cirugía, la mayor parte de los participantes percibe tener una buena calidad de vida y está satisfecha con su estado de salud. Para la enfermería es un reto implementar programas y proyectos educativos, teniendo en cuenta la diversidad sociocultural de las personas y las comunidades, a partir de un trabajo interdisciplinar e intersectorial, que contribuya al bienestar de las personas obesas sometidas a cirugía bariátrica, así como al de su familia.

Objetivo. Identificar o estado de saúde e qualidade de vida (CV) dos pacientes pós-operados de cirurgia bariátrica. Metodologia. Estudo cross-sectional realizado em 2012 no que participaram 338 pessoas que assistiram à consulta particular de um cirurgião bariátrico de Medellín (Colômbia. Prévio consentimento informado assinado se aplicou uma enquete que foi diligenciada por cada paciente. A informação coletada foi de tipo sócio-demográfica e o questionário abreviado de qualidade de vida da Organização Mundial da Saúde (WHOQoL-Bref). Resultados. 82.2% foram mulheres, a idade média foi 41±12 anos. Praticaram-lhes Bypass gástrico ao 79.6% dos casos. O peso médio antes da cirurgia foi de 106.3±17.5 Kg e depois dela de 73.2±13.4 Kg. 9 de cada 10 participantes qualificaram entre extremamente bem e bastante bem seu CV e o estado de saúde. A qualidade de vida foi melhor nos homens, nos menores de 40 anos, nos que pertenciam a estratos socioeconômicos 4 a 6 e nos que tinham estudos superiores aos secundários. Conclusão. Como consequência à importante e rápida perda de importância ocorrida durante os primeiros meses depois da cirurgia, a maior parte dos participantes percebem ter uma boa qualidade de vida e estão satisfeitos com o estado de saúde. Para a enfermagem é um repto implementar programas e projetos educativos, tendo em conta a diversidade sociocultural das pessoas e as comunidades, através de um trabalho interdisciplinar e intersetorial, que contribua a bem-estar das pessoas obesas, suas famílias que são submetidas a cirurgia bariátrica.

Ansiedad y depresión en pacientes obesos mórbidos: efectos a corto plazo de un programa orientado a la disminución de la sintomatología / Anxiety and depression in morbid obesity patients: short-term effect of a program oriented to the diminution of the symptomatology

La obesidad mórbida es, por sus repercusiones en la calidad de vida, salud física y psicológica, uno de los principales temas de interés e investigación en el campo de la salud. La mayoría de los programas de intervención apuntan directamente a la disminución de masa corporal excluyendo o ignorando dimensiones centrales en la enfermedad, tales como la depresión o ansiedad. En este artículo pretendemos dar a conocer los efectos en las dimensiones psicológicas de un programa interdisciplinario de 10 meses de duración. Participaron 18 personas, cuyas edades oscilaron entre 20 y 60 años, (M = 39.5; DT = 9.2), 17 mujeres y 1 hombre. Todos fueron parte del programa de apoyo interdisciplinario del equipo de trabajo OBEMOB de la Universidad Santo Tomás, sede Temuco. Los resultados muestran una disminución, estadísticamente significativa, en la sintomatología ansiosa y depresiva de todos los participantes. El artículo finaliza reflexionando sobre los alcances de la intervención, las dimensiones teóricas que pueden explicar los cambios y los requerimientos de futuros programas en el área.

Morbid obesity is, by its impact on life quality and physical-psychological health, one of the main topics of interest and research in the field of health. Most intervention programs aimed directly at decreasing body mass excluding or ignoring central dimensions in the disease, such as depression or anxiety. The aim of this article was to raise awareness of the effects on the psychological dimensions of an interdisciplinary program of 10 months duration. Participated 18 persons whose ages ranged between 20 and 60 years (M = 39.5, SD = 9.2), 17 women and 1 man. All were part of the program of support interdisciplinary (multidisciplinary) team working OBEMOB from the Santo Tomas University, located in Temuco, Chile. The results show a decrease, statistically significant, in anxious and depressive symptoms of all participants. The article concludes by reflecting on the scope of the intervention, the theoretical dimensions that may explain the changes, limitations and requirements of future programs in this area.

Changes in qualtty of life after short and longterm follow-up of roux-en-y gasstric bypass for morbid obesity / Alteracoes da qualidade de vida no seguimento a curto e longo prazos de individuos obesos morbidos submetidos a derivacao gastrica com Y de Roux

Context It is unclear whether health-related quality of life (HRQL) is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB). Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up. Methods We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery. Results The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions. Conclusions RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality) in the short-term and two SF-36 domains (general health perceptions and vitality) in the long-term. .

Contexto Ainda não está claro se as melhorias na qualidade de vida relacionada a saúde se sustentam no acompanhamento a longo prazo de pacientes obesos mórbidos que se submetem a derivação gástrica com Y de Roux (RYGB). Objetivo Este estudo tem como objetivo analisar as alterações na qualidade de vida relacionada a saúde no acompanhamento a curto e longo prazos de obesos mórbidos submetidos a RYGB. Métodos Foram comparados aspectos da qualidade de vida relacionada a saúde entre os três grupos distintos de pacientes, usando o questionário 36-Item Health Survey Short-Form (SF-36). Grupo A - 50 pacientes obesos mórbidos no pré-operatório, Grupo B - 50 pacientes submetidos à RYGB 1-2 anos pós-cirurgia e, Grupo C - 50 pacientes submetidos à RYGB há mais de 7 anos. Resultados Os grupos comparados eram semelhantes quanto ao sexo, idade e índice de massa corporal antes da cirurgia. Quanto aos aspectos componentes do questionário SF-36, observou-se que capacidade funcional, aspectos social e emocional e saúde mental não variaram quando se comparou os resultados dos três grupos. Quanto ao componente aspectos físicos, observou-se que permaneceu inalterado na avaliação de curto prazo e piorou em comparação aos valores obtidos no pré-operatório no seguimento a longo prazo. O componente dor corporal melhorou após a operação, mas voltou para nível semelhante ao pré-operatório após 7 anos. Vitalidade e estado geral de saúde melhoraram após a operação e apresentaram manutenção destes resultados após 7 anos, em comparação com as percepções pré-operatórias. Conclusões RYGB melhorou a qualidade ...

Análisis metacontingencial de la obesidad mórbida como problemática de salud pública / Metacontingencial anaylis to morbid obesity public health problema

El análisis metacontingencial es una estrategia ventajosa para la explicación de fenómenos socio-culturales a partir de los principios del análisis del comportamiento. Los estudios relacionados con la obesidad se han centrado en aspectos de orden epidemiológico, que han resultado útiles para caracterizarla, pero no han logrado explicar e identificar las relaciones entre los factores del contexto particular y los de tipo global, que son críticos para la adquisición y mantenimiento de esta, con los comportamientos de las personas con obesidad. En este artículo se realizó el mapa de contingencias para esta problemática, con base en la propuesta de Matainni (1996), que muestra las relaciones de dependencia entre las conductas, las ocasiones, los modelos, las reglas y las consecuencias. Además se señalan aspectos importantes que se podrían modificar para cambiar algunos factores implicados en el mantenimiento de la obesidad y ayudar a disminuir su incidencia y prevalencia, entendiéndola a nivel cultural.

Metacontingencial Analysis had been a useful strategy to explain socio-cultural phenomenon, with base on behavior analysis principles. Obesity studies, it was especially related with epidemiology aspects, whose principal result was characterizes these problem, but it doesn't achieve explain and neither establish the relations between particular and global contextual factor, that been critical to acquire and maintenance, and the behavior's obesity people. It make a contingencial map for this problem, base it on Matainni (1996) propose, this show dependent relations between behaviors, occasions, models, rules and consequences. Also presents important topics that could be changed to affect factors related with obesity maintenance and help to diminished its prevalence and incidence, understanding this phenomenon in a cultural level.

Percepção corporal e cirurgia bariátrica: o ideal e o possível / Body perception and bariatric surgery: the ideal and the possible

RACIONAL: A cirurgia bariátrica favorece significativa perda de peso. Pouco se sabe se a mudança no tamanho e forma corporal é suficiente para suprir as expectativas criadas no pré-operatório. OBJETIVO: Avaliar as diferentes percepções de tamanho e forma corporal antes e após operação bariátrica. MÉTODO: Foram avaliados 423 pacientes utilizando-se a Escala de Desenhos de Silhuetas. Desses, 32% foram avaliados no pré-operatório (PreO), 20% entre 10 e 12 meses após a operação (PO-1), 13% entre 18 e 24 meses (PO-2), 15% entre 30 e 36 meses (PO-3) e 20% a partir de 42 meses da operação (PO-4). Os grupos foram comparados utilizando-se ANOVA (SPSS 17.0). RESULTADOS: Ao escolheram figuras representativas de um homem e de uma mulher de tamanho normal, não se observaram diferenças entre os grupos. Quanto às escolhas de figuras que representavam o próprio tamanho, o grupo PreO diferenciou-se de todos os grupos (p<0,001) escolhendo figuras maiores. Ao escolherem figuras representativas de um tamanho que acreditavam que poderiam alcançar, o grupo PreO se diferenciou de PO-1, PO-2 e PO-3 (p<0,001), mostrando tendência a escolha de figuras de silhuetas maiores depois da operação. Nas escolhas de figuras que representavam um tamanho que gostariam de ter, o grupo PO-4 se diferenciou de PO-1 e PO-2 (p<0,05), mostrando que no PO-4 houve tendência a escolha de figuras maiores. CONCLUSÃO: A percepção corporal parece estar de acordo com o próprio tamanho, inclusive após perda de peso. Quanto maior o tempo pós- operatório, maior a consciência das reais possibilidades de perda de peso. Observaram-se sinais de insatisfação com o tamanho e forma corporal, principalmente no PO-1 e PO-2, o que pode levar à frustração e pouco uso dos benefícios da operação para a saúde e qualidade de vida.

BACKGROUND: Bariatric surgery helps significantly in weight loss. Little is known whether the change in body shape and size is enough to meet the expectations created preoperatively. AIM: To evaluate the different perceptions of body size and shape before and after bariatric surgery. METHOD: A total of 423 patients were evaluated by Nine-figure Outline Scale. Of these, 32% were pre-surgery (PreS), 20% were evaluated between 10 and 12 months after surgery (PO-1), 13% between 18 and 24 months (PO-2), 15% between 30 and 36 months (PO-3) and 20% after 42 months of operation (PO-4). Groups were compared using one-way analysis of variance. RESULTS: When choosing figures that represented a man and a woman of normal size, no differences were observed between groups. Regarding the choice of figures representing the own size, differences were observed between groups PreS and all other groups (p<0.001), and PreS chosen larger figures. In choosing figures that represented a size that believed they could achieve, PreS differed from the PO-1, PO-2 and PO-3 (p <0.001), showing a tendency to choose larger silhouettes after surgery. When choosing figures that represented a size that would like to have PO-4 differed from PO-1 and PO-2 (p <0.05), showing that in the PO-4 there was a tendency to choose larger figures. CONCLUSION: The body perception seems to comply with own body size, even after weight loss. As longer postoperative period, the participants were more aware of the real possibilities of weight loss. There were signs of dissatisfaction with the body size and shape, mainly in the PO-1 and PO-2, which can lead to frustration and little use of the benefits of the surgery for health and quality of life.

Qualidade de vida de pessoas com obesidade grau III: um desafio comportamental / Quality of life of people with class III obesity: a behavioral challenge

JUSTIFICATIVA E OBJETIVOS: A obesidade constitui-se em preocupação na esfera de saúde pública, uma vez que aumenta o risco de mortalidade, acarreta comorbidades, danos psicossociais relacionados à alteração da imagem, que contribui negativamente para a qualidade de vida (QV) do indivíduo, além de acarretar outros diferentes problemas à saúde. O estudo teve por objetivo caracterizar e avaliar a QV de adultos com obesidade grau III atendidos nas unidades da rede básica de saúde e contribuir com informações que subsidiem os profissionais de saúde na formulação de estratégias de atenção à saúde desses pacientes. MÉTODO: Estudo quantitativo, descritivo, exploratório, de delineamento transversal realizado com 83 pessoas com obesidade grau III provenientes da rede pública e cadastradas nas unidades básicas de saúde de um município do sul de Minas Gerais. A coleta de dados foi realizada em visita domiciliar, por meio de um questionário semiestruturado e o Questionário Abreviado de Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-bref ). RESULTADOS: A média de índice de massa corpórea (IMC) encontrada foi de 43,139 kg/m2 ± 3,016; predominaram pacientes do sexo feminino (89,16%), casados (72,3%), com faixa etária entre 40 e 59 anos (55,42%), com baixo nível de escolaridade e de renda familiar. A obesidade esteve frequentemente associada à comorbidades, entre as quais foram identificados problemas psicoemocionais como ansiedade, depressão e dificuldades para o trabalho e o lazer. CONCLUSÃO: As pessoas que participaram deste estudo apresentam problemas de saúde decorrentes da obesidade e classificam sua QV como "nem ruim/nem boa"; o que pode ser associado à condição de serem "indiferentes" em relação à mesma. Portanto, é necessário que os profissionais de saúde busquem estratégias que promovam a percepção do próprio bem estar e favoreçam a mudança de comportamento que resulte na melhoria da QV desses pacientes.

BACKGROUND AND OBJECTIVES: Obesity is a major public health concern since it increases the risk of mortality; causes comorbidities and psychosocial damage related to self-image change, which contributes negatively to the quality of life (QL) of individuals; and lead to other different health problems. The study aimed at characterizing and evaluating the quality of life of adults with class III obesity that were attended in units of the primary care network, and at contributing with information to health care professionals that subsidizes the formulation of strategies for these patients' health care. METHOD: Quantitative, descriptive, exploratory, cross-sectional study which was conducted with 83 people with class III obesity assisted in the Public Service and registered in the Primary Health Care of a city placed in the south of the State of Minas Gerais. Data collection was performed during home visits, using a semistructured questionnaire and instruments for quality of life assessment that were proposed by the World Health Organization (WHOQOL-bref ). RESULTS: The mean body mass index (BMI) was found to be 43.139 ± 3.016 kg/m2, patients were predominantly female (89.16%), married (72.3%), aged between 40 and 59 years (55.42%), with low educational level and family income. Obesity was often associated with comorbid conditions, which were related to psycho-emotional problems such as anxiety, depression and difficulties in work and leisure. CONCLUSION: People who participated in this study have health problems resulting from obesity, and estimated their QL as "not bad/not good" which can be associated with the condition of being "indifferent" about this matter. Therefore, it is necessary that health care professionals seek strategies that promote the perception of own welfare and foster behavior change that results in improved QL of these patients.

Manejo nutricional del niño obeso / Nutritional management of obese children

La obesidad constituye un problema grave de salud pública. La OMS la define como una acumulaciónanormal o excesiva de grasa que puede ser perjudicial para la salud. La prevalencia se ha incrementado.Enfermedad crónica, compleja y multifactorial, en la que interaccionan factores genéticos y ambientales. Elíndice de Quételet o índice de masa corporal (IMC), es usado para estimar la gravedad. La valoración inicialdebe incluir exploración física y valorar el desarrollo puberal. Se asocia, con complicaciones inmediatas,int e rmedi a s y t a rdí a s . El t r a t ami ento e s multidisciplinario e individualizado. La cirugía en la población pediátrica está limitada. No se debe perder de vista que la solución ideal a este problema es laprevención.

Obesity is a serious public health problema. WHO defines it as an accumulation of abnormal or excessive fat that can be harmful to health. The prevalence has increased. It's a chronic, complex and multifactorial patology, in which genetic and environmental factors interact. Quetelet index or body mass index is used to estímate the severity. The initial assessment should include physical examination and assess pubertal development. It is associated with immediate, intermédiate and late complications. The treatment is multidisciplinary and individualized. Surgery in the pediatric population is limited. Do not forget that the ideal solution to this problema is prevention.