Crenças alimentares em indivíduos que se submeteram à cirurgia bariátrica / Alimentary convictions on persons submited to bariatric surgery

Uma alternativa para solucionar o problema da obesidade mórbida é a cirurgia bariátrica. As mudanças inerentes ao processo de emagrecer no pós-operatório são de extrema complexidade. As crenças alimentares são representações, com funções defensivas, que mediam o sujeito dos seus desejos e do mundo.Este trabalho tem como propósito realizar uma investigação do papel da mediação operado pelas crenças alimentares após a cirurgia bariátrica.O método utilizado foi o estudo transversal com a utilização da Escala de Crenças Alimentares (MFH) e questionário desenvolvido pelos pesquisadores contendo 35 itens. Foram incluídos 60 pacientes que haviam se submetido à cirurgia de "Fobi-Capela" há pelo menos seis meses. Analisando os resultados obtidos com a Escala MFH, constatamos a presença significativa de crenças alimentares após a cirurgia bariátrica. Concluímos que as mudanças impostas ao paciente depois da gastroplastia favorecem a adesão a um conjunto de crenças, sendo esta uma postura defensiva mediante a tantas transformações vividas(AU)

The bariatric surgery is an alternative to solve the problem of morbid obesity. The changes inherent to the process of weight loss in the postoperative period are very complex. The food beliefs are representations with defensive duties, which mediate the subject relationships with their desires and the world. The aim of this paper is to conduct an investigation of the mediation role operated by food beliefs after bariatric surgery. A cross study with the application of the food beliefs scale (MFH)and a questionnaire developed by researchers containing 35 items was used as a method. Sixty patients who had undergone the surgery, "Fobi-Capella" for at least six months were included. Analyzing the results obtained with the scale MFH, we found a significant presence of food beliefs after bariatric surgery. We conclude that the changes imposed on the patient after gastroplasty encourage the adherence to a set of beliefs, and this is a defensive posture through many transformations experienced(AU)

Abordagem multidisciplinar de pacientes obesos mórbidos submetidos a tratamento cirúrgico pelo método da banda gástrica ajustável / Multidisciplinary approach to morbidly obese patients undergoing surgical treatment by adjustable gastric banding

OBJETIVO: Avaliar o resultado do tratamento cirúrgico de pacientes obesos mórbidos pelo método da BGA, acompanhados em ambulatório multidisciplinar. MÉTODOS: Foram estudados 20 pacientes com IMC que variou de 36,6 a 72 kg/m2 (X=47,51 +/- 6,1) e idade entre 36 a 60 anos, submetidos à colocação de BGA. As comorbidades encontradas no pré-operatório foram hipertensão arterial (nove), diabetes tipo II (quatro), apneia do sono grave (um), hipertrigliceridemia (quatro) e problemas ortopédicos graves (três). No seguimento pós-operatório os pacientes foram atendidos em ambulatório multidisciplinar (cirurgião, endocrinologista, psiquiatra e nutricionista). Nos primeiros seis meses, a orientação foi de visitas mensais para ajustes da banda e orientação nutricional. Após, as visitas ocorreram a cada dois ou três meses, conforme a necessidade. RESULTADOS: O tempo cirúrgico variou de 40 a 180 minutos; o de internação de 1 a 10 dias (X = 36 horas). Duas pacientes necessitaram reintervenção cirúrgica por complicações tardias: uma rotação do portal e um deslizamento superior da banda . O tempo de seguimento variou de 28 a 36 meses. A perda de peso média foi de 29,26 kg +/- 8,8, ou 24,37 por cento +/- 6,1 do peso inicial e 49,16 por cento +/- 11,3 do excesso de peso. O IMC médio variou de 47,51 para 34,88. Houve melhora global das comorbidades, mais acentuada nos pacientes com maior perda de peso. CONCLUSÃO: Os resultados obtidos foram satisfatórios para a maioria dos pacientes nos quesitos perda de peso e melhora das comorbidades.

OBJECTIVE: To evaluate the outcome of the surgical treatment of morbidly obese patients by Adjustable Gastric Banding (ABG) followed in a multidisciplinary clinic. METHODS: We studied 20 patients with BMI ranging from 36.6 to 72 kg/m2 (X = 47.51 + / - 6.1) and aged between 36 to 60 years, undergoing placement of AGB. Preoperative comorbidities were hypertension (nine), type II diabetes (four), severe sleep apnea (one), hypertriglyceridemia (four) and severe orthopedic problems (three). In the post-operative period patients were followed at a multidisciplinary clinic (surgeon, endocrinologist, psychiatrist and nutritionist). In the first six months, the orientation was of monthly visits for band adjustments and nutritional counseling. After six months the visits occurred every two or three months, as needed. RESULTS: The operative time ranged from 40 to 180 minutes; hospital stay varied from one to ten days (X = 36 hours). Two patients required surgical reintervention for late complications: a rotation of the portal and a band superior slippage. Follow-up ranged from 28 to 36 months. The average weight loss was 29.26 kg +/- 8.8, or 24.37 percent +/- 6.1 of the original weight and 49.16 percent +/- 11.3 overweight. The average BMI ranged from 47.51 to 34.88. There was global improvement of comorbidities, markedly in the patients with greater weight loss. CONCLUSION: The results were satisfactory for most patients on the variables weight loss and improvement of comorbidities.

Imagem corporal, práticas de dietas e crenças alimentares em adolescentes e adultas / Body image, dieting and beliefs on nourishment in adolescents and adults

Insatisfação com o peso, uso de métodos de emagrecimento inadequados e crenças mágicas sobre alimentação constituem fatores de risco para o desenvolvimento de sintomas alimentares. O presente estudo compara a prevalência de tais fatores em grupos de adolescentes e de adultas. Participaram da pesquisa 160 mulheres (80 adolescentes e 80 adultas com idades entre 20 e 40 anos) sem diagnóstico previamente conhecido de transtornos alimentares. Concluiu-se que, nos dois grupos, as crenças estão associadas à insatisfação com o peso e às tentativas de emagrecer. Adolescentes e adultas que se julgam gordas tendem a adotar com mais freqüência a crença no jejum como forma de desintoxicar o corpo e utilizam mais métodos de dietas como laxantes e purgação. No entanto, há mais adolescentes insatisfeitas com seu peso, por isso discute-se como as mulheres se relacionam com o corpo em diferentes fases da vida.(AU)

Dissatisfaction with weight, inappropriate dieting methods and magical beliefs about eating constitute risk factors which lead to the development of eating disorder symptoms. The present study compares the prevalence of such factors in groups of adolescent and adult women. 160 subjects took part in this study (80 teenagers and 80 adult women between the ages of 20 and 40 years old). None of them had been previously diagnosed with eating disorders. In both groups it is possible to conclude that the beliefs are associated with weight dissatisfaction and attempts to lose weight. Adolescent and adult women who see themselves as fat more frequently tend to believe in fasting as a form of detoxifying the body, and they use more laxatives and purgatives to lose weight. Even so, there are more teenagers that are dissatisfied with their weight. Finally, the study gives a broader explanation of how women relate to their bodies in different stages of their lives.(AU)

Evoluçäo clínica de pacientes com hipercolesterolemia familiar e doença coronaria submetidas a derivaçäo ileal parcial (bypass ileal) / Clinical outcome of patients with familial hypercholesterolemia and coronary artery disease undergoing partial ileal bypass surgery

Familial hypercholesterolemia is characterized by high serum levels of total cholesterol and LDL-cholesterol. It may be homozygous or heterozygous. In homozygous patients, LDL-cholesterol levels range from 500 to 1000mg/dL and coronary artery disease is precocious, usually manifesting itself between the 2nd and 3rd decades of life. The diagnosis is often made by the presence of xanthoma tuberosum and tendinous xanthomas that appear between the 1st and 2nd decades of life. The use of high doses of statins or even unusual procedures (apheresis, partial ileal bypass surgery, liver transplantation, gene therapy), or both, is necessary for increasing survival and improving quality of life, because a reduction in cholesterol levels is essential for stabilizing the coronary artery disease and reducing xanthomas. We report our experience with 3 patients with xanthomatous familial hypercholesterolemia and coronary artery disease, who underwent partial ileal bypass surgery. Their follow-up over the years (approximately 8 years) showed a mean 30 percent reduction in total cholesterol, with a significant reduction in the xanthomas and stabilization of the coronary artery disease