RESUMEN
En la actualidad, la obesidad es conside-rada una pandemia, cuya incidencia se ha triplicado en los últimos 30 años, y ha ge-nerado problemas de salud pública cada vez mayores. Tomando como base las guías de la Asociación Americana de Endocrinólogos (AACE), la Sociedad para la Obesidad, la Sociedad Americana de Cirugía Bariátrica y Metabólica (ASMBS), la Asociación para Medicina de la Obe-sidad y la Asociación Americana de Anes-tesiólogos, se realiza el presente docu-mento, con el fin de que se constituya en la hoja de ruta que guíe el procedimiento a seguir en los pacientes que padecen de esta enfermedad crónica y que acuden al Hospital General San Francisco (HGSF)1. La obesidad se caracteriza por el uso de varios medicamentos debido a las co-morbilidades relacionadas: enfermedad cardiovascular, diabetes mellitus tipo 2, enfermedad renal crónica, hígado graso no alcohólico, síndrome metabólico y varios tipos de cánceres2. Este protocolo contiene el más alto nivel de evidencia disponible hasta la fecha, en relación al manejo quirúrgico y no quirúrgico del paciente con diagnóstico de obesidad, incluyendo temas como la identificación de los pacientes candidatos para los pro-cedimientos bariátricos, tipo de proce-dimientos que deberían ser ofertados, el manejo preoperatorio, transoperatorio y el cuidado post operatorio de seguimiento2-4.Desde la publicación por parte de la Ame-rican Society for Metabolic and Bariatric Surgery (ASMBS) en el año 2013 de las guías de manejo del paciente con obe-sidad, se ha evidenciado un incremento significativo en las publicaciones que avalan excelentes resultados para el tra-tamiento de los pacientes con obesidad y con diabetes mellitus tipo 2 mediante la cirugía bariátrica y metabólica 2,5,6. En el año 2016 la publicación del Diabetes Sur-gery Summit (DSS2)7 marca diferencia en el manejo de los pacientes con diabetes mellitus tipo 2, es así que las mismas han crecido sustancialmente y la evidencia demuestra que el manejo metabólico ba-riátrico de estos pacientes es superior al manejo médico y cambios de estilo de vida cuando se evalúa el control glucémico y remisión de las comorbilidades. Con la evaluación previa del equipo mul-tidisciplinario, tendremos información científica del más alto nivel que nos per-mita tener un paciente con recuperación óptima aplicando los criterios de En-hanced Recovery after Bariatric Surgery (ERASB)8. En el Ecuador, la obesidad se ha conver-tido en un problema de salud pública, es así que en la población pediátrica ha au-mentado desde el año 1986 pasando del 8,0% al 26,0% para el año 2012 en el grupo de 11 a 19 años. La prevalencia de sobrepeso y obesidad en población adulta en el Ecuador es del 62,8%, según el sexo es 5,5% mayor en las mujeres (65,5%) que en los hombres (60,0%), y el mayor índice de obesidad y sobrepeso se pre-senta entre la cuarta y quinta décadas de vida, con prevalencias superiores a 73,0%9,10.
Currently, obesity is considered a pan-demic, the incidence of which has tripled in the last 30 years, and has generated in-creasing public health problems. Based on the guidelines of the American As-sociation of Endocrinologists (AACE), the Obesity Society, the American So-ciety for Metabolic and Bariatric Surgery (ASMBS), the Association for Obesity Medicine and the American Association of Anesthesiologists, this document is intended to serve as a roadmap to guide the procedure to be followed in patients suffering from this chronic disease who come to San Francisco General Hospital (HGSF)1.Obesity is characterized by the use of se-veral medications due to related comor-bidities: cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease, meta-bolic syndrome and several types of can-cers2. This protocol contains the highest level of evidence available to date, in relation to the surgical and non-surgical management of the patient with a diag-nosis of obesity, including issues such as the identification of candidate patients for bariatric procedures, type of proce-dures that should be offered, preopera-tive, trans-operative management and fo-llow-up post-operative care2-4.Since the publication by the American So-ciety for Metabolic and Bariatric Surgery (ASMBS) in 2013 of the guidelines for the management of patients with obesity, there has been a significant increase in publications that support excellent results for the treatment of patients with obesity and type 2 diabetes mellitus through bariatric and metabolic surgery2,5,6. In 2016 the pu-blication of the Diabetes Surgery Summit (DSS2)7 makes a difference in the mana-gement of patients with type 2 diabetes mellitus, it is so that the same have grown substantially and the evidence shows that bariatric metabolic management of these patients is superior to medical manage-ment and lifestyle changes when glycemic control and remission of comor-bidities are evaluated. With the previous evaluation of the multidisciplinary team, we will have scientific information of the highest level that will allow us to have a patient with optimal recovery applying the criteria of Enhanced Recovery after Bariatric Surgery (ERASB)8.In Ecuador, obesity has become a public health problem; thus, in the pediatric population it has increased since 1986 from 8,0% to 26,0% in 2012 in the 11 to 19 years age group. The prevalence of overweight and obesity in the adult po-pulation in Ecuador is 62,8%, according to sex is 5,5% higher in women (65,5%) than in men (60,0%), and the highest rate of obesity and overweight occurs between the fourth and fifth decades of life, with prevalences higher than 73,0%9,10.
Asunto(s)
Humanos , Masculino , Femenino , Cirugía Bariátrica , Programas de Reducción de Peso , Manejo de la Obesidad , Enfermedades Nutricionales y Metabólicas , Obesidad , Peso Corporal , Pérdida de Peso , Trastornos de Alimentación y de la Ingestión de Alimentos , Índice de Masa Corporal , Nutrición, Alimentación y Dieta , MetabolismoRESUMEN
Objetivo: identificar las intervenciones psicoeducativas (IP) dirigidas a reducir factores psicosociales (ansiedad, depresión, estrés, imagen corporal, autoestima y apoyo social) y controlar el aumento de peso en mujeres embarazadas. Método: revisión sistemática de ensayos clínicos aleatorizados y estudios cuasi-experimentales consultado en las bases de datos de PubMed, Academic Search Complete, Medline, Web of Science, Ovid, ScienceDirect, Wiley Online Library y Scopus. Resultados: se incluyeron 4 estudios publicados entre el 2000 y 2016. Las IP que incluyen algún componente psicoeducativo como: psicoterapia, entrevista motivacional, establecimiento de objetivos y resolución de problemas junto con asesoramiento en conductas como alimentación saludable y actividad física, tienen un efecto significativo en disminuir la depresión y ansiedad, y a la vez mejoran el control del peso gestacional. Las IP dirigidas al estrés, autoestima, imagen corporal y apoyo social no mostraron efecto significativo para mejorar estas condiciones ni para el control de peso gestacional. Conclusión: se debe considerar componentes psicoeducativos, aunado con terapias complementarias para reducir los factores psicológicos y GPG. Se necesitan más investigaciones para identificar la detección de estos síntomas.
Objective: Identify psychoeducational interventions (PI) aimed at reducing psychosocial factors (anxiety, depression, stress, body image, self-esteem and social support) and controlling weight gain in pregnant women. Method: Systematic review of randomized clinical trials and quasi-experimental studies consulted in the databases of PubMed, Academic Search Complete, Medline, Web of Science, Ovid, ScienceDirect, Wiley Online Library and Scopus. Results: We include four studies published between el 2000 y 2016. The PIs that include some psychoeducational component such as: psychotherapy, motivational interview, goal setting and problem solving together with counseling on behaviors such as healthy eating and physical activity, have a significant effect in reducing depression and anxiety, and at the same time improve the control of gestational weight. The PIs aimed at stress, self-esteem, body image and social support showed no significant effect to improve these conditions or for the control of gestational weight. Conclusion: psychoeducational components should be considered, combined with complementary therapies to reduce psychological factors and GPG. More research is needed to identify the detection of these symptoms.
Objetivo: Identificar intervenções psicoeducativas (IP) voltadas à redução de fatores psicossociais (ansiedade, depressão, estresse, imagem corporal, autoestima e suporte social) e controle do ganho de peso em gestantes. Método: Revisão sistemática de ensaios clínicos randomizados e estudos quase-experimentais consultados nas bases de datos de PubMed, Academic Search Complete, Medline, Web of Science, Ovid, ScienceDirect, Wiley Online Library e Scopus. Resultados: Quatro estudos publicados entre 2000 e 2016. IP incluindo um componente psicoeducacional como incluído: psicoterapia, entrevista motivacional, estabelecimento de metas e resolução de problemas, juntamente com conselhos sobre comportamentos, como alimentação saudável e atividade física, têm um efeito significativo na diminuição depressão e ansiedade e, ao mesmo tempo, melhorar o controle do peso gestacional. Os IPs voltados ao estresse, autoestima, imagem corporal e suporte social não apresentaram efeito significativo para melhorar essas condições ou para o controle do peso gestacional. Conclusão: os componentes psicoeducacionais devem ser considerados, combinados com terapias complementares para reduzir fatores psicológicos e GPG. Mais pesquisas são necessárias para identificar a detecção desses sintomas.
Asunto(s)
Índice de Masa Corporal , Paquetes de Atención al PacienteRESUMEN
Abstract: INTRODUCTION: Scaling in obesity classes increases its effect on medical comorbidities and psychiatric symptoms. Anxiety and depression have a significant effect on treatment adherence and weight loss. OBJECTIVE: This study had three aims: a) to evaluate the prevalence of psychiatric symptoms; b) to evaluate the interactions between obesity classes and demographic variables in relation to psychiatric symptoms; and c) to analyze the interactions between obesity classes, demographic variables, and psychiatric symptoms in association with medical comorbidities in a sample of obese individuals seeking treatment for weight loss. METHOD: Medical record review of 22 weight loss clinics during January-December 2014. Binomial logistic regression was carried to assess univariate associations, second- and third-order interactions. RESULTS: Total sample was composed of 13,305 patients, mostly women (82.04%), married (53.66%), with elementary education (38.6%), mean body max index was 34.94 (SD = 4.39). The most prevalent psychiatric symptoms were anxiety (45.21%) and depression (16.36%). When analyzing interactions, it was found that men with class II obesity had higher odds for alcohol use (OR 1.56, IC 95% 1.10-2.22), and participants with obesity class III and married had more probability of diabetes II (OR 1.53, IC 95% 1.06-2.19). DISCUSSION AND CONCLUSION: Results show the complexity of the relation between demographic variables, psychiatric symptoms, medical comorbidities and obesity, underscoring the need to tailor treatments based in such variables, to promote adherence and weight loss.
Resumen: INTRODUCCIÓN: El incremento en el grado de obesidad se asocia con comorbilidades médicas y los síntomas psiquiátricos. La ansiedad y la depresión afectan la adherencia al tratamiento de la obesidad y la reducción de peso corporal. OBJETIVO: El estudio tuvo tres objetivos principales: a) Evaluar la prevalencia de síntomas psiquiátricos; b) evaluar las interacciones entre grados de obesidad, variables demográficas y síntomas psiquiátricos; c) analizar las interacciones entre grados de obesidad, síntomas psiquiátricos y comorbilidades médicas. MÉTODO: A través de revisión de expedientes médicos de 22 clínicas de reducción de peso entre enero-diciembre de 2014. Se analizó a través de regresión logística univariada y evaluando interacciones de segundo y tercer orden. RESULTADOS: La muestra total fue de 13305, mayormente mujeres (82.04%) la mayoría son casados (53.66%) con escolaridad de secundaria (38.6%) y preparatoria (36.7%), el IMC promedio fue de 34.94 (SD = 4.39). Las comorbilidades más prevalentes fueron síntomas de ansiedad (45.21%) y depresión (16.36%). Al analizar las interacciones los hombres con obesidad tipo II tuvieron mayor probabilidad de consumo de alcohol (OR 1.56 IC 95% 1.10-2.22), y los participantes con obesidad tipo III y casados tuvieron mayor probabilidad de diabetes (OR 1.53 IC 95% 1.06-2.19). DISCUSIÓN Y CONCLUSIÓN: Los resultados muestran la compleja relación entre variables demográficas, obesidad, síntomas psiquiátricos y comorbilidades, implicando la necesidad de desarrollar programas de tratamiento que tomen en cuenta dichas variables para promover la adherencia al tratamiento y la reducción de peso.
RESUMEN
OBJETIVO: Avaliar o efeito dos programas de intervenções com a atividade física e/ou a educação nutricional na redução do índice de massa corporal em escolares. MÉTODOS: Revisão sistemática com metanálise de estudos controlados randomizados disponíveis nas seguintes bases de dados eletrônicas entre o ano de 1998 a 2010: PubMed, Lilacs, Embase, Scopus, Web of Science e Cochrane Library, com os descritores: estudo controlado randomizado, sobrepeso, obesidade, índice de massa corporal, criança, adolescente, atividade física, educação nutricional e escolas. Medida de sumário baseada na diferença das médias padronizadas foi usada com intervalo de 95% de confiança. O teste de inconsistência foi utilizado para avaliar a heterogeneidade dos estudos. RESULTADOS: Foram identificados 995 estudos, dos quais 23 foram incluídos e realizadas três metanálises. Intervenções isoladas com atividade física não apresentaram efeito significativo na redução do índice de massa corporal, com diferença das médias padronizadas: -0,02 (IC95% -0,08;0,04). Resultado semelhante (n = 3.524) foi observado nas intervenções isoladas com educação nutricional, com diferença das médias padronizadas: -0,03 (IC95% -0,10;0,04). Quando combinadas as intervenções com atividade física e educação nutricional, o resultado da metanálise (n = 9.997) apresentou efeito estatisticamente significativo na redução do índice de massa corporal em escolares, com diferença das médias padronizadas: - 0,37 (IC95% -0,63;-0,12). CONCLUSÕES: As intervenções combinadas de atividade física e educação nutricional tiveram mais efeitos positivos na redução do índice de massa corporal em escolares do que quando aplicadas isoladamente.
OBJECTIVE: To evaluate the effect of intervention programs using nutritional education, physical activity or both on the reduction of body mass index in school-age students. METHODS: The systematic review with meta-analysis included randomized controlled studies available from the following electronic databases for the years 1998 to 2010: PubMed, Lilacs, Embase, Scopus, Web of Science and Cochrane Library. The descriptors were: randomized controlled trial, overweight, obesity, body mass index, child, adolescent, physical activity, nutrition education and Schools. A weighted average was based on the standardized means difference and used a 95% confidence interval. The inconsistency test was utilized to evaluate the heterogeneity of studies. RESULTS: Initially, 995 studies were identified, of which 23 were included, and 3 meta-analyses were performed. Isolated physical activity interventions did not present a significant reduction in BMI, with a standardized mean difference of -0.02 (95%CI: -0.08; 0.04). A similar result (n= 3,524) was observed in the isolated interventions of nutritional education, with a standardized mean difference of -0.03 (95%CI: -0.10; 0.04).When the interventions with physical activity and nutritional education were combined, the result of the meta-analysis (n= 9,997) presented a statistically significant effect in the reduction of body mass index in school-age students, with a standardized mean difference: -0.37 (95%CI: -0.63; -0.12). CONCLUSIONS: The interventions that combined physical activity and nutritional education had more positive effects in the reduction of body mass index among school-age students than when they were applied individually.
