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No / Bariatric surgery has emerged as an increasingly popular weight loss intervention, with larger and more endurable weight loss compared to pharmacological and behavioural interventions. The degree of weight loss patients experience varies, between individuals, surgeries and over time. An explanation as to why differing weight loss trajectories exist post-surgery could be due to the complex interplay of individual differences in relation to eating behaviours and appetite. Thus the aim of this narrative review is to explore literature between 2008 and 2018, to assess the impact of impact of bariatric surgery on food selection and nutrient status, on eating behaviour traits and on disturbed and disordered eating behaviour, to determine their impact of weight loss success and weight loss trajectories. Immediately post-surgery, up until 1–2 years post-surgery, there is a reliance upon the surgery's alteration of the gastrointestinal tract to control food intake and subsequently lose weight. Energy intake is reduced, dietary adherence is higher, supplement intake is higher, appetite ratings are lower, there is a reduction in psychopathology, and an increase in wellbeing. After this point, patients become more susceptible to weight regain, as this is the point where passive observation of the weight reducing action of surgery, moves into more cognitive effort, on the part of the individual, to control energy intake. There are various factors which influence an individual's ability to successfully regulate their energy intake post-surgery, such as their level of Disinhibition, Restraint, Hunger, Emotional Eating, Uncontrolled Eating, psychopathology and wellbeing. The need for continued psychological and nutritional support post-surgery is necessary to reduce weight regain susceptibility.

Bone health in the context of two common maladies, osteoporosis and obesity, has spurred research in the area of physical activity (PA) and bariatric surgery (BarS). Objectives: To examine: 1) relationships between PA and the skeleton utilizing the peripheral Quantitative Computed Tomography (pQCT) and Dual-energy X-ray Absorptiometry (DXA) in pre-menopausal women; 2) effects of adjustable gastric banding (AGB) vs. Roux-en-Y gastric bypass (RYGB) surgeries on pQCT and DXA measures; 3) 6-month time course changes on serum biomarkers of bone turnover and associated adipokines induced by AGB vs. RYGB. Methods: Standard DXA and pQCT measurements were taken for all subjects. PA tertiles (PA-L, PA-M, PA-H) were based on a calculated average MET-min/day determined from 4-d self-reported PA and pedometer step counts. For BarS subjects, bone measurements were taken pre-surgery, 3- and 6-months post-surgery along with serum (or plasma) from fasting blood draws, with ELISA assays for total OC, undercarboxylated OC, CTx, adiponectin, and leptin. Results: Minimal DXA differences between the highest and lowest PA tertiles were seen, while pQCT tibial measures and polar strength-strain index (SSIp) indicated differences along the tibial shaft. Comparing the two instruments and adjusting for BMI, the DXA leg and hip BMD and BMC showed differences (p<0.05) between PA-M and PA-L as well as PA-H and PA-L. Similarly, the pQCT tibial cortical area, BMC, and SSIp were progressively greater for the different levels of PA (p<0.05). 3- and 6-months post-BarS weight, fat-free mass, fat mass, central body fat, tibial and radial subcutaneous fat, and radial MCSA decreased (p<0.05). Comparing the AGB and RYGB and adjusting for weight, DXA BMC showed decreases (p<0.01) at both time points for RYGB. RYGB demonstrated differences (p<0.05) in bone measures at 3- and 6-months post-surgery along the tibial shaft that are indicative of increases in bone strength, and at 6-months, total OC, undercarboxylated OC, and HMW adiponectin increased, while leptin decreased. Conclusions: PA is associated with increases in bone, but pQCT data are more discriminatory and sensitive. 6-months post-RYGB, pQCT measures indicate increases in bone strength parameters, and greater bone adaptation was evidenced by biomarkers of increased osteoblastic activity. / Ph. D.

Bakgrund: Fetma är ett folkhälsoproblem som har ökat dramatiskt de senaste två decennierna. För att behandla extrem fetma har magsäcksoperationer blivit en allt mer vanlig metod. De hälsoekonomiska aspekterna av operation har ännu inte studerats i Sverige. Syfte: Studiens syfte var att belysa hälsoekonomiska aspekter av magsäcksoperationer som intervention mot fetma. Metod: Metoden var en litteraturstudie. Elva vetenskapliga studier valdes ut, analyserades och sammanställdes utifrån hälsoekonomiska aspekter. Resultat: Magsäcksoperationer var kostnadseffektiva som intervention mot fetma i jämförelse med ingen intervention, traditionell intervention och medicinsk behandling. Studiernas resultat varierade i tid till break even och beräkning av inkrementell kostnadskvot. Troliga anledningar till dessa skillnader var studiernas olika ursprungsländer och tidsperspektiv. Slutsats: Ur ett hälsoekonomiskt perspektiv rekommenderas operationer som intervention mot fetma. Dock bör etiska aspekter beaktas när samhällets begränsade ekonomiska resurser ska fördelas mellan olika interventioner. / Background: Obesity has increased dramatically in the last 20 years and has become a major public health issue. Bariatric surgery has become a more commonly used method for treating morbid obesity. The health economic aspects of bariatric surgery have not yet been studied in Sweden. Aim: The study highlights the health economic aspects of bariatric surgery as an intervention to treat obesity. Method: The method used was a literature review. Eleven scientific studies were selected, analyzed and compiled using a health economic perspective. Results: Bariatric surgery was a cost effective intervention for treating obesity, compared with no interventions, traditional interventions and medical treatment. The results of the studies vary in time to break even and incremental cost ratio. The studies different countries of origin and time perspectives are possible reasons for these differences. Conclusion: From a health economic perspective bariatric surgery was recommended as an intervention for treating obesity. However, ethical issues should be considered when the society's limited financial resources are distributed between different interventions.

This diploma thesis deals with obese patients' motivation to undergo or refuse a bariatric surgery in obesity treatment. The aim of the thesis was to create an overview of patient's motivation to undergo or refuse a bariatric surgery, to show an obese patient's situation (a candidate for a bariatric surgery) from a closer perspective and offer recommendations for the work with obese patients. The qualitative research method in a form of a semistructured interview with the obese patients, who are being treated in obesity ambulances, and with the psychologists, who work with obese patients, was used to analyse the theme of the research. The eight interviews were conducted and analysed with open coding. Obese patients are motivated to undergo a bariatric surgery by improvement of their health, increased attractiveness and by expectation of their obesity's final solution. Obese patients don't want to undergo a bariatric surgery because they're convinced, that they could manage to lose weight and keep it without undergoing a bariatric surgery. Also because they are worried about the bariatric surgery, its complications, its restrictions, required anesthesia and about the failure after undergoing bariatric surgery. Obese patients' motivation to undergo or refuse a bariatric surgery is also influenced by...

Obesity is a public health issue linked to high morbidity and mortality among critically ill patients. There are approximately 15.5 million morbidly obese adults in the United States. The purpose of the project was to develop and implement an educational program using evidence-based protocols for bariatric care to educate nurses and caregivers regarding best practices when attending to obese patients. The practice-focused question examined whether learning about evidence-based bariatric care would improve the knowledge of nurses and caregivers caring for morbidly obese patients in an acute care setting. The theoretical foundation was Bandura'€™s self-efficacy theory. A questionnaire using a Likert scale was used to collect data from the 100 participants before and after the learning intervention. The selection criteria involved the inclusion of all nurses and caregivers working at the adult in-patient unit. A paired-samples t-test was used to evaluate levels of improvement in knowledge of the causes, treatment, management, and care of patients with obesity and the challenges in caring for morbidly obese patients. The findings indicated a statistically significant increase in participants'€™ knowledge of the causes (p < 0.000), treatment, management, and care of patients with obesity (p < 0.000) and the challenges involved in caring for morbidly obese patients after the learning intervention (p < 0.004). Thus, the implementation of an educational intervention may be effective in improving nurses'€™ knowledge of bariatric care. The implications of the project for social change involve the improvement in nurse'€™s knowledge of clinical guidelines, which can lead to increase in patient satisfaction, and improved overall health outcomes.

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Sammanfattning Bakgrund: Övervikt och fetma är ett växande problem i Sverige och i stora delar av världen. Överviktskirurgin har ökat kraftigt de senaste åren och är idag en utbredd metod för att behandla övervikt och dess följdsjukdomar. Trots att syftet med operationen är att minska risken för ohälsa så visar studier att personer som genomgått denna typ av behandling, konsumerar mer sjukvård än personer som behandlats med andra metoder mot sin fetma. Därav är det viktigt att få en djupare förståelse för hur personer som genomgår överviktskirurgi upplever sin situation i samband med ingreppet.   Syfte: Att beskriva personers upplevelser och behov i samband med överviktskirurgi ur ett vårdvetenskapligt perspektiv. Teoretisk utgångspunkt: Transitionsteorin utifrån Meleis et. al., (2000) har använts som teoretisk referensram till denna litteraturstudie. Metod: En systematisk litteraturstudie baserad på åtta vetenskapliga artiklar med kvalitativ ansats. Resultat: Tre teman framkom: Livet före operationen, Den första tiden efter operationen och En längre tid efter operationen. Livet före operationen beskrevs som en hopplös kamp mot vikten och beslutet att operera sig som en sista utväg. Informanterna hade stora förväntningar på operationens resultat, vilka med tiden inte alltid visade sig vara realistiska. Ingreppet beskrevs dock som en mycket positiv livsförändrande händelse. Gemensamt för informanterna var att de upplevde svårigheter med att behålla en hälsosam livsstil en längre tid efter operationen, vissa lyckades med detta, andra inte. Det framkom att informanter hade negativa erfarenheter av sjukvården. Diskussion: Resultatet visar ett behov av ökade förberedelser och stöd från sjuksköterskan inför operationen. Genom att understödja det hopp om ett hälsosammare liv, som uttrycktes efter operationen, kan sjuksköterskan motivera till livsstilsförändringar och därmed främja en hälsosam transition även på längre sikt. Resultaten tyder på att det finns ett omvårdnadsbehov som kvarstår många år efter ingreppet, samt att en god vårdrelation är av stor vikt för ett lyckat behandlingsresultat. / Abstract Background: Obesity is a growing problem in Sweden and in many parts of the world. Bariatric surgery has increased dramatically in recent years and is now a widespread method to treat obesity and its sequelae. Although the purpose of the surgery is to reduce the risk of illness, studies show that patients, who have undergone this type of treatment, consume more healthcare resources than those treated with other methods to manage their obesity. It is therefore important to better understand how individuals who undergo bariatric surgery experience their situation in the context of the intervention. Purpose: To describe individual´s experiences and needs associated with bariatric surgery from a caring science perspective. Theoretical basis: Theory of Transition by Meleis et. al. (2000) has been used as a theoretical framework for this study. Methods: A systematic literature review based on eight scientific articles with qualitative approach. Results: Three themes emerged: Life before the surgery, the first period after the surgery and a longer period after surgery. Life prior to the surgery was described as losing a battle against obesity and the decision to undergo surgery was regarded as a last resort. The respondents had high expectations of the surgery results, which in time did not always prove to be realistic. The procedure was described as a very positive life changing event. It showed to be common for the respondents to experience difficulties in maintaining a healthy lifestyle for a prolonged period of time after the surgery. However, some were able to achieve this whilst others were not. It was revealed that respondents had negative experiences of health care. Discussion: The results show a need for increased preparation and support from the nurse before surgery. By supporting the hope of a healthier life, as expressed after the surgery, the nurse can motivate lifestyle changes and thus promote a healthy transition in the longer term. The results suggest that there is a need for nursing care that persists for years after the procedure, and that a good care relationship is vital for a successful treatment outcome.

Dans ce travail, nous décrivons les conséquences physiologiques et physiopathologiques de l'obésité, ainsi que les difficultés techniques et logistiques de la prise en charge clinique. Puis, nous étudions les caractéristiques de la prise en charge des patients obèses et obèses morbides aux urgences, au bloc opératoire et en réanimation, ainsi que les modifications de la fonction respiratoire liées à l'obésité morbide et à la perte de poids. Aux urgences, nous démontrons que les patients obèses (IMC et#8805; 30 kg/m²) ont un capital veineux moins accessible et sont plus difficiles à perfuser que les non obèses. En physiologie clinique, nous avons pu confirmer l'absence de variation de la CRF en position couchée et démontrer pour la première fois l'effet de la perte de poids et de la position couchée sur les variations de la CRF. Au bloc opératoire, nous montrons que la préoxygénation des obèses morbides est optimisée par la ventilation non invasive (VNI), qui permet une augmentation rapide et importante de la fraction expirée en oxygène (FEo2) que la préoxygénation classique. Nous montrons aussi que la position assise à 45° associée à la VNI n'améliore pas la préoxygénation chez l'obèse morbide comparé à la VNI seule. Enfin, nous rapportons que les patients obèses médicaux en réanimation se caractérisent par une surmortalité, qui persiste un an après la sortie de l'hôpital, alors que les patients obèses chirurgicaux bénéficient d'un effet protecteur qui persiste jusqu'à un an. Nos travaux proposent la mise en place de nouvelles techniques afin d'optimiser les conditions de prise en charge spécifiques des patients obèses aux urgences, au bloc opératoire et en réanimation. / To specifically address arising issues in managing obese patients, we have developed a physiological and a clinical approach. We first describe the physiological and pathophysiological consequences of obesity, as well as the technical and logistic difficulties in obese patient management. We then underline respiratory alterations in morbid obesity and study characteristics of obese and morbidly obese patients' care in the emergency department (ED), the operating room (OR) and the intensive care unit (ICU).In the ED, we demonstrate that obese patients (BMI ³ 30 kg/m2) are more difficult to perfuse than normal weight patients. In clinical physiology, as for alterations in respiratory function induced by obesity, we confirm the maintained functional residual capacity (FRC) in morbidly obese patients adopting a supine position and we further demonstrate for the first time, the effect of weight loss on postural changes in FRC, from the sitting to the supine position in a same individual.In the OR, we show that obese patient's pre-oxygenation can be optimized by using non-invasive ventilation (NIV), thus allowing a better and faster FeO2 increase than classical pre-oxygenation with spontaneous ventilation. We also demonstrate that combining a upright position at 45° to non invasive ventilation (NIV) does not improve pre-oxygenation in the morbidly obese patients. In the ICU, we show that medical obese patients show a higher mortality, whereas surgical obese patients benefit from a protective effect of obesity up to one year after hospital leave. In light of our data, we propose new techniques to specifically optimize obese patient management in the ED, OR and in the ICU.