Orientador: Egberto Ribeiro Turato / Tese (doutorado) - Universidade EStadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T12:18:02Z (GMT). No. of bitstreams: 1 MagdalenoJunior_Ronis_D.pdf: 2731308 bytes, checksum: 8ebca8702c1a9bcf508be125634537e7 (MD5) Previous issue date: 2009 / Resumo: Este estudo teve por objetivo compreender as vivências emocionais de mulheres obesas mórbidas submetidas à cirurgia bariátrica. A obesidade tornou-se, globalmente, um grave problema de saúde pública e, em função disto, tem crescido de modo expressivo o número de cirurgias bariátricas como opção de tratamento para a obesidade mórbida. Contudo, é um procedimento que implica em importantes modificações físicas e psicossociais para o paciente. Metodologia: Aplicamos o Método Clínico Qualitativo a uma amostra intencional e fechada pelo critério de saturação, composta por sete mulheres operadas num período de um ano e meio a três anos no Hospital das Clínicas da UNICAMP. Entrevistas semidirigidas de questões abertas foram realizadas pelo pesquisador, gravadas, transcritas e analisadas em profundidade, tendo emergido deste procedimento categorias que serviram como base para sustentação e discussão dos resultados. Resultados e Discussão: a cirurgia bariátrica está relacionada com uma importante melhora da aceitação social das pacientes, elevação da auto-estima e recuperação da identidade que esteve cronicamente encoberta pelo excesso de gordura corporal. Existe um risco de desilusão com a cirurgia no, caso das expectativas em relação a ela sejam irreais no pré-operatório. Nestes casos ocorre frequentemente uma desmotivação do desafio de manter a perda de peso. A perda massiva de peso também está relacionada com sentimentos de desproteção, sobretudo naqueles casos onde a obesidade desempenhava uma função defensiva em relação aos outros e a própria sexualidade. A fome sofre transformações importantes após a cirurgia, tanto qualitativas como quantitativas, o que facilita a luta em favor da perda de peso. Contudo, o procedimento cirúrgico afeta diretamente a experiência de saciedade, mas não a satisfação alimentar, o que pode levar a uma sensação de intensa insatisfação pessoal. Esta insatisfação é vivida como angústia e, pode levar à transformação da compulsão alimentar em direção a outras compulsões ou mesmo ao desenvolvimento de novas estratégias alimentares que permitam a ingestão de quantidades aumentadas de calorias, levando ao re-ganho de peso. Como o procedimento cirúrgico provoca uma restrição volumétrica do estômago, a paciente se vê rapidamente impedida de lidar com a ansiedade ingerindo alimentos. Este impedimento expõe a impossibilidade que têm em encontrar referenciais simbólicos para a angústia, mostrando que a fome para o obeso mórbido é uma área de déficit representacional psíquico, o que os impossibilita elaborar psiquicamente a angústia, restando a via de descarga corporal como única possível. Conclusões: A cirurgia bariátrica é um procedimento que traz importantes transformações psíquicas, sociais e físicas para a mulher portadora de obesidade mórbida. Em função disto, a equipe de saúde que lida com esta população deve estar instrumentalizada para compreender e atuar de modo eficiente tanto no pré como no pós-operatório. Trata-se de um procedimento médico que gera fortes demandas psíquicas para o paciente e, consequentemente, para a equipe de saúde, devendo esta contar, necessariamente, com profissionais da área de saúde mental que estejam preparados para intervir psicologicamente tanto com os pacientes, como com os movimentos emocionais da equipe. / Abstract: This study aims at understanding the emotional experiences of morbidly obese women who have undergone bariatric surgery. Obesity has become a serious public health problem worldwide and, due to this, the number of bariatric surgeries, as an option for treating morbid obesity, has grown considerably. However, it is a procedure that involves significant physical and psychosocial changes for the patient. Methodology: We applied the Clinical Qualitative Method to an intentional sample, closed according to the criterion of saturation, of seven women operated on during a period of between one and a half and three years at the University Hospital of UNICAMP (the State University of Campinas, S.P., Brazil). Semidirected interviews with open-ended questions were carried out, recorded, transcribed and analyzed in-depth by the researcher. From this procedure there emerged categories that served as a basis to underpin the results and for the discussion of the material obtained. Results and Discussion: bariatric surgery is related to a substantial improvement in the social acceptance of these patients, increasing their self-esteem and recovering their identity which had been chronically concealed by the excess of body fat. There is a risk of disillusionment with the surgery when pre-operative expectations are unreal. In these cases, there is frequently a loss of motivation to keep up the weight loss. The massive weight loss is also related to feelings of helplessness, especially in those cases where obesity played a defensive role in regard to others and to their own sexuality. Hunger undergoes significant transformations after the surgery, both qualitative and quantitative, which make the struggle to lose weight easier. However, the surgical procedure directly affects the experience of satiety, but not of satiation, which can lead to a sensation of intense personal dissatisfaction. This dissatisfaction is experienced as anguish and may transform the eating compulsion into other compulsions or even lead to the development of new eating strategies that allow the ingestion of increased quantities of calories resulting in regaining weight. As the surgical procedure brings about a volumetric restriction of the stomach, the patient is soon unable to cope with anxiety by ingesting food. This exposes the impossibility of finding symbolic references for the anguish, showing that hunger for the morbidly obese is an area of psychic representational deficit, which makes it impossible to elaborate the anguish psychically, leaving the body as the only possible means of discharge. Conclusions: Bariatric surgery is a procedure that brings about significant psychic, social and physical transformations for women with morbid obesity. Due to this, the team dealing with this population should have the necessary training to understand and act efficiently both in the pre- and post-operative period. It is a medical procedure which generates huge demands on the patient and, consequently, on the health team, which should include mental health professionals who are prepared to intervene psychologically both with the patients as well as with the emotional movements of the team. / Doutorado / Saude Mental / Doutor em Ciências Médicas

Obesity is a multifactorial chronic disease, associated with increased cardiovascular risk, that produces hemodynamic changes, in cardiac structure and function, increasing the risk of heart failure, especially the diastolic; what is important to evaluate these patients more carefully. The aim of this study is to evaluate left ventricular diastolic function in severe obese in preoperative for bariatric surgery. This is an observational, prospective and analytical study. Were evaluated in 132 patients, severely obese, asymptomatic, with normal systolic function that were in the preoperative evaluation for bariatric surgery. Stratified into three groups, according to diastolic function, the group Nl comprised 61 patients with normal diastolic function, the group DD mild, consisted of 24 patients with mild diastolic dysfunction and the group DD M/S composed of 41 patients with moderate diastolic dysfunction (pseudonormal pattern) and 06 patients with severe diastolic dysfunction (restrictive pattern). After stratification, we compared the clinical and echocardiographic characteristics among groups. Of the 132 patients, 97 (73.5%) were women. The mean age was 38.5 ± 10.5 years and average BMI was 43.7 ± 7.2 kg/m². 48 patients had obesity class II and 84 grade III obesity. The cardiovascular risk factors that showed significant differences between groups Nl vs DD mild and Nl vs DD M/G were: metabolic syndrome with 67.5% (81 patients), hypertension with 59.8% (79 patients) and diabetes mellitus with 25.2% (32 patients). Regarding clinical values we found significant differences among groups in age, waist circumference and systolic blood pressure. Regarding echocardiographic variables, we found a larger left atrial diameter, left ventricular diastolic diameter, left atrial volume at 4 and 2 chambers, index of left atrial volume, index of left ventricular mass to body surface, and this index for height, in the groups with DD mild and DD M/S vs Nl. The higher prevalence of left ventricular diastolic dysfunction in pre-clinical phase in severe obese patients justifies the need for a careful echocardiographic assessment using joint analysis of all available echocardiographic techniques, in order to identify individuals at high risk for heart failure, so that early intervention measures are adopted. / Obesidade é uma doença crônica, multifatorial, associada a aumento do risco cardiovascular e de insuficiência cardíaca, principalmente a diastólica, o que torna importante a avaliação mais criteriosa dos pacientes obesos. O objetivo deste estudo é avaliar a função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica. Trata-se de um estudo observacional, transversal, prospectivo e analítico. Foram avaliados 132 pacientes obesos graves e assintomáticos, do ponto de vista cardiovascular, e que estavam em avaliação pré-operatória para cirurgia bariátrica. Estratificados em 3 grupos, de acordo com a função diastólica, sendo o grupo N1 constituído por 61 pacientes com função diastólica normal, o grupo DD leve constituído por 24 pacientes com disfunção diastólica leve e o grupo DD M/G constituído por 41 pacientes com disfunção diastólica moderada (padrão pseudonormal) e 06 pacientes com disfunção diastólica grave (padrão restritivo). Após estratificação, foram comparadas as características clínicas e ecocardiográficas entre os grupos. Dos 132 pacientes, 97 (73,5%) eram mulheres. A idade média foi de 38,5 ± 10,5 anos e o IMC médio foi de 43,7 ± 7,2 Kg/m², sendo 48 pacientes com obesidade grau II e 84 com obesidade grau III. Os fatores de risco cardiovascular que apresentaram diferença significativa entre os grupos Nl vs DD leve e Nl vs DD M/G foram: síndrome metabólica com 67,5% (81 pacientes), HAS com 59,8% (79 pacientes) e DM com 25,2% (32 pacientes). Quanto as variáveis clínicas, apresentaram diferença significativa entre os grupos foram a idade, a circunferência abdominal e a pressão arterial sistólica. Em relação às variáveis ecocardiográficas, encontrou-se um maior diâmetro do átrio esquerdo, diâmetro diastólico do ventrículo esquerdo, volume do átrio esquerdo em 4 e 2 câmaras, índice de volume atrial esquerdo, índice de massa do ventrículo esquerdo para superfície corpórea e esse índice para altura, nos grupos com DD leve e DD M/G vs o grupo Nl. A alta prevalência de disfunção diastólica do ventrículo esquerdo na fase pré-clínica em obesos graves justifica a necessidade de uma avaliação ecocardiográfica criteriosa, utilizando a análise conjunta de todas as técnicas ecocardiográficas disponíveis, com o objetivo de identificar indivíduos com maior risco de insuficiência cardíaca, para que medidas de intervenção precoce sejam adotadas.

Este estudo teve como objetivo avaliar e comparar desgaste dentário e perda dentária de pacientes eutróficos, obesos mórbidos pré cirúrgico, operados com até 24 meses e operados com mais de 36 meses de cirurgia bariátrica. O estudo foi do tipo observacional transversal e analítico com pareamento de sexo e idade. A amostra foi composta por 240 pacientes, (GC) - pacientes eutróficos (N=60), (GO) - pacientes obesos mórbidos (N=60), (G24) - pacientes operados com menos de 24 meses (N=60) e (G36) - pacientes operados com mais de 36 meses (N=60). As variáveis que foram analisadas: sexo, raça, escolaridade, classe econômica, hipertensão, diabetes, triglicerídeos, colesterol, tabagismo, etilismo, idade, IMC, % de perda de peso, perda dentária, desgaste dentário e relação cintura-quadril. Foi aplicada a análise estatística descritiva para obter as frequências absolutas e relativas. Para verificar a associação entre obesidade e os desfechos bucais (desgaste dentário e perda dentária) foi usado o modelo de regressão linear multivariada, Odds ratio (OR) e o intervalo de confiança (IC) de 95%. Não houve diferenças estatisticamente significativas entre os grupos considerando etnia (p=0,135), escolaridade (p=0,108), triglicerídeos (p=0,078), tabagismo (p=0,568) etilismo (p=0,712), dentes perdidos (p=0,686) e o desgaste dentário tanto por sextantes, quanto total (p=0,448). Porém houve desgaste maior entre os sextantes II e V. O GO apresentou menor classe econômica (p=0,012), maior proporção de hipertensão (p<0,001), diabetes (p<0,001), colesterol (p=0,001), IMC (p<0,001) e relação cintura-quadril (p<0,001), % de perda de peso foi maior no G24 comparado ao G36 (p<0,001). Pode-se concluir que indivíduos submetidos à cirurgia Bypass Gástrico em Y de Roux, independente do período de cirurgia, apresentaram mais desgaste dentário nas superfícies incisais/oclusais, sendo que os dentes anteriores foram os mais afetados. O desgaste dentário esteve associado à idade e ao número de dentes perdidos. / The aim of this study was to evaluate and compare dental wear and tooth loss of eutrophic, preoperative, morbidly obese patients operated on for up to 24 months and operated with more than 36 months of bariatric surgery. The study was crosssectional and analytical with gender and age matching. The sample consisted of 240 patients (GC) - Eutrophic patients (N = 60), (GO) - morbidly obese patients (N = 60), (G24) - patients operated on less than 24 months (G36) - patients operated on for more than 36 months (N = 60). The variables that were analyzed were sex, race, schooling, economic class, hypertension, diabetes, triglycerides, cholesterol, smoking, alcoholism, age, BMI, weight loss, dental loss, dental wear and waist-to-hip ratio. The descriptive statistical analysis was applied to obtain the absolute and relative frequencies. The multivariate linear regression model, odds ratio (OR) and 95% confidence interval (CI) were used to verify the association between obesity and oral outcomes (dental wear and tooth loss). There were no statistically significant differences between groups (p=0,135), schooling (p=0.108), triglycerides (p=0.078), smoking (p=0.568) and dental wear by both sextants and total (p=0.448). However, there was greater wear among the II and V sextants. The GO presented lower economic class (p=0.012), higher proportion of hypertension (p<0.001), diabetes (p<0.001), cholesterol (p=0.001), BMI (p<0.001) and waist-hip ratio (p<0.001), % weight loss was higher in G24 compared to G36 (p<0.001). It can be concluded that individuals submitted to the Roux-en-Y obesity surgery, regardless of the surgery period, presented more tooth wear on the incisal / occlusal surfaces, and the anterior teeth were the most affected. Dental wear was more related to age and tooth loss.

Introduction Previous study investigating Emergency Department (ED) visits rate and admission rates in bariatric patients’ post-surgery shows a 2-year admission rate of 26%. Aim The primary aim of this study was to assess the number of ED visits and admissions as well as examine if there is a correlation with comorbidities, education level, quality of life, and image method used. The secondary aim was to compare the ED and admission rate between the cohort and the general population. Methods This retrospective study included a total of 190 patients. They were followed for 2 years. All the patients were operated on during 2017 in Region Örebro. The cohort and data were obtained from the Scandinavian Obesity Surgery Registry and data concerning ED visit and admittance rate was collected by reviewing medical records. Results The ED visit rate was 116 (61%) and the admittance rate was 76 (40%). Poor mental health, low education level and smoking were correlated to a higher degree of admittance and ED visit rate. There were more imagining used in the group that visited the ED or got admitted. The most common diagnoses were symptoms related to the digestive system and abdomen. The study population had a higher degree of admittance and ED visit rate than the general population. Conclusions Rate of admittance seem to be correlated to factors related to socioeconomic status. More research is needed to investigate what intervention would help this subgroup most, so they don’t have to seek medical care to the same degree.

No description available.

Title: The effect of movement program on static postural stability in individuals after bariatric surgery Aims: The aim of this diploma thesis was to find out whether a three-month regular exercise program including strenght and aerobic training has an impact on static postural stability in obese individuals who underwent bariatric surgery. Methodology: The special part was written on the basis of data obtained from posturographic measurement of obese patients who underwent bariatric surgery. The static postural stability was measured using pressure plate a MobileMat from Tekscan. Participants were measured before surgery and approximately 4 months after surgery. A total of 30 subjects aged 31-65 years with BMI values between 35-55 kg/m2 (obesity class II and III) who underwent initial and exit examination including stabilometry, were included in this diploma thesis. They were divided into 2 groups, first group participating in a three-month exercise program (n = 10; age 51 ± 7.3 years; BMI 41.7 ± 6.4 kg/m2 ) and a group undergoing bariatric surgery only (n = 20; age 48 ± 9, 4 years; BMI 43.6 ± 6.5 kg/m2 ). The exercise program included exercise three times a week: once a week one-hour strength training and one-hour aerobic group training, and at least once a week home intervention. Results: In...

Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery.

Purpose: To investigate the effects of eccentric exercise on lower body skeletal muscle mass during rapid body mass loss induced by bariatric surgery. Methods: All participants began 6 to 8 weeks after undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Skeletal muscle mass (SMM) in the lower body was measured via magnetic resonance imaging (MRI); additional exercise measurements included muscular strength and functional capacity. Quality of life was measured using Short Form 36 (SF-36). Nineteen females (age = 37.6 ± 9.8 yr, height = 164.4 ± 7.2 cm, mass = 106.9 ± 15.6 kg) were randomly assigned to 1 of 3 groups: eccentric exercise (EEX; n = 6), concentric exercise (CEX; n = 7), or standard-of-care control (CON; n = 6). Exercise groups performed 30-minute lower-body exercise sessions 3 times per week for 16 weeks. Each month the exercise tests were evaluated. At the end of 16 weeks, all participants performed the final exercise tests, received a final MRI scan, and completed the SF-36 questionnaire. Results: Thirteen individuals completed the study. All groups lost mass: CON: 21.4 ± 3.7 kg (p < 0.001), CEX: 19.9 ± 4.0 kg (p = 0.001), and EEX: 21.8 ± 3.3 kg (p < 0.001). SMM decreased in all groups: CON: 0.77 ± 0.5 kg (p = 0.18), CEX: 1.19 ± 0.6 kg (p = 0.06), and EEX: 0.90 ± 0.5 kg (p = 0.09). The skeletal muscle loss in percent of total mass loss was 3.7 ± 4.1%. All measures of muscular strength showed no difference, except for a small decrease in dynamic (60°·sec-1) strength in the eccentric group. Functional capacity and physical quality of life increased significantly in all groups (p < 0.05). Conclusion: SMM loss still occurred in the lower body regardless of resistance training, but the loss was less than what was previously documented. Improved postsurgical functional capacity and physical quality of life may be due to a reduction in fat mass and maintenance of muscular strength during the period of rapid mass loss.

Übergewicht und Diabetes werden zunehmend zum globalen Gesundheitsproblem, eine vielversprechende Behandlungsmöglichkeit der therapieresistenten Adipositas stellen bariatrische Eingriffe dar. Ein positiver Effekt bariatrischer Chirurgie auf die Herzfunktion und das kardiovaskuläre Risiko wurde beobachtet, molekularbiologische Erklärungen dieses Zusammenhanges fehlen bislang. Material und Methoden. Es wurden zwei verschiedene Tiermodelle genutzt, um den Auswirkungen von Übergewicht und bariatrischer Chirurgie auf das Herz nachzugehen: ein HFD-Mausmodell und ein HFD-Rattenmodell mit duodenojejunalem Bypass (DJB). Linksventrikuläres Gewebe beider Modelle wurde mittels quantitativer Real-Time-PCR und Western Blot auf Expression der Zielgene und -proteine untersucht. Aus dem linksventrikulären Gewebe des DJB-Rattenmodells wurde RNA für eine differentielle Genexpressionsanalyse gewonnen. Die Genexpressionsanalyse wurde von der Deep Sequencing Group am CRTD Dresden durchgeführt. Die Analyse der Sequenzierungsdaten erfolgte mittels Ingenuity Pathway Analyse. Ergebnisse. Die zwölfwöchige Hochfettfütterung führte bei den Mäusen zu keiner echokardiographisch darstellbaren Einschränkung des Herzens. Die Tiere wiesen allerdings eine prä- bzw. diabetische Stoffwechsellage auf. Das linksventrikuläre Gewebe der HFD- Mäuse zeigte eine Herabregulation der Glukosetransporter Glut1 und Glut4. Die bariatrische Intervention führte im linksventrikulären Gewebe der Ratten zu einer Heraufregulation des Glukosetransporters Glut1, die Proteinexpression war unverändert. Die Expression des β1-, des β2-Rezeptors und ausgewählter Calcium-handling Proteine war zwischen den beiden Gruppen ebenfalls nicht verschieden. Repräsentative Gene des kardialen Fettsäurestoffwechsels zeigten keine Beeinflussung durch die bariatrische Intervention. Die Analyse der differentiellen Genexpressionsanalyse zeigte für die DJB-Gruppe Veränderungen innerhalb der oxidativen Phosphorylierung und innerhalb adrenerger Signalwege. Zusammenfassung. Es konnte gezeigt werden, dass es durch Übergewicht und eine (prä-) diabetische Stoffwechsellage im linken Ventrikel zur Herabregulation der Glut1- und Glut4- Expression kommt. Nach bariatrischer Chirurgie zeigten Herzen der Interventionsgruppe eine vermehrte Glut1-Expression. Ausgewählte Gene und Proteine der adrenergen Signalkaskade zeigten keine Veränderung innerhalb der DJB-Gruppe, die Pathway-Analyse lässt allerdings vermuten, dass andere Proteine innerhalb dieses Signalweges durchaus differentiell exprimiert vorliegen. Die Überrepräsentation von Genen der oxidativen Phosphorylierung und die protektive Heraufregulation von Glut1 könnten neue Ansatzpunkte für die Therapie kardiovaskulärer Erkrankungen liefern.

Purpose: Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. Methods: In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T. Results: Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses. Conclusions: Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.