Bakgrund: Övervikt och fetma är ett globalt hälsoproblem somår 2016drabbade1.9 miljarder människor. Individer med fetma har en högre förekomst av psykisk ohälsa. Ångest och depression drabbar cirka 600 miljoner människor per år och är de två vanligaste formerna av fetmarelaterad psykisk ohälsa. En viktminskningsmetod som har haft goda resultat på lång sikt är bariatrisk kirurgi. Sjuksköterskans postoperativa roll omfattar identifiering av patientens individuella vårdbehov och vården därefter. Syfte: Syftet med studien var att undersöka psykisk hälsa hos patienter efter fetmakirurgi. Metod: En litteraturstudie genomfördes som baserades på åttaresultatartiklar vilka granskades och kategoriserades efter likheter och olikheter. Resultat: Resultatet sammanställdes enligt två olika resultatkategorier: Förändring i psykisk hälsa efter fetmakirurgi -tidsperspektivsamt Förändring i psykisk hälsa efter fetmakirurgi -livsstilsperspektivet. Konklusion: Den psykiska hälsan förbättrades det första året efter fetmakirurgin men stagnerade därefter. Vissa studier visade även att den psykiska hälsan försämrades postoperativt. I samband med fetmakirurgi bör den psykiska-och fysiska hälsan behandlas likvärdigt då de båda är viktiga faktorer som kan relateras till en förändrad livsstil. Sjuksköterskor bör erbjudas mer resurser för dessa patienter för att främja en personcentrerad vård och därmed öka chansen till goda postoperativa resultat. / Background: Obesity and overweight is a worldwidehealth concern which in 2016 affected1.9 billion people. Individuals with obesity have a higher risk of mental health problems. Anxiety and depression affectabout 600 million people every year and are two of the mostcommon forms of obesity related mental health illnesses. The nurse’spostoperative role includes identifying patients' individual healthcare needs and to adapt the care thereafter. Aim: The aim of the study was to examine the mental health of patients after bariatric surgery. Method: A literature review was conducted based on eight result articles which were reviewed and categorized after similarities and differences. Findings: The findings were compiled into two main categories: Changes in mental health after bariatric surgery -time perspective and Changes in mental health after bariatric surgery -lifestyle perspective. Conclusion: The mental health improved the first year after the bariatric surgery but stagnated thereafter. Some studies showed that themental health worsened postoperative. In regard tobariatric surgery should the physical-and mental health be treated equal since they both are important factors that can be related to a change in lifestyle. Nurses should be offered more resources for these patients to promote an individually based healthcare and thus increasing the chances of positive postoperative results.

Obstructive sleep apnea (OSA) is underrecognized. Between 10% and 69% of preoperative patients have undiagnosed OSA. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the OSA detection rate with screening practices, the prevalence of OSA within patients who underwent publicly funded bariatric surgery in Ontario between 2010 and 2016 was measured. Secondly, to understand the effect of OSA screening practices on perioperative and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days post-bariatric surgery, as well as in the 1 year post-bariatric surgery. The Ontario Bariatric Registry (OBR) linked to the ICES health administrative databases were used. A diagnosis of OSA was identified if recorded in the OBR at time of initial bariatric consultation, or if recorded in ICES databases from the bariatric surgery admission records. Costs were calculated based on the “Guidelines on Person-Level Costing Using Administrative Databases in Ontario” using ICES costing algorithms. The overall prevalence of OSA was 47% (95% CI 46% to 47%). Total health care costs per patient, in the 30-day post-operative period, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. Similarly, at 1 year postbariatric surgery, total health care costs per patient, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. At 30 days and 1 year, this difference was driven by lower hospitalization-related costs. OSA screening practices at surgical centers in our network led to similar rates of OSA detection as reported in the literature. However, the literature suggests that screening practices lead to missed OSA diagnoses. Further study is required to understand the reduced post-bariatric surgery costs in patients with OSA compared to matched controls without OSA; and, we postulate that missed OSA diagnoses may be a contributor. / Thesis / Master of Science (MSc) / Obstructive sleep apnea (OSA) is underrecognized and a good proportion of patients with OSA are undiagnosed. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the performance of OSA screening practices, using a province-wide registry, the proportion of patients diagnosed with OSA within patients who underwent publicly-funded bariatric surgery in Ontario between 2010 and 2016 was measured at 47%. Furthermore, to understand the effect of OSA screening practices on peri-operative costs and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days and 1 year post-bariatric surgery. Total health care costs per patient were 1% lower in patients with OSA compared to patients without OSA, and this difference was driven by lower hospitalization-related costs.

Studies have shown that following bariatric surgery, there is an almost immediate reversal of type 2 diabetes. However, there still remains questions as to why this occurs and what possible explanations there may be. This paper aims to focus on several studies that have found a reversal of diabetes in obese patients who have undergone bariatric surgery. Furthermore, it explores several possibilities for the reasons behind this reversal including the role of AMP-activated protein kinase, the incretins gastric inhibitory peptide and glucagon-like peptide-1, and also looks at genetics. Bariatric surgery and a description of certain mechanisms are first described for an understanding. Following is a literature review of published studies on bariatric surgery, the reversal of diabetes following the procedure, and roles of AMPK and incretins. Because of the possibility that reduced caloric intake may not be the major factor in the diabetic reversal, it is suggested that further research be done on obese and normal weight patients and observe the levels of the mentioned mechanisms and also various genes to see if they offer a more thorough explanation.

Bakgrund: Obesitas är en folksjukdom som ökar på många håll i världen. Det medför risker för att drabbas av följdsjukdomar som kan orsaka lidande och leda till en förkortad livslängd. Att leva med obesitas präglas också av andra aspekter som berör identitet och omgivning. Syfte: Syftet var att beskriva patienters upplevelser efter att ha genomgått bariatrisk kirurgi. Metod: En litteraturöversikt med utgångspunkt i tio kvalitativa vetenskapliga artiklar. Artiklarna hämtades från databaserna CINAHL Complete och PubMed. Sökorden som användes var Bariatric surgery, Obesity, Patient experience, Qualitative och Interview. Kategorisering samt tematisering har utförts för att sammanställa likheter och skillnader. Resultat: Resultatet redovisas under tre teman och ett undertema. Nya kostvanor, anpassning och utmaningar i vardagen beskriver upplevelser som berör anpassning och utmaningar relaterade till utförd kirurgi. Stöd från familj, närstående och sjukvården beskriver upplevelser kopplade till familjens stöd samt upplevelser som präglade kontakten med sjukvården. Den nya kroppen, fysiska och psykiska förändringar berör upplevelser kring de fysiska och psykologiska förändringar som förekom efter bariatrisk kirurgi. Stigmatisering beskriver upplevd självbild och de förändringar som uppstod i relation till den nya kroppen och omgivningen. Sammanfattning: I litteraturöversiktens resultat ges en mångfacetterad bild av hur personer som genomgått bariatrisk kirurgi upplever livet efter operationen. Förändringen leder till olikartade upplevelser som påverkar relationen till omgivningen och den biologiska kroppen. Upplevelserna skiljde sig åt beroende på hur väl deltagarna lyckades anpassa sig till de utmaningar de ställdes inför. / Background: Obesity is increasing in many parts of the world. It entails risks of suffering from secondary diseases that can cause suffering and lead to a shortened lifespan. Living with obesity is also characterized by other aspects that affect identity and the environment. Aim: The aim was to describe patients experiences after undergoing bariatric surgery.Method:A literature review based on ten qualitative scientific articles. The articles were retrieved from the databases CINAHL Complete and PubMed. The keywords used were Bariatric surgery, Obesity, Patient experience, Qualitative and Interview. Categorization and thematization have been carried out to compile similarities and differences. Results: The results are presented under three major themes and one subtheme. New dietary habits, adaptation and challenges in everyday life: describes experiences concerning adaptation and challenges related to the performed surgery. Support from family, relatives and the healthcare system: describes experiences linked to the family's support as well as experiences that characterized the contact with the healthcare system. The new body, physical and psychological changes: experiences regarding the physical and psychological changes that occurred after bariatric surgery. Stigmatization: is about perceived self-image and the changes that occurred in relation to the new body and the environment. Summary: The results of this literature review provide a multifaceted picture of how people who have undergone bariatric surgery experience life after surgery. The change leads to different experiences that affect the relationship with the environment and the biological body. The experiences differed depending on how well the participants managed to adapt to the challenges they faced.

Abstrakt  Bakgrund: Obesitas är ett ökande folkhälsoproblem och omkring 650 miljoner människor lever med obesitas världen över. Sjukdomen innebär svårigheter både fysiskt och psykosocialt för de drabbade. Som sjuksköterska är det därför viktigt att ha god kunskap om dessa personers erfarenheter för att kunna ge god omvårdnad och bidra till ökad hälsa. Syfte: Syftet med litteraturstudien var att skildra erfarenheter av viktstigmatisering hos personer som lever med obesitas. Metod: Litteraturstudien baserades på nio kvalitativa studier. Databassökning genomfördes i Cinahl och Pubmed. Analys genomfördes med hjälp av Fribergs femstegsmodell. Resultat: Analysen resulterade i tre huvudteman och nio underteman. Huvudteman; ”att uppleva uttryck för viktstigmatisering”, ”att kämpa ensam” och ”att uppleva konsekvenser av viktstigmatisering”. Konklusion: Personer som lever med obesitas upplever viktstigmatisering i en rad olika kontext vilket kan resultera i negativa effekter både fysiskt och psykosocialt. Resultatet visade även att bariatrisk kirurgi som behandlingsmetod vid obesitas var omgärdat av stigmatisering. Kunskap saknas gällande viktstigmatisering, obesitas som sjukdom samt bariatrisk kirurgi som behandlingsmetod inom både vården och samhället. Personer som lever med obesitas förtjänar ett gott bemötande fritt från stigmatisering. / Abstract  Background: Obesity is a growing issue and around 650 million people are living with obesity worldwide. The disease comes with difficulties both physically and psychosocially for those affected. As a nurse, it it’s therefore important to have good knowledge of these people’s experiences in order to provide good care and contribute to increased health. Aim: The aim of this study was to describe people living with obesitas experiences of weight stigmatization.  Methods: This review was based on nine qualitative studies. Database searches were made in Cinahl and PubMed. Analysis was conducted with assistance of Fribergs five-step-model. Results: The analysis resulted in three main themes and nine subthemes. Themes as described: “to experience expressions of weight stigmatization”, “to fight alone” and “experiencing consequences of weight stigma”.  Conclusion: People living with obesity experience weight stigmatization in a variety of contexts which may result in negative effects both physically and psychosocially. The results also showed that bariatric surgery as treatment was surrounded by stigmatization. There is a lack of knowledge regarding weight stigmatization, obesity as a disease and bariatric surgery as method of treatment in both healthcare and society. People living with obesity deserves to be met with a respectful attitude, free from stigmatization.

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