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.

Introduction: Obesity and type 2 diabetes mellitus (hereinafter referred to as DM2T) are called the greatest epidemic of the 21st century. Its occurrence is on the rise not only in the Czech Republic but all around the world. Overweight and obesity are the key factors in developing DM2T, they are affecting the occurrence of the disease in men in 64 % and 77 % in women. Based on the observations, nearly 60 % of the population in the Czech Republic are considered obese or overweight. Bariatric/Metabolic surgery is one of the most effective treatments of the DM2T. Objectives: The objective of this thesis is to describe and analyze the effect of each bariatric surgery on the patients of 3rd Internal Clinic of Endocrinology and Metabolism, General University Hospital and 1st Medical Faculty, Charles University in Prague within the first two years post-surgery. The same time period is observed to monitor the DM2T compensation depending on the type of bariatric surgery. Methodology: 128 patients were observed (including 52 patients diagnosed with DM2T), that underwent the bariatric surgery. The data were gathered from the medical records in the hospital's information system Medea. These data were further analyzed, processed and assessed in Microsoft Excel and also together with the agency STEM/MARK a.s....

The diploma thesis deals the problematics of weight reduction with the using of bariatric- metabolic surgery and focuses on the changing risk components of the metabolic syndrome during one year long observation of 45 probands who have undergone Partial Jejuno-Ileal Diversion, Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Plication. The main aim of the diploma thesis is to evaluate the changing risk components of the metabolic syndrome during weight reduction after undergoing bariatric surgery. The thesis shows that in the studied sample of bariatric patients it is an effective method of weight reduction (in PJID the success rate was 48 % EWL, in LGCP 51 % EWL and the most successful was LSG with 76 % EWL) with metabolic effect such as for example observed positive changes in risk components of the metabolic syndrome - reduction of morning glucose levels, increase of HDL cholesterol and decrease of triacylglycerols in the blood, decrease of waist circumferences and decrease of blood pressure or elimination of metabolic syndrome. Up to 68.9 % of the monitored probands showed signs of metabolic syndrome when evaluating the initial measurement before bariatric surgery, the remaining 22.2 % of the probands showed the signs after the year's observation. As part of the risk assessment for the...

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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The present study was a retrospective chart review (N=128) that investigated the efficacy of profiles derived from the three factors of the Eating Inventory® test (EI) - cognitive restraint, disinhibition, and hunger - to predict successful weight loss in post surgical laparoscopic banding patients at 6 and 9 months post surgery. Although the EI is commonly used in bariatric presurgical assessment, few studies have found consistent relationships between presurgical factor scores and subsequent weight loss in this population. Based on restraint theory, 7 profiles (high CR, super high CR, high D, super high D, high H, super high H, and null) were derived from the raw scores on the subscales of the EI and tested for weight loss predictive ability using direct logistic regression. Results were mixed with high CR, super high CR, and null profiles accurately predicting successful weight loss. Raw scores on the three factors (cognitive restraint, disinhibition, and hunger) were tested individually for predictive ability using direct logistic regression. Overall results indicated that the profile model accurately predicted more cases than the general factor model. This study significantly contributes to both the bariatric presurgical assessment literature and the restraint theory literature. Suggestions for future research are offered.

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.

I Sverige har frekvensen av fetma fördubblats sedan 1980-talet och fortsätter att öka. Individer med fetma tenderar att ha en negativ kroppsuppfattning i större utsträckning än normalviktiga personer. Patienters kroppsuppfattning efter fetmaoperation är komplex och är ett mindre utforskat område som behövs belysas. Syftet var att belysa vuxna patienters kroppsuppfattning efter en fetmaoperation. En allmän litteraturstudie genomfördes och tio vetenskapliga artiklar användes i resultatet. I resultatet framkom tre teman och fem kategorier. Följande teman var; Kroppsuppfattning relaterat till viktförlust, kroppsuppfattning relaterat till överflödig hud samt kroppsuppfattning relaterat till omgivningen. Kategorierna var; Den egna kroppen uppfattades positivt, den egna kroppen uppfattades negativt, överflödig hud uppfattades positivt och negativt, överflödig hud orsakade skamkänslor samt positiv och negativ verbal respons från omgivningen. Resultatet visar att fetmaoperationens påverkan på patienters kroppsuppfattning är individuell. Det behövs vidare forskning för att avgöra de bakomliggande orsakerna till att vissa patienter får en positiv kroppsuppfattning medan andra präglas av en negativ kroppsuppfattning postoperativt. Fortsatt forskning kan underlätta sjuksköterskor identifiering av patienters individuella behov i avsikt att utföra hälsofrämjande omvårdnadsåtgärder. / The incidence of obesity has doubled in Sweden since 1980 and is still increasing. Individuals with obesity tends to have more of a negative body image than individuals with normal weight status. The body image of patients that have undergone bariatric surgery is complex and has not sufficiently been researched, therefore clarification is needed. The aim was to illustrate an adult patient’s body image after a bariatric surgery. A litterature study was conducted and ten scientific articles were used as a basis for the results. Three themes and five categories emerged. The themes were; Body image related to weight loss, Body image related to excessive skin and Body image related to ones surrounding. The categories were; The own body was percieved positively, The own body was percieved negatively, Excessive skin was percieved positively and negatively, Excessive skin caused feelings of shame and Positive and Negative verbal response from ones surrounding. The result shows that bariatric surgery’s impact on the patient’s body image is individual. Further scientific research is needed to determine the underlying causes to why some patients’ acquires a positive body image and to why other patients’ acquires a negative body image. Further research can help nurses to identify the patients’ individual needs in order to implement health promoting nursing interventions.