Syftet med studien var att beskriva patientens upplevelser efter en gastric bypass operation. En empirisk studie med kvalitativ ansats genomfördes, där intervjuer skedde med sex personer som genomfört en gastric bypass operation. Data analyserades genom kvalitativ innehållsanalys. Under intervjuerna framkom att informanterna upplevde att operationen inte hade någon negativ inverkan på deras vardagliga liv. De upplevde en ökad livskvalitet och förbättrad hälsa som lett till ett mer fysiskt aktivt liv. Viktnedgången tillsammans med omgivningens positiva reaktioner på den nya kroppen hade stärkt deras självförtroende. Den största förändringen informanterna upplevde i det vardagliga livet var deras förändrade matvanor. De beskrev att maten var i fokus och att de planerade sin vardag efter måltiderna. De följder som framkom upplevdes inte som något stort problem, utan viktminskningen och de positiva hälsoupplevelserna dominerade. Informanterna kände sig välinformerade och hade realistiska förväntningar på operationen, samt var förberedda på de konsekvenser som kunde uppstå. Studien visar att den specialiserade vården på överviktskliniker kan bidra till att underlätta tiden efter operationen för patienten. Det framkom att informanterna upplevde en kunskapsbrist om gastric bypass operationer bland sjukvårdspersonal, inom primärvård och slutenvård. För att patienten ska känna trygghet och förtroende är det därför viktigt att öka kunskapen om överviktsoperationer bland hälso- och sjukvårdspersonal.

Bakgrund: Fetma är ett ökande problem i dagens samhälle. Laparoskopiskt Gastric bypass (LGBP) utförs för att hjälpa personer med fetma till viktminskning och det är vanligt att dessa patienter upplever postoperativt illamående, buksmärta och huvudvärk efter ett operativt ingrepp. Det råder meningsskiljaktigheter i tidigare studier hur väl preoperativ näringsdryck kan ha ett samband gällande det postoperativa förloppet.Syfte: Syftet var att jämföra tre olika preoperativa dryckers effekt på postoperativt illamående, buksmärta och huvudvärk efter LGBP under de 24 första timmarna.Metod: En randomiserad studie med kvantitativ design utfördes på en av Nordens största kliniker inom fetmakirurgi. Totalt tillfrågades n=90 kvinnor och tilldelades slutna kuvert med antingen kolhydratdryck, proteindryck eller kranvatten.Resultat: Illamående toppade ca åtta timmar efter operation, det vill säga kl.19.00 på kvällen, för att sedan under natten återgå till preoperativa värden uppmätta kl.06.00. Skillnad mellan kolhydratrik- och proteinberikadryck gav p= 0, 2046 och för kolhydratrikdryck och kranvatten p= 0.8722. Buksmärtan var som högst vid ankomst till uppvakningsavdelningen och stabiliserades två timmar senare och minskade något under natten men försvann inte helt. Huvudvärk låg stabilt i alla grupperna med en ökning runt kl. 19:00 på kvällen för att sedan plana ut under natten. Inga skillnader mellan buksmärta och huvudvärk, p= 0,1569. Det sågs ingen statistisk signifikans hos någon av grupperna i de olika variablerna.Slutsats: Preoperativ vätskebehandling med kolhydratdryck, proteindryck eller kranvatten inför en LGBP operation påverkar inte signifikant illamående, buksmärta och huvudvärk efter operation. / Background: Obesity is a growing problem in today’s society. Laparoscopic Gastric bypass is performed to help people with obesity lose weight and it is common for these patients to experience postoperative nausea, stomach pains, and headaches after a surgical procedure. There are differences in opinion in earlier studies as to the extent that preoperative nutritional beverages can correlate to the postoperative process.Aim: The aim of this paper was to compare three different preoperative beverages’ effect on postoperative nausea, stomach pains, and headaches after LGBP during the first 24 hours after surgery.Method: A randomised study of quantitative design was performed on one of the Nordic countries’ largest clinics specializing in obesity surgery. A total tally of n=90 women were asked to participate and each received sealed packages containing either carbohydrate beverage, protein beverage, or tap water.Results: Nausea peaked eight hours after surgery, at 7.00 PM, and then returned during the night to preoperative values measured at 6.00 AM. The difference between the carbohydrate and protein beverages is expressed as p=0.2046, and the difference between the carbohydrate beverage and the tap water is expressed as p=0.8722. Stomach pains peaked at arrival to the recovery ward and stabilized two hours later, followed by a slight drop-off during the night but without subsiding entirely. Headache was experienced at stable values in all groups, with some increase at 7.00 PM only to level out during the night. There were no differences between stomach pains and headaches, as expressed by p=0.1569. No statistical significance was observed in any group in the different variables.Conclusion: Preoperative fluid treatment with carbohydrate beverages, protein beverages, or tap water before a LGBP surgery does not significantly affect nausea, stomach pain, or headache after the surgery.

<p>In our first study, we explored the barriers to complying with iron supplement recommendations using focus groups. We recruited adults, ages 18-75 years, who have had bariatric surgery at least two months previously to participate in one of four 90-minute focus groups. Participants filled out a survey asking for information on demographics and supplement use, and a facilitator asked a set of pre-determined questions to each group. Responses were written, recorded, transcribed using TranscribeMe (San Francisco CA), and analyzed using NVivo (QSR International Pty Ltd, Doncaster, Victoria). The focus groups contained nineteen participants, five of which had sleeve gastrectomy (SG) and fourteen had Roux-en-Y gastric bypass (RYGB). The average age of the participants was 49.3 ± 9.4 years, and they had undergone surgery 3.9 ± 3.6 years previously. The key factors that influenced participants’ adherence to supplement guidelines were cost, tolerability, and palatability of the supplement, level of knowledge and support from healthcare providers, and convenience of the supplementation regime.</p> <p>The second study was a prospective observational study to determine the bioavailability of ASP compared to FS. Iron deficient RYGB patients ages 18-65 years, who had surgery at least 6 months previously, participated in 8-hour iron absorption tests. Participants received a low-iron breakfast with 65 mg ASP (N=7) or FS (N=3). We assessed serum iron every 30 minutes for 8 hours following the supplementation using a colorimetric assay (South Bend Medical Foundation, South Bend, IN). In participants administered FS, serum iron increased 96.0 ± 27.2 µg/dL compared to baseline, whereas with ASP, serum iron increased 5.8 ± 4.7 µg/dL compared to baseline (<i>P</i> = 0.02). These data indicate that ASP is not as bioavailable as FS in RYGB patients.</p>

Bakgrund: Fetma är ett allvarligt folkhälsoproblem då fetma ökar risken att drabbas av följdsjukdomar, samt att patienter med fetma visat sig ha lägre genomsnittlig hälsorelaterad livskvalitet (HRQoL) jämfört med befolkningen i allmänhet. Syfte: med denna litteraturöversikt var att beskriva hälsorelaterad livskvalitet bland personer som genomgått fetmakirurgi. Metod: Litteraturöversikt baserad på 8 kvantitativa interventionsstudier med uppföljningar mellan 9 månader - 10 år efter genomförd behandling. Litteratursökning skedde i databaserna PubMed och Cinahl. Analys av studierna skedde genom att studierna sammanställdes baserat på redovisning av frågeformulär SF-36 för index fysisk och mental hälsa och dess åtta dimensioner. Resultat: Samtliga studier indikerar att den fysiska hälsan i genomsnitt ökar efter fetmakirurgi. Samtliga utom en studie indikerar att hälsoindex för mental hälsa i genomsnitt ökar efter fetmakirurgi. Studier som sträcker sig över flera uppföljningsperioder visar att den initiala ökningen av hälsoindex minskar med tiden och effekten är som högst 1–2 år efter fetmakirurgi. Konklusion: Resultaten pekar på att fetmakirurgi initialt leder till en förbättring av fysisk och mental HRQoL med en tydlig topp efter 1–2 år. Studier med högt deltagande och uppföljning över tid är för få för att dra slutsatser kring effekten av fetmakirurgi på HRQoL på längre sikt. Utbildning av vårdpersonal och uppföljningsprogram kan bidra till ökat uppföljningsdeltagande, och minska risken för bortfall till följd av brister i vårdpersonalens bemötande. / Background: Obesity is a serious public health problem as it increases the risk of secondary diseases. Patients with obesity have been shown to have lower average health-related quality of life (HRQoL) compared to the general population. Aim: of this literature review was to describe health-related quality of life among people who have undergone bariatric surgery. Methods: Literature review of eight quantitative intervention studies with follow-ups between 9 months to 10 years. Literature search took place in the databases PuBMed and Cinahl. Analysis of the studies was done by summarizing the studies based on the reported result of the SF-36 questionnaire for physical and mental health and its eight dimensions. Results: All studies indicate that physical health increases on average after bariatric surgery. All but one study indicate that the mental health index increases, on average, after bariatric surgery. Studies that extend over several follow-up periods show that the initial increase in mental health decreases over time and the effect is highest 1–2 years after bariatric surgery. Conclusion: The results indicate that bariatric surgery initially leads to an improvement in physical and mental HRQoL with a clear peak after 1–2 years. Studies with high participation and follow-up over time are too few to draw conclusions about the effect of bariatric surgery on HRQoL in the longer term. Training of healthcare professionals and follow-up programs can contribute to increased follow-up participation, and reduce the risk of non-response.

Highly palatable and/or calorically dense foods, such as those rich in fat, engage the striatum to govern and set complex behaviors. Striatal dopamine signaling has been implicated in hedonic feeding and the development of obesity. Dieting and bariatric surgery have markedly different outcomes on weight loss, yet how these interventions affect central homeostatic and food reward processing remains poorly understood. Here, we propose that dieting and gastric bypass produce distinct changes in peripheral factors with known roles in regulating energy homeostasis, resulting in differential modulation of nigrostriatal and mesolimbic dopaminergic reward circuits. Enhancement of intestinal fat metabolism after gastric bypass may also modify striatal dopamine signaling contributing to its unique long-term effects on feeding behavior and body weight in obese individuals.

Highly palatable and/or calorically dense foods, such as those rich in fat, engage the striatum to govern and set complex behaviors. Striatal dopamine signaling has been implicated in hedonic feeding and the development of obesity. Dieting and bariatric surgery have markedly different outcomes on weight loss, yet how these interventions affect central homeostatic and food reward processing remains poorly understood. Here, we propose that dieting and gastric bypass produce distinct changes in peripheral factors with known roles in regulating energy homeostasis, resulting in differential modulation of nigrostriatal and mesolimbic dopaminergic reward circuits. Enhancement of intestinal fat metabolism after gastric bypass may also modify striatal dopamine signaling contributing to its unique long-term effects on feeding behavior and body weight in obese individuals.

Η λαπαροσκοπική γαστρική παράκαμψη κατά Roux-en-Y είναι μία από τις πιο ευρέως χρησιμοποιούμενες βαριατρικές επεμβάσεις για την αντιμετώπιση της νοσογόνου παχυσαρκίας. Η απώλεια βάρους μετά από βαριατρικού τύπου επεμβάσεις έχει συσχετισθεί με τις επερχόμενες μεταβολές των γαστρεντερικών ορμονών, που έχει δειχθεί ότι συνδέονται με τον έλεγχο του μεταβολισμού και της όρεξης. Σκοπός: Η μελέτη της επίδρασης της εκτομής του θόλου του στομάχου σε ασθενείς με νοσογόνο παχυσαρκία που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη στην έκκριση των ορμονών, τα επίπεδα της γλυκόζης αλλά και την απώλεια βάρους. Μέθοδος: Δώδεκα ασθενείς υποβλήθηκαν σε λαπαροσκοπική γαστρική παράκαμψη και δώδεκα σε λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου του στομάχου. Όλοι οι ασθενείς μελετήθηκαν προοπτικά πρίν και τρείς, έξι και δώδεκα μήνες μετά την επέμβαση. Η συλλογή των δειγμάτων έγινε μετά από δωδεκάωρη νηστεία και 30, 60 και 120 λεπτά μετά την χορήγηση πρότυπου γεύματος θερμιδικού φορτίου 300 Kcal. Αποτελέσματα: Το σωματικό βάρος και ο δείκτης μάζας σώματος μειώθηκαν σημαντικά (p<0.001) και στις δύο ομάδες χωρίς όμως διαφορές μεταξύ των ομάδων. Για την ομάδα της γαστρικής παράκαμψης τα επίπεδα γκρελίνης νηστείας μειώθηκαν στους τρείς μήνες μετεγχειρητικά και αυξήθηκαν στούς δώδεκα μήνες σε επίπεδα υψηλότερα σε σχέση με τα προεγχειρητικά (p<0.01), αντίθετα, μετά από λαπαροσκοπική γαστρική παράκαμψη και εκτομή του θόλου, τα επίπεδα γκρελίνης νηστείας μειώθηκαν σημαντικά και παρέμειναν χαμηλά σε όλες τις χρονικές στιγμές της μελέτης (p<0.01). H μεταγευματική απόκριση του PYY, του GLP-1 και της ινσουλίνης ενισχύθηκαν μετεγχειρητικά (p<0.01) και στις δύο επεμβάσεις αλλά η απόκριση ήταν σημαντικά μεγαλύτερη και τα μεταγευματικά σάκχαρα χαμηλότερα μετά από γαστρική παράκαμψη και εκτομή του θόλου του στομάχου (p for interaction <0.05). Μετεγχειρητικά οι μεταβολές της γκρελίνης συσχετίστηκαν αρνητικά με τις μεταβολές του GLP-1. Συμπεράσματα: Η εκτομή του θόλου του στομάχου σε ασθενείς που υποβάλλονται σε λαπαροσκοπική γαστρική παράκαμψη οδηγεί σε χαμηλότερα βασικά επίπεδα γκρελίνης, σε μεγαλύτερη μεταγευματική απόκριση GLP-1, PYY και ινσουλίνης και σε χαμηλότερα σάκχαρα σε σχέση με την λαπαροσκοπική γαστρική παράκαμψη. Η εκτομή του θόλου του στομάχου με συνοδό γαστρική παράκαψη μπορεί να αποδειχθεί μια πολύ χρήσιμη καινούργια χειρουργική τεχνική για την αντιμετώπιση της νοσογόνου παχυσαρκίας και του σακχαρώδη διαβήτη τύπου ΙΙ. / Background: Laparoscopic Roux-en Y-Gastric bypass (LRYGBP) is the commonest available option for the surgical treatment of morbid obesity. Weight loss following bariatric surgery has been linked to changes of gastrointestinal peptides, shown to be implicated also in metabolic effects and appetite control. The purpose of this study was to evaluate whether gastric fundus resection in patients undergoing LRYGBP enhances the efficacy of the procedure in terms of weight loss, glucose levels and hormonal secretion. Methods: 12 patients underwent LRYGBP and 12 patients LRYGBP plus gastric fundus resection (LRYGBP+FR). All patients were evaluated before and at 3, 6, and 12 months postoperatively. Blood samples were collected after an overnight fast and 30, 60 and 120 min after a standard 300 kcal mixed meal. Results: Body weight and body mass index decreased markedly and comparably after both procedures. Fasting ghrelin decreased three months after LRYGBP, but increased at 12 months to levels higher than baseline while after LRYGBP+FR was markedly and persistently decreased. Postprandial GLP-1, PYY and insulin responses were enhanced more and postprandial glucose levels were lower after LRYGBP+FR compared to LRYGBP. Postoperatively, ghrelin changes correlated negatively with GLP-1 changes. Conclusions: Resection of the gastric fundus in patients undergoing LRYGBP was associated with persistently lower fasting ghrelin levels, higher postprandial PYY, GLP-1 and insulin responses and lower postprandial glucose levels compared to LRYGBP. These findings suggest that fundus resection in the setting of LRYGBP may be more effective than RYGBP for the management of morbid obesity and diabetes type 2.

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.

Truncal adiposity impairs ventilation in obese adults by altering normal ventilatory mechanics. Leptin, an inflammatory adipocytokine, is elevated in obesity and has been shown to alter ventilatory responses to exercise. Leptin’s bioavailability appears to be regulated by its soluble receptor (LRe), which is reduced in obesity. Roux-en-Y gastric bypass surgery (RYGBS) is a weight loss intervention that reduces total fat mass and improves several obesity related co-morbidities including pulmonary dysfunction. The purpose of this study was to first evaluate the differences between ventilatory responses to carbon dioxide (VE/VCO2 slope) during progressive treadmill walking in morbidly obese and normal weight females. Second, we will analyze the relationships between the VE/VCO2 slope, truncal adiposity, serum leptin, and LRe. Lastly, we want to evaluate the changes in the ventilatory responses to exercise (VE/VCO2 slope), truncal adiposity, serum leptin, and LRe 3 months following Roux-en Y gastric bypass surgery. Thirteen obese (OB 37.7 ±11.4 years, 42.0 ± 4.8 kg/m2) and 12 normal weight females (NW 36.1 ±8.0 years, 22.8 ± 1.2 kg/m2) participated in this study. Blood samples for measure of fasting serum leptin and soluble leptin receptor were obtained prior to exercise. Cardiopulmonary variables were measured throughout exercise. Regional adiposity was determined through dual energy x-ray absorptiometry. Truncal adiposity was significantly greater in the obese group than the normal weight group. Serum leptin was greater in the obese group while LRe was lower than the normal weight group. The VE/VCO2 slopes were lower in obese group when compared to the normal weight group. There were no significant group differences in maximal ventilation, tidal volume or respiratory rate. Stepwise regression determined that truncal adiposity accounted for 31.5% of variance in VE/VCO2 slope (R= 0.561, R2 =0.315, p = 0.004). At 3 months post-surgery we observed significant reductions in the obese group in total percentages of fat, truncal adiposity, serum leptin. The soluble leptin receptor was not changed at any measured time point following RYGBS. There were no changes in 3 months post-surgery VE/VCO2 slopes in the obese group. Truncal adiposity, serum leptin and LRe were associated with reduced ventilatory responses to weight bearing exercise (VE/VCO2 slope) in obese females when compared to normal weight females. There were no differences between obese and normal weight females in maximal minute ventilation, tidal volume or respiratory rate. This result suggests that differences in VE/VCO2 slopes may not be entirely from maximal pulmonary capacity. Rather, the differences in VE/VCO2 slope may be attributed to truncal adiposity and its positive relationship with leptin. Elevated leptin in the obese group may indicate a state of central leptin resistance which has been shown to reduce the ventilatory responses to exercise. At 3 months post RYGBS significant reductions in total percent fat, serum leptin, truncal adiposity and BMI were observed. However, despite improvement in fat mass and serum leptin there were no changes in the VE/VCO2 slope and LRe at 3 months post RYGBS. Therefore, it is possible that the improvements in body composition and leptin following RYGBS were not sufficient to increase ventilation responses to weight bearing exercise in obese females.

The purpose of this study was to examine the experiences and perceptions of behavioral factors that contribute to successful weight loss in male bariatric patients. By analyzing participant experiences and perceptions, this study contributes to a better understanding of which factors are most important in the postoperative phase of gastric bypass in males owing to successful weight loss. Although there is a tremendous amount of quantitative research within the bariatric population, there is a significant gap within the qualitative literature as it relates to male outcomes. As such, by conducting interviews with 10 postoperative male gastric bypass patients, this study was able to further understand how and why these participants obtained successful weight loss. Furthermore, by identifying relevant categories and thematic responses from the participants, this study may serve future researchers in designing other qualitative studies that target best practices in males for successful weight loss outcomes. The findings of this study indicate that participants found greater weight loss success by following proper eating behaviors and engaging in physical activity whereas support group attendance was not found to be an important factor in successful weight loss. This study also revealed that follow up with the bariatric nurse coordinator was greatly viewed as a positive step in adjusting to lifestyle postsurgery. As such, this supportive role by the nurse coordinator may provide further impetus for the ways in which bariatric personnel interact with patients who might not always be able to see their surgeon for follow-up.