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Class of 2008 Abstract / Objectives: To assess the effect of treatment with placebo on weight loss in obese patients. Methods: The placebo groups from nine orlistat and three sibutramine weight loss studies, as identified from the Padwal meta-analysis, were analyzed for: weight loss in kilograms; change in BMI; type of nutrition and exercise interventions; and bias. The means and standard deviations for weight loss were entered into the Stata meta-analysis program to obtain a forest plot to determine an overall estimate of weight loss. The Potential for Methodological Bias Assessment Tool (PMBAT) was used to create a bias score for each study. Results: Overall, subjects in the placebo group lost 3.8 kg (p<0.001). Placebo subjects in the orlistat trials lost significantly more weight (4.3 kg) than did subjects in the sibutramine trials (1.1 kg, p=0.014). The subjects in the sibutramine studies did not lose a significant amount of weight (p=0.397). There were distinct differences between the sibutramine and orlistat studies with regard to nutrition and exercise interventions. The mean score on the PMBAT was 16.7 ± 3.6; and no study scored higher than 25 out of 45 total points. Conclusions: Overall subjects in the placebo group in the combined orlistat and sibutramine studies lost a significant amount of weight. Differences in study design, bias, and the Hawthorne effect may have contributed to this weight loss.

A) Bariatric surgery for the treatment of obesity has shown much promise. The Roux-en-Y gastric bypass is a procedure that combines both restrictive and malabsorptive elements. Post-operative weight loss and co-morbidity improvements previously achieved are over and above those which are seen during life style modification and drug therapy. 330 patients (2005-2007) with a mean BMI of 45.87 ± 0.63 were characterised pre-operatively with regard to clinical, anthropometric and DEXA scan measurements. 130 were matched for the same parameters post-operatively over a 9-12 month observation period. The data was analysed statistically using paired t-tests and regression analyses. Significant post-operative improvements were observed with regard to patients’ weight loss and co-morbidity improvement. Positive and significant correlations of anthropometric measures to biochemical parameters ensued. Risk factor scoring methodology produced an average total score of 17 points / 36. Average post-op weight loss at 9-12 months follow-up was 20% of initial pre-op weight. Co-morbid diseases and anthropometric measurements illustrated significant changes following surgery. Risk factor scoring is a valuable pre-op tool for assessing eligibility for medical aid re-imbursement for surgery. B) Obesity is a global epidemic and is increasing the worlds’ mortality rate. Genetic predisposition to obesity is recognized as being significant. Polymorphisms within the Melanocortin 4 Receptor (MC4R) gene, which encodes a G-protein coupled receptor responsible for post-prandial satiety signalling, have been associated with monogenic obesity. Obesity prevalence in South Africa is drastically increasing, however there has been no causative investigation done. Thus we sought to perform an initial assessment of the prevalence of MC4R polymorphisms within a South African representative group. Blood was drawn from a mixed Body Mass Index (BMI) cohort of 259 adult individuals and their DNA was extracted. The MC4R gene was PCR amplified from the DNA, the amplicon sequenced and the sequence data was analyzed for polymorphisms. A polymorphism prevalence of 13.51% was found within the patients across a BMI range that spanned from underweight (19.6) to super-obese (126.0). In addition to MC4R polymorphisms that had been identified previously, two new polymorphisms namely R7H and S36T were observed. Four haplotypes were also identified. MC4R mutation frequency was observed to be ethnically dependant; however the hypothesis of differing ethnic backgrounds illustrating varying mutational penetrance was not confirmed. The expected trend regarding MC4R polymorphism functional effect and associated pathogenicity was not followed in light of our results. The question of whether or not MC4R polymorphisms contribute to the development of obesity is indisputable; however the current accepted trend regarding their precise role may be incorrect and must be challenged. / Dissertation (MSc)--University of Pretoria, 2009. / Immunology / unrestricted

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.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / Esta pesquisa teve como objetivo investigar os discursos que circulam no grupo terapÃutico realizado com pacientes diagnosticados obesos de um hospital pÃblico de referÃncia em cirurgia bariÃtrica no municÃpio de Fortaleza-CE e como esses pacientes sÃo subjetivados por esses discursos. Assim, esse estudo possui como tema central a obesidade, porÃm sem tomar como verdade os discursos biomÃdicos hegemÃnicos que a tratam enquanto fenÃmeno de doenÃa, e sim questionar e problematizar discussÃes, com base em Michel Foucault, sobre os efeitos de verdade que esses discursos produzem. A metodologia utilizada foi a observaÃÃo participante do referido grupo composto por pacientes de ambos os sexos que estÃo na fase prÃ-operatÃria da cirurgia bariÃtrica e tambÃm com aqueles que jà se submeteram a essa operaÃÃo. A cirurgia bariÃtrica funciona como uma estratÃgia biopolÃtica que incide sobre o corpo de uma populaÃÃo obesa. Dentre as tÃticas da biopolÃtica percebidas no grupo terapÃutico, pode-se citar: o conjunto de prÃticas discursivas que funcionam como regimes de verdades (prescriÃÃes de dietas, hÃbitos, comportamentos e modos de viver em nome da saÃde), especialistas (mÃdicos, psicÃlogos, nutricionistas, etc) que proferem essa âverdadeâ, intervenÃÃes (clÃnicas, cirÃrgicas) sobre a populaÃÃo obesa e subjetivaÃÃo dos pacientes que sÃo enredados na teia do poder, nas estratÃgias de conduÃÃo de condutas de si e dos outros. Assim, esse trabalho nÃo buscou construir um juÃzo de valor de se posicionar a favor ou contra a cirurgia bariÃtrica, nem assumir uma visÃo moralista diante da obesidade e sim problematizar como o corpo obeso à demarcado por prÃticas (discursivas e nÃo-discursivas) de saber-poder que o constituem. Consistiu, ainda, em pensar diferentemente do que se pensa, criar formas que escapam, que se constituem como resistÃncias, linhas de fuga e formas libertÃrias ao discurso mÃdico-cientÃfico sobre saÃde, beleza e boa forma dos corpos.

GONÇALVES, Shirley Dias. Obesidade em discurso: cenas do grupo terapêutico com pacientes diagnosticados obesos em um hospital público de Fortaleza-CE. 2011. 91 f. Dissertação (Mestrado em Psicologia) – Universidade Federal do Ceará, Departamento de Psicologia, Programa de Pós-Graduação em Psicologia, Fortaleza-CE, 2011. / Submitted by moises gomes (celtinha_malvado@hotmail.com) on 2012-05-17T17:29:59Z No. of bitstreams: 1 2011_dis_SDGonçalves.pdf: 2822735 bytes, checksum: 706bdee0adb4571c14053cebef959fc1 (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-06-15T16:21:55Z (GMT) No. of bitstreams: 1 2011_dis_SDGonçalves.pdf: 2822735 bytes, checksum: 706bdee0adb4571c14053cebef959fc1 (MD5) / Made available in DSpace on 2012-06-15T16:21:55Z (GMT). No. of bitstreams: 1 2011_dis_SDGonçalves.pdf: 2822735 bytes, checksum: 706bdee0adb4571c14053cebef959fc1 (MD5) Previous issue date: 2011 / Esta pesquisa teve como objetivo investigar os discursos que circulam no grupo terapêutico realizado com pacientes diagnosticados obesos de um hospital público de referência em cirurgia bariátrica no município de Fortaleza-CE e como esses pacientes são subjetivados por esses discursos. Assim, esse estudo possui como tema central a obesidade, porém sem tomar como verdade os discursos biomédicos hegemônicos que a tratam enquanto fenômeno de doença, e sim questionar e problematizar discussões, com base em Michel Foucault, sobre os efeitos de verdade que esses discursos produzem. A metodologia utilizada foi a observação participante do referido grupo composto por pacientes de ambos os sexos que estão na fase pré-operatória da cirurgia bariátrica e também com aqueles que já se submeteram a essa operação. A cirurgia bariátrica funciona como uma estratégia biopolítica que incide sobre o corpo de uma população obesa. Dentre as táticas da biopolítica percebidas no grupo terapêutico, pode-se citar: o conjunto de práticas discursivas que funcionam como regimes de verdades (prescrições de dietas, hábitos, comportamentos e modos de viver em nome da saúde), especialistas (médicos, psicólogos, nutricionistas, etc) que proferem essa ‘verdade’, intervenções (clínicas, cirúrgicas) sobre a população obesa e subjetivação dos pacientes que são enredados na teia do poder, nas estratégias de condução de condutas de si e dos outros. Assim, esse trabalho não buscou construir um juízo de valor de se posicionar a favor ou contra a cirurgia bariátrica, nem assumir uma visão moralista diante da obesidade e sim problematizar como o corpo obeso é demarcado por práticas (discursivas e não-discursivas) de saber-poder que o constituem. Consistiu, ainda, em pensar diferentemente do que se pensa, criar formas que escapam, que se constituem como resistências, linhas de fuga e formas libertárias ao discurso médico-científico sobre saúde, beleza e boa forma dos corpos.