Purpose: To investigate the effect of the 12-week Active Living Every Day (ALED) internet-based PA intervention on PA levels, health profile and health-related psychosocial factors in bariatric patients. Methods: Efficacy of the ALED program was compared across pre-intervention, post-intervention and six-month post-surgery time points. PA was measured using the Omron pedometer (HJ-720ITC) and Actigraph GT3X accelerometer in 19 bariatric patients (2 male, 17 female, 43  12 years). Results: Mean steps/day and time spent in sedentary, light, and MVPA increased from pre-intervention through six-months post-surgery. Significant improvements (P < 0.05) in body composition occurred from pre-intervention to post-intervention and from post-intervention to six-month post-surgery. Conclusion: The 12-week ALED PA intervention did not significantly improve PA levels in previously sedentary bariatric surgery patients who were non-compliant prior to bariatric surgery or six-months post-surgery; however, the intervention led to improvements in cardiovascular risk factors, RPE and self efficacy. / School of Physical Education, Sport, and Exercise Science

Access to abstract restricted until 05/2017. / Access to thesis restricted until 05/2017. / Department of Family and Consumer Sciences

The current research was conducted to determine if some social cognitive and psychosocial variables (e.g., maintenance self-efficacy, action planning, & depression) would accurately classify bariatric patients into one of three groups—maintenance, relapse, or recovery—related to adherence to post-surgical nutrition recommendations. One hundred sixty one female bariatric patients aged 18 years or older who had undergone surgery at least six months prior to participation were recruited for this study. Participants completed instruments that assessed social cognitive variables, psychosocial variables, and current nutrition behaviors. In general, it was hypothesized that the combination of the social cognitive and psychosocial variables would predict membership in one of the three groups. Each of the three discriminant analyses performed to test the hypotheses yielded a significant first function. The second function of the first analysis was also significant. The findings of the current study suggested that the social cognitive (54%) and psychosocial (57%) variables as well as a combination of the social cognitive and psychosocial variables (59%) were able to predict a patient's group membership at a rate better than chance. The findings, therefore, revealed that it was possible to predict group membership in terms of adherence to post-surgical nutrition recommendations at a rate better than chance. This study represented a first step toward identifying bariatric patients who were at-risk for non-adherence to nutrition recommendations, which researchers have argued is responsible for poor outcomes after bariatric surgery. Implications and recommendations for future research are discussed. / Department of Counseling Psychology and Guidance Services

The vitamin E, vitamin B-6, vitamin B-12, and folate status of 22 gastric bypass subjects ages 23 to 60 yr was evaluated before, 6 mo, and 12 mo post-surgery. Before surgery 77.3% of subjects had adequate vitamin E status; 36.3%, adequate vitamin B-6 status; 100.0%, adequate vitamin B-12 status; and 45.5%, adequate folate status. After surgery, subjects were classified into 3 vitamin supplement groups based on average daily vitamin supplement intake. Subjects taking higher levels of supplements containing these vitamins had significantly higher plasma concentrations of the vitamins than those taking low or moderate levels. The mean plasma vitamin values in the moderate supplement group were indicative of adequate status for all vitamins, but plasma vitamin B-12 levels at 12 mo post-surgery were significantly lower than pre-surgery levels. In the low supplement group, mean plasma vitamin levels were in or near marginal or deficient range. The majority of subjects consuming supplements of vitamin E, vitamin B-6, and folate near the US RDA maintained normal vitamin status. Subjects taking 100+ ug vitamin B-12 daily had adequate vitamin B-12 status. Significant correlations (r = .67 to .94) were observed between vitamin supplement levels and the respective plasma vitamin concentrations. / Ph. D. / incomplete_metadata

Bariatric surgery has emerged as the most effective method for producing substantial long-term weight loss and inducing remission or reducing severity of many comorbidities for individuals with severe obesity. However, maintaining these successes from surgery requires that individuals combine the surgical intervention with numerous behavioral changes including dietary, physical activity, and lifestyle behaviors. Despite the positive weight and health outcomes associated with bariatric surgery, a proportion of the population experiences insufficient weight loss or weight regain, which may depend on the individual’s adherence to the bariatric behavioral recommendations. Few studies have investigated specific bariatric behaviors and whether they are impactful on weight outcomes. The purpose of this study was to (1) examine the extent to which constructs of the extended Theory of Planned Behavior (TPB) predicted six bariatric behaviors: (a) eating protein at the start of a meal, (b) eating three to five daily servings of fruits and vegetables, (c) avoiding sweet foods, (d) avoiding salty snack foods, (e) avoiding sugar sweetened beverages, and (f) exercising for 30 minutes daily at moderate to vigorous intensity; (2) to evaluate the relationship of the aforementioned behaviors with excess weight loss outcomes; and (3) to explore the facilitators and barriers successful bariatric patients identify as factors that influence their adherence to bariatric dietary and exercise behaviors. A sequential explanatory mixed methods approach was used to address the purpose of this study. The first component consisted of collecting quantitative data from bariatric patients between 6-24 months post-operative while the second was completed by collecting qualitative data from participants, who based on certain criteria, were considered to be successful one year or more after their bariatric surgeries. Quantitative component: A cross sectional design examined a convenience sample of 136 mainly female (89.7%) and Hispanic (72.1%) bariatric patients that underwent either a Roux-en-Y gastric bypass or sleeve gastrectomy in one ethnically diverse New York City hospital. Instruments for this study were developed based on previous research and translated into Spanish. Reliability estimates and content validity were assessed with a sample similar to that used in the study for both the English and Spanish instruments. The variables found in the extended TPB were assessed through instrument items that measure intention, attitudes, subjective norms, perceived behavioral control, anticipated behavioral outcomes, normative beliefs, control beliefs, and the additional constructs of anticipated emotions and self-identity in relation to the six bariatric behaviors. Adherence to bariatric behaviors was measured by a frequency instrument. Pre- and post-operative weight measures were obtained from participants’ electronic medical records. Multiple regressions were used to establish the predictors for each behavior. For each behavior, attitudes towards the behavior contributed to the model for predicting behavioral intention. On the other hand, subjective norms were not found to be predictive for all behaviors with the exception of avoiding sweet foods. Behavioral intention for all behaviors was low and mainly non-significant, suggesting other constructs may be involved in order to adhere to the behavior. The level of adherence to these six behaviors remained consistent over the 6 to 24 post-operative months. To note, participants were not adherent to fruit and vegetable consumption and physical activity recommendations. Qualitative component: A purposeful sample of 11 bariatric patients that were considered successful based on study criteria participated in in-depth, semi-structured, individual interviews using a questionnaire developed from the main theoretical constructs of the TPB. In an effort to increase the understanding of the facilitators of and barriers to adherence, the addition of constructs found in the Health Action Process Approach framework were used to identitfy emerging themes. Content analysis of audio recording revealed (a) outcome expectations, (b) nutrition knowledge and skills, (c) social support, (d) attitudes towards adherence, (e) perceived behavioral control, (f) coping and planning strategies, and (g) recovery self-efficacy as major themes that influenced participants’ behaviors. A main facilitator to adhere to bariatric recommendations was outcome expectation, as post-operative patients saw the improvements in their health and quality of life following the bariatric surgery intervention as motivators to continue following recommendations and therefore preserve positive outcomes. At the same time, many participants stated difficulty in adhering to the recommendation of exercising at a moderate or vigorous intensity for 30 minutes on a daily basis. Conclusion: Using a behavioral change theory provides a valuable framework for explaining adherence to healthy dietary and physical activity behaviors for bariatric patients. Nutrition education and behavioral interventions should focus on improving adherence to the recommendations of consuming fruits and vegetable and exercising daily, aiming to enhance attitudes towards these post bariatric surgery behaviors and addressing barriers to physical activity.

Orientador: Érico Bruno Viana Campos / Banca: José Francisco Miguel Henriques Bairrão / Banca: Christiane Carrijo Eckhardt Mouammar / Resumo: Os excessos estão cada vez mais permeando os modos possíveis de vivência na atualidade. O corpo enquanto entidade em permanente construção tornou-se o receptáculo principal destes excessos da pós-modernidade, culminando em estatísticas alarmantes para a saúde pública mundial. De acordo com a Organização Mundial da Saúde, em 2008 mais de 1.4 bilhão de adultos estavam acima do peso e mais meio bilhão eram obesos. Pelo menos, 2.8 milhões de pessoas por ano morrem como resultado do excesso de peso ou obesidade. Buscou-se, neste estudo, investigar as vivências emocionais e significados atribuídos ao corpo em sujeitos que se submetem a cirurgia bariátrica e metabólica. Trata-se de um estudo clínico-qualitativo em psicanálise, delineado a partir de um estudo de casos múltiplos. O estudo contou com a participação de 15 pacientes vinculados a uma clínica particular e a um fórum de debates em uma rede social, sendo cinco pré-operatórios e 10 pós-operatórios. Os instrumentos utilizados para a coleta foram: uma entrevista semiestruturada e o procedimento de desenhos-estória. Os dados foram analisados à luz da perspectiva psicanalítica. Os resultados mostram uma tendência de reintegração da autoimagem e de melhora na autoestima nos pacientes ao longo do tempo de readaptação, refletindo em uma melhora dos sintomas depressivos. Contudo, no que diz respeito à sintomas de ansiedade e compulsão, a transformação não é tão positiva. Em geral, as expressões e formas da ansiedade e compulsão se mo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The excesses are increasingly permeating the possible ways of living in the present. The body as an entity in permanent construction has become the main receptacle of these excesses of postmodernism, culminating in world public health alarming statistics. According to the World Health Organization, in 2008 more than 1.4 billion adults were overweight and another half a billion were obese. At least 2.8 million people die each year as a result of being overweight or obese. This study aims to investigate the emotional experiences and meanings attributed to the body in subjects who undergo bariatric and metabolic surgery. It is a clinical-qualitative study, outlined from a multiple case study. The study counted on the participation of 15 patients linked to a private clinic and a discussion forum in a social network, five of which were preoperative and 10 were postoperative. The instruments used for the collection were: semi-structured interview and the Drawings-Story Procedure. The data was analyzed from a psychoanalytical perspective. The results show a tendency of reintegration of the self-image and improvement in the self-esteem in the patients along the time of rehabilitation, reflecting in diminishing of depressive symptoms. However, regarding the symptoms of anxiety and compulsion, the transformation is not so positive. In general, the expressions and forms of anxiety and compulsion change, but are not suppressed or find more adapted destinations. In the same way, interpersonal and romantic relationships are little changed in their qualitative aspects, although there is an expansion of their scope. The discussion shows that the aspects related to the image and body schema of the patients find very basic modifications, which do not come to integrate in a functional and dynamic way to the more deeply rooted subjective structuring. Also discussed are the structural implications of this condition in terms of / Mestre

While the concept of oppression has been studied in the context of many social or cultural identity variables (e.g., race, gender, sexual orientation), body size and weight are just beginning to be considered as additional multicultural or diversity factors that may lead to experiences of oppression or privilege. Previous research has examined weight bias, fat-phobia, obesity stigma, and related concepts, but mostly using quantitative methods and often only in very specific realms (e.g., employment discrimination based on weight/body size). The purpose of the current study was to examine the subjective experiences of weight-related oppression of individuals who are, or have been, of large body size. A sample of 20 adults (16 women and 4 men) who have, or will, undergo bariatric weight loss surgery were interviewed about their experiences of weight or body size-related oppression, and their responses qualitatively analyzed using a grounded theory approach. Semi-structured interviews were conducted and included questions or prompts regarding participants’ personal experiences of weight-based discrimination, perceived prejudice, stigma, as well as other concepts related to oppression (or conversely, privilege). Four constructs emerged from 14 themes in the data. The overarching constructs included a) weight-related oppression occurs at multiple levels, b) weight-related oppression occurs in multiple areas of participants’ lives, c) belief and attitudes about weight and body size, and d) reactions to oppression. The 14 themes were comprised of 58 ideas that were relevant for this topic and repeated both within and across the participants. Clinical implications for medical and mental health providers, limitations of the current study, and future research directions are also addressed and discussed. / Access to thesis permanently restricted to Ball State community only. / Department of Counseling Psychology and Guidance Services

Made available in DSpace on 2014-08-13T14:50:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-05Bitstream added on 2014-08-13T18:00:54Z : No. of bitstreams: 1 000750755.pdf: 1008474 bytes, checksum: cde1a5b02dad6c8027986aa31e699b86 (MD5) / A apneia obstrutiva do sono (AOS) é caracterizada pelo colabamento parcial ou completo, repetido das vias aéreas superiores durante o período de sono que leva a uma fragmentação do sono, hipoxemia, hipercapnia, oscilações da pressão intratorácica e aumento da atividade simpática. No adulto, a obesidade é o principal fator de risco para o desenvolvimento de AOS e o fator de risco reversível mais importante da AOS. A exata fisiopatologia da AOS em pacientes obesos permanece pouco compreendida. Essa estreita relação entre AOS e obesidade é constatada nos números, onde aproximadamente 40%-45% dos obesos têm AOS e 70% dos pacientes com AOS são obesos. Entre 71-91% dos obesos mórbidos (IMC ≥ 40 kg/m²) possuem AOS. O objetivo deste trabalho foi avaliar a frequência e classificar a gravidade da AOS em pacientes obesos em programação de cirurgia bariátrica. Além de avaliar a chance de AOS apontada pelo Questionário de Berlin (QB), a sonolência diurna excessiva através da Escala de Sonolência de Epworth (ESE) e se um ou ambos os questionários seriam instrumentos de screening nesta população. Foram incluídos pacientes do ambulatório de cirurgia bariátrica do serviço de gastrocirurgia com idade superior a 18 anos. Foram excluídos do estudo: usuários de medicamentos sedativos, portadores de doença pulmonar dependente de oxigênio ou descompensada e/ou insuficiência cardíaca congestiva descompensada, presença de sinais e/ou sintomas de outros distúrbios do sono (narcolepsia, síndrome das pernas inquietas, insônia), portadores de deformidades craniofaciais, diagnóstico e/ou tratamento de AOS previamente. Esse mesmo grupo foi submetido à anamnese e exame físico específico e respondeu ao QB e a ESE. Do grupo citado, 35 pacientes foram submetidos à poligrafia noturna para pesquisa de AOS. O aparelho utilizado foi o Stardust II (Respironics, Inc.,USA). Os dados demográficos foram descritos em suas médias e ... / Obstructive sleep apnea (OSA) is characterized by repetitive partial or complete upper airway collapse during sleep leading to sleep fragmentation, hypoxemia, hypercapnia, intrathoracic pressure oscillations and increased sympathetic activity. Obesity is the main risk factor for the development of OSA in adults as well as its most important reversible risk factor. The exact pathophysiology of OSA in obese patients remains poorly understood. Such narrow relationship between OSA and obesity can be observed in numbers, so nearly 40–45% of obese patients have OSA whereas 70% of patients with OSA are obese. Between 71–91% of the morbidly obese (BMI ≥ 40 kg/m2) present OSA. The purpose of this study was to evaluate the frequency and classify the severity of OSA in obese patients scheduled for bariatric surgery, also evaluating the risk for OSA pointed out by Berlin Questionnaire (BQ), excessive daytime sleepiness that was measured by Epworth Sleepiness Scale (ESS) and if one or both questionnaires would be tools for screening in such population. Patients (over 18 yrs) from the Outpatient Bariatric Surgery at Gastro-surgery Department were included. On the other hand, users of sedative medication, patients with oxygen-dependent lung disease or decompensated and/or congestive decompensated heart failure, presence of signs and/or other sleep disorders (narcolepsy, restless legs syndrome, insomnia), craniofacial deformities, diagnosis and/or previous OSA treatment were excluded. This group was submitted to anamnesis and specific physical examination and answered BQ and ESS. From such group, 35 patients were submitted to portable monitoring for OSA research and Stardust II (Respironics, Inc., USA) was used. The demographic data were described in their average and standard deviation as well as absolute number or percentage and compared for gender. BQ and ESS results were compared according to gender and BMI, being described in absolute numbers ...

Orientador: Silke Anna Theresa Weber / Banca: Walmar Kerche de Oliveira / Banca: Inge Elly Kiemie Trindade / Resumo: A apneia obstrutiva do sono (AOS) é caracterizada pelo colabamento parcial ou completo, repetido das vias aéreas superiores durante o período de sono que leva a uma fragmentação do sono, hipoxemia, hipercapnia, oscilações da pressão intratorácica e aumento da atividade simpática. No adulto, a obesidade é o principal fator de risco para o desenvolvimento de AOS e o fator de risco reversível mais importante da AOS. A exata fisiopatologia da AOS em pacientes obesos permanece pouco compreendida. Essa estreita relação entre AOS e obesidade é constatada nos números, onde aproximadamente 40%-45% dos obesos têm AOS e 70% dos pacientes com AOS são obesos. Entre 71-91% dos obesos mórbidos (IMC ≥ 40 kg/m²) possuem AOS. O objetivo deste trabalho foi avaliar a frequência e classificar a gravidade da AOS em pacientes obesos em programação de cirurgia bariátrica. Além de avaliar a chance de AOS apontada pelo Questionário de Berlin (QB), a sonolência diurna excessiva através da Escala de Sonolência de Epworth (ESE) e se um ou ambos os questionários seriam instrumentos de screening nesta população. Foram incluídos pacientes do ambulatório de cirurgia bariátrica do serviço de gastrocirurgia com idade superior a 18 anos. Foram excluídos do estudo: usuários de medicamentos sedativos, portadores de doença pulmonar dependente de oxigênio ou descompensada e/ou insuficiência cardíaca congestiva descompensada, presença de sinais e/ou sintomas de outros distúrbios do sono (narcolepsia, síndrome das pernas inquietas, insônia), portadores de deformidades craniofaciais, diagnóstico e/ou tratamento de AOS previamente. Esse mesmo grupo foi submetido à anamnese e exame físico específico e respondeu ao QB e a ESE. Do grupo citado, 35 pacientes foram submetidos à poligrafia noturna para pesquisa de AOS. O aparelho utilizado foi o Stardust II (Respironics, Inc.,USA). Os dados demográficos foram descritos em suas médias e ... / Abstract: Obstructive sleep apnea (OSA) is characterized by repetitive partial or complete upper airway collapse during sleep leading to sleep fragmentation, hypoxemia, hypercapnia, intrathoracic pressure oscillations and increased sympathetic activity. Obesity is the main risk factor for the development of OSA in adults as well as its most important reversible risk factor. The exact pathophysiology of OSA in obese patients remains poorly understood. Such narrow relationship between OSA and obesity can be observed in numbers, so nearly 40-45% of obese patients have OSA whereas 70% of patients with OSA are obese. Between 71-91% of the morbidly obese (BMI ≥ 40 kg/m2) present OSA. The purpose of this study was to evaluate the frequency and classify the severity of OSA in obese patients scheduled for bariatric surgery, also evaluating the risk for OSA pointed out by Berlin Questionnaire (BQ), excessive daytime sleepiness that was measured by Epworth Sleepiness Scale (ESS) and if one or both questionnaires would be tools for screening in such population. Patients (over 18 yrs) from the Outpatient Bariatric Surgery at Gastro-surgery Department were included. On the other hand, users of sedative medication, patients with oxygen-dependent lung disease or decompensated and/or congestive decompensated heart failure, presence of signs and/or other sleep disorders (narcolepsy, restless legs syndrome, insomnia), craniofacial deformities, diagnosis and/or previous OSA treatment were excluded. This group was submitted to anamnesis and specific physical examination and answered BQ and ESS. From such group, 35 patients were submitted to portable monitoring for OSA research and Stardust II (Respironics, Inc., USA) was used. The demographic data were described in their average and standard deviation as well as absolute number or percentage and compared for gender. BQ and ESS results were compared according to gender and BMI, being described in absolute numbers ... / Mestre

Orientador: Flávia Heloísa dos Santos / Banca: Vânia Cristina Lamônica / Banca: Hugo Ferrari Cardoso / Resumo: A cirurgia bariátrica (CB) tem se tornado uma prática cada vez mais utilizada no tratamento da obesidade grau III, por auxiliar na redução do peso e eliminação ou diminuição das comorbidades. Por outro lado, pouco se sabe sobre seus efeitos com relação ao funcionamento biopsicossocial. A presente pesquisa consiste de um estudo prospectivo dos efeitos da redução de peso rápida (CB) ou lenta (dieta), nos aspectos emocionais, cognitivos, de autoeficácia e qualidade de vida, em pessoas com obesidade grau III avaliadas em dois momentos em um intervalo de três meses. Participaram do estudo 58 indivíduos com obesidade grau II e III, de ambos os sexos, com idade superior a 20 e inferior a 60 anos, avaliados quantos aos sintomas depressivos e ansiosos, funções executivas, autoeficácia geral, autoeficácia para regular hábitos alimentares e qualidade de vida. No estudo transversal a amostra total (n=58) foi dividida em dois grupos, GJ (Grupo Jovem) e GM (Grupo Maduro) para análise da influência da idade sobre as variáveis. No estudo prospectivo os pacientes participantes foram divididos em dois grupos CB (tratados por cirurgia bariátrica) e o NCB (tratados por dieta). O estudo transversal indicou que o GJ apresentou um melhor desempenho na memória operacional no subsistema visuoespacial quando comparado ao GM, não houve diferenças nos demais quesitos. O estudo prospectivo revelou que os pacientes do grupo CB apresentaram melhoras nos sintomas depressivos e de ansiedade, assim como apres... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bariatriac surgery (BS) has become an increasingly used procedure in the treatment of class III obesity, as this surgery helps to lose weight while eliminate or reduce comorbidities. On the other hand, little is known about its effects on an individual's biopsychosocial functioning. The present research contrasts fast weight loss (BS) and slow weight loss (diet) effects in emotional, cognitive, self-efficacy and life quality aspects in people with morbid obesity assessed in two moments over a three-month interval. Participants were 58 individuals from both genders, aged 20 to 60 years, with class II and III obesity assessed regarding depression and anxiety symptoms, executive functions, general self-efficacy, self-efficacy to regulate eating habits and quality of life. In the cross-sectional study, the sample was divided into two groups, YG (Young Group) and MG (Mature Group), for age analysis over the variables. In the prospective study, the patients were divided into two groups: BS (treated by bariatic surgery) and NBS (treated by diet). The cross-sectional study indicated that MG had better performance in working memory in the visuospatial subsystem when compared to MG - no differences were found in other inquiries. The prospective study revealed that BS patients had improvements in depression and anxiety symptoms, more positive scores regarding quality oflife, improvements in working memory and self-efficacy assessment when compared to NBS patients. Benefits in NBS group ... (Complete abstract click electronic access below) / Mestre