Orientador: Maria Rita Marques de Oliveira / Banca: Anderson Marlieri Navarro / Banca: Karina Pfrimer / Resumo: Um importante viés observado nos instrumentos de avaliação da dieta é a subnotificação ou o sub-registro do consumo de alimentos. Quando um indivíduo saudável e em balanço energético equilibrado relata um consumo energético muito baixo, implausível com a viabilidade biológica, este é identificado como um subnotificador ou sub-relatador. O objetivo deste estudo foi comparar seis diferentes abordagens para avaliação da subnotificação da ingestão energética entre obesas que aguardam na fila de espera para a cirurgia bariátrica, bem como verificar a associação da subnotificação com algumas características das voluntárias. Os resultados obtidos foram analisados em dois artigos científicos, sendo que o primeiro foi focado na comparação de diferentes abordagens para avaliar a subnotificação e o segundo se destina aos fatores associados à subnotificação na amostra. Participaram do estudo 100 candidatas à cirurgia da obesidade da Clínica Bariátrica de Piracicaba, localizada no interior do estado de São Paulo, Brasil. Dados como idade, cor, estado civil, grau de escolaridade, hábito de fumar, consumo de bebida alcoólica e alteração de peso recente foram obtidos por meio de uma entrevista. Para divisão das participantes em classes econômicas foi utilizado o questionário da Associação Brasileira de Empresas de Pesquisa. Medidas antropométricas e de composição corporal também foram coletadas. A subnotificação do consumo alimentar foi avaliada baseada na diferença entre ingestão energética relatada (IErel) e requerimentos energéticos calculados: gasto energético de repouso (GER) e o nível de atividade física (NAF). Foram adotadas seis abordagens para definição de pontos de corte levando... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: An important bias observed in diet assessment instruments is food intake underreporting or under-recording. When a healthy individual in a balanced energy state reports a very low energy intake, implausible with biological viability, this individual is called an underreporter. The objective of this study was to compare six different approaches for assessing energy intake underreporting in obese women in the waiting line for bariatric surgery, as well as to verify the association between underreporting and some characteristics of these women. The results were analyzed in two scientific articles. The first article focused on the comparison of different approaches for assessing underreporting and the second article focused on the factors associated with underreporting by the studied sample. The sample consisted of 100 women in the waiting line for bariatric surgery at the Bariatric Clinic of Piracicaba, a city located in upstate São Paulo, Brazil. An interview was used for collecting the following data: age, skin color, marital status, education level, smoking status, intake of alcoholic beverages and recent weight changes. The questionnaire created by the Brazilian Market Research Association (Associação Brasileira de Empresas de Pesquisa) was used to determine the socioeconomic classes of the participants. Anthropometric measurements and body composition data were also collected. Underreporting was determined by the difference between reported energy intake (rEI) and calculated energy requirements: resting metabolic rate (RMR) and physical activity level (PAL). Six approaches were used for defining the cut-off points, taking into account the variances of the components of the equation rEI:RMR = PAL, as a function of assumed PAL, number of subjects (n) of the sample and measured or estimated... (Complete abstract click electronic access below) / Mestre

Purpose: The authors' aim in this study was to gain insight on the psychological risk factors related to weight loss following bariatric surgery. Method: The authors used archival data of 137 participants who underwent both a psychological pre-assessment and bariatric surgery and attended a post-operative appointment at least six months following surgery. The factors examined at the psychological pre-assessment included alcohol abuse, smoking, exercise, binge eating, depression, stress, social support, dieting history, and history of sexual abuse. These factors were examined in relation to weight loss success defined as 50% loss of excess weight at follow-up. Main Findings: No significant relationships were found between weight loss success and the predictor variables. Conclusions: The researchers evaluated the present study results in relation to previous literature on bariatric surgery. Several limitations were evaluated, including examiner bias, participant population, and the assessment tool used. Areas of future research included examining alcohol consumption, exercise behavior, and binging and purging after surgery.

Preoperative optimization of patients with obesity prior to non-bariatric surgery through weight loss interventions may significantly improve perioperative outcomes and decrease healthcare resource utilization associated with this increasingly prevalent patient population. Ultimately, very low energy diets and bariatric surgery have the potential to become a cornerstone of pre-habilitation protocols for patients with obesity undergoing elective operations for both benign and malignant disease processes. Further adequately powered prospective study is warranted. / Background: Improved preoperative weight loss strategies for patients with obesity undergoing major non-bariatric surgery are necessary. As such, this research program focusing on evaluating different preoperative weight loss interventions, namely very low energy diets (VLEDs) and bariatric surgery, for patients with obesity undergoing major non-bariatric surgery was developed. Methods: The first chapter is a systematic review evaluating the use of preoperative VLEDs reported according to PRISMA. Medline, EMBASE, CENTRAL, and PubMed were systematically searched from inception through to July 2021. Articles were included if they evaluated VLED utilization prior to non-bariatric surgery. Pairwise meta-analyses using inverse variance random effects were performed. The second chapter is a retrospective study investigating the impact of a history of bariatric surgery on patients undergoing surgery for colorectal cancer. Adult patients undergoing resection for colorectal cancer from 2015-2019 were identified from the National Inpatient Sample (NIS). Patients were stratified according to their history of bariatric surgery. Propensity score matching with 4:1 nearest-neighbor matching was performed. Results: In Chapter 1, 13 studies with 395 patients with obesity receiving VLEDs preoperatively in preparation for non-bariatric surgery were included. Adherence with VLEDs ranged from 94- 100%. Mean preoperative weight loss ranged from 3.2-19.2kg. Patients using VLEDs had decreased intraoperative blood loss (MD 305.20mL, 95%CI 208.18-402.23, p<0.00001). In Chapter 2, 1,197 patients without prior bariatric surgery and 376 patients with prior bariatric surgery were included. Patients with prior bariatric surgery had an absolute reduction of 6.5% in overall in-hospital postoperative morbidity (19.1% vs. 25.6%, p<0.0001) and a $5,256 decrease in hospitalization cost ($70,344 vs. $75,600, p=0.034). iv Conclusion: These studies support the use of preoperative weight loss techniques for patients with obesity prior to non-bariatric surgery. VLEDs and bariatric surgery have the potential to become cornerstones of pre-habilitation protocols for patients with obesity undergoing elective operations. Further adequately powered prospective study is warranted. / Thesis / Master of Science (MSc) / Preoperative weight loss strategies for patients with obesity undergoing major non- bariatric surgery are becoming a necessity given the ubiquitous nature of obesity in our current surgical patient population. The first chapter is a systematic review and meta-analysis evaluating the use of preoperative very low energy diets (VLEDs) prior to non-bariatric surgery for patients with obesity. After screening nearly 800 citations and including 13 studies, this review identified that while currently available evidence is heterogenous, preoperative VLEDs are safe, well tolerated, and effectively induce preoperative weight loss in patients with obesity undergoing non-bariatric surgery for both benign and malignant disease. The second chapter is a population- level retrospective study investigating the impact of a history of bariatric surgery for weight loss on patients undergoing surgery for colorectal cancer. The findings from this study suggested that bariatric surgery prior to surgery for colorectal cancer may be associated with decreased postoperative morbidity and healthcare resource utilization.

Vårdpersonal och allmänheten uttrycker ofta negativa attityder till patienter som är överviktiga. Antalet patienter som genomgår en operation för sin övervikt ökar för varje år. Det är en omvälvande operation för patienten och patienter söker mycket information innan operationen. Den perioperativa dialogen, en ideal arbetsmodell har tidigare prövats på andra patientgrupper men inte på patienter som skall genomgå en operation för sin övervikt.  Syfte med studien var att beskriva patienters upplevelse av sin övervikt och hur kontinuiteten i den perioperativa dialogen kan ge lindrat lidande i samband med operation för övervikt. Studien har en hermeneutisk design. Data samlades in med hjälp av den perioperativa dialogen som dokumenterats vid sjuksköterskans möte med 26 patienter. Data tolkades genom hermeneutisk texttolkning. Resultatet beskrivs i två huvudteman Att leva i en överviktig kropp och Kontinuiteten i den perioperativa dialogen skapar möjligheter för lindrat lidande. Övervikten hindrar patienter i det dagliga livet både fysiskt och psykiskt, vilket tär på krafter och erfars som en lidande kropp. Genom den perioperativa dialogens kontinuitet lindras oro och tryggheten ökar, patienter upplever att de får vara med och planera, påverka och genomföra sin vård. Delaktighet minskar oron och därmed lidandet för patienten. Den perioperativa dialogen borde vara en självklarhet eftersom förtroende och trygghet skapas genom kontinuitet och patienten får möjlighet att bevara sin autonomi.  Utan kontinuiteten i den perioperativa vården försvinner patientens möjlighet till delaktighet i sin vård. / Health professionals and the public often have negative attitudes towards patients who are overweight. The number of patients undergoing surgery for their obesity is increasing every year. A surgery for obesity is a major change for the patient and patients seek a lot of information before surgery. The perioperative dialogues have been tried in other patient groups before but not in patients with overweight. The overall aim of the study was to describe how anesthesia and theatre nurses through the continuity of the perioperative dialogue can alleviate suffering of the patient during a surgery for obesity. The study has a hermeneutic design. Data were collected with the help of the perioperative dialogue as documented on the nurse's meeting with 26 patients. Data were interpreted through a hermeneutic text interpretation.The results are described in two main themes To live in an overweight body and Continuity in the perioperative dialogue creates opportunities for the alleviation of suffering. Obesity hinders patients in daily life both mentally and physically, which is putting a strain on their forces, and is experienced as a suffering body. Through the perioperative dialogue continuity reduces anxiety and increases safety. Patients feel that they may be involved in planning, influencing and implementing their care. This participation reduces anxiety and therefore the suffering for the patient. The perioperative dialogue should be obvious as the confidence and safety created by the continuity and patients should be able to maintain its autonomy. Without continuity in the perioperative care disappear the patient's ability to participate in their care. / Den perioperativa dialogen - ett applicationsmoment som skapar kontinuitet

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.

INTRODUÇÃO: A obesidade é uma doença crônica com crescimento alarmante no mundo todo. Atualmente, o tratamento cirúrgico, especialmente o Bypass Gástrico em Y de Roux (BGYR), tem se mostrado como a forma mais eficiente para perda de peso e sua manutenção a longo prazo. Contudo, com a formação do neo-estômago e a mudança na conformidade intestinal, há alterações significantes das muitas propriedades físicas e funcionais desses órgãos que levam à deficiência de nutrientes, inclusive de cálcio. Com isso, podem ocorrer modificações no metabolismo ósseo e, conseqüentemente, na estrutura óssea. OBJETIVOS: Avaliar a ingestão de cálcio, as alterações no metabolismo ósseo e mineral; e a ocorrência de osteopenia e osteoporose em mulheres que se submeteram ao BGYR há oito anos. MÉTODO: Neste estudo transversal, foram estudadas 30 mulheres que se submeteram ao BGYR no período de outubro de 1995 a janeiro de 1999, no Hospital das Clínicas da Faculdade de Medicina da USP. Para avaliação da ingestão de cálcio, utilizamos o recordatório de 3 dias (R3D) e o questionário de freqüência alimentar (QFA). Também foram realizados exames laboratoriais referentes ao metabolismo ósseo e mineral e densitometria óssea do seguimento L1-L4, colo femoral (CF) e fêmur proximal (FP). RESULTADOS: Em média, o consumo de cálcio foi de 525,5 ± 250,7 mg/dia pelo R3D e de 542,2 ± 195,6 mg/dia pelo QFA. Houve uma relação estatisticamente significativa entre a ingestão de cálcio por esses dois métodos (p<0,001). Não houve alteração nas determinações de cálcio total e ionizado, magnésio, fósforo e CTX. Os níveis de PTH, Fosfatase alcalina fração óssea (BSAP) e osteocalcina estavam elevados em 53%, 57% e 20% das mulheres, respectivamente; 90% apresentavam deficiência de 25 (OH) vitamina D (40% leve e 50% moderada), e em 70% a calciúria estava abaixo dos valores normais. Observou-se uma correlação positiva entre 25 (OH) vitamina D e a calciúria (p<0,04) e negativa entre 25 (OH) vitamina D e PTH (p<0,017). Com relação à densidade mineral óssea, 13% das mulheres foram diagnosticadas com osteoporose com relação ao CF e FP; 67%, 40% e 27% apresentavam osteopenia em L1-L4, CF e FP, respectivamente. CONCLUSÃO: Na maioria das mulheres estudadas verificou-se um consumo de cálcio cerca de 50% abaixo da recomendação diária para esta faixa etária. Observou-se também, uma deficiência de 25 (OH) vitamina D e elevação de PTH e BSAP. Além disso, houve uma ocorrência de osteopenia superior à esperada indicando que alterações no metabolismo ósseo são provavelmente uma complicação do BGYR. Mais estudos são necessários para definir uma rotina de suplementação de cálcio e vitamina D, e também para a prevenção das alterações ósseas. / INTRODUTION: Obesity is a chronic disease that rises rapidly around the world. Nowadays bariatric surgical procedures, especially Roux-en-Y Gastric Bypass (RYGB) has been shown the most efficient way to lose weight and maintain the weight loss for a long time. However, with the neo-stomach and the modification of intestinal anatomy by the surgery there are significant changes on physiological properties of these organs that lead to a nutrient deficiency, including calcium. Thus, bone metabolism changes may occur leading to a metabolic bone disease. OBJECTIVES: To evaluate calcium intake, bone and mineral metabolism changes and the prevalence of metabolic bone disease in women who were submitted to RYGB after eight years. METHOD: we studied 30 women who were submitted to RYGB during the period between October of 1995 and January of 1999 at Clinical Hospital of Medicine School of São Paulo University. To access calcium intake we used a 3 day dietary recall (3DR) and food frequency questionnaire (FFQ). Laboratory tests of bone metabolism and bone mass density of L1-L4, femoral neck (FN) and proximal femur (PF) were also accessed. RESULTS: calcium intake was 525,5 ± 250,7 mg/day according 3RD and 542,2 ± 195,6 mg/day according FFQ. There was a significantly relation between both methods (p<0,001). Total and ionic calcium, magnesium, phosphorus and CTX were not altered. PTH, bone specific alkaline phosphatase (BSAP) and osteocalcin levels were elevated respectively in 53%, 57% and 20% of women. 90% presented 25 (OH) vitamin D deficiency (40% mild and 50% moderate) and 70% had low urinary calcium. Was observed a positive correlation between 25 (OH) vitamin D and urinary calcium (p<0,04); and a negative correlation between 25 (OH) vitamin D and PTH (p<0,017). 13% of women had osteoporosis in FN and PF; 67%, 40% and 27% had metabolic bone disease in L1-L4, FN and PF respectively. CONCLUSION: Most studied women had a low calcium intake, about 50% of daily recommendation. We also noticed a 25 (OH) vitamin D deficiency and elevated levels of PTH and BSAP. Besides, there was a high prevalence of metabolic bone disease than expected, suggesting that this could be a complication of this surgery. Further studies are needed to define a supplementation routine of calcium and vitamin D to prevent bone metabolic diseases in these patients.

Orientador: Paulo Nascimento Junior / Banca: Angélica de Fátima Assunção Braga / Banca: Geraldo Rolim Rodrigues Junior / Banca: Leandro Gobbo Braz / Banca: David Ferez / Resumo: Problemas associados à manipulação das vias aéreas em pacientes obesos desafiam os anestesiologistas. O objetivo deste estudo foi comparar o uso do Airtraq® com o laringoscópio convencional observando-se o tempo de intubação traqueal, a necessidade de manobras facilitadoras, o grau de visualização das cordas vocais, bem como a influência de variáveis anatômicas na intubação traqueal de pacientes obesos posicionados em rampa. Em cento e trinta e dois pacientes, de ambos os sexos, com índice de massa corporal > 35 kg.m-2 e idade entre 18 e 60 anos, candidatos à cirurgia bariátrica, anotou-se o perímetro cervical, a distância mento-fúrcula e interincisivos, e o índice de Mallampati. Antes da indução da anestesia e após posicionamento com coxins dorsais (ramped position), os pacientes foram aleatoriamente divididos em dois grupos, de acordo com o dispositivo empregado para a intubação traqueal: laringoscópio de Macintosh (n = 64) ou Airtraq® (n = 68). Foram avaliados o índice de Cormack e Lehane, o tempo para intubação, os valores da saturação de pulso de oxigênio (SpO2), a pressão arterial média (PAM) e a frequência cardíaca. Observou-se o número de tentativas e necessidade de auxilio para a intubação. Houve falha na intubação em dois pacientes do grupo laringoscópio de Macintosh, que foram incluídos na análise por intenção de tratamento no pior cenário. O tempo de intubação foi menor com o Airtraq® (13,7 ± 3,1 segundos) do que com o laringoscópio de Macintosh (36,9 ± 22,8 segundos) (P<0,01). Os valores da SpO2 não apresentaram variação com relevância clínica e a PAM foi significativamente mais baixa no grupo Airtraq® três minutos após a intubação traqueal, 82,0 ± 11,4 mmHg e 76,9 ± 12,5 mmHg (P<0,05) nos grupos Airtraq® e laringoscópio de Macintosh, respectivamente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Airway management in bariatric surgery is a major challenge for anaesthesiologists. Thus, the aim of this study was to investigate the time required for tracheal intubation, the number of attempts to intubate, larynx visualization and the need for manoeuvres to optimize the glottis view of obese patients in ramped position by comparing the AirtraqTM and Macintosh laryngoscopes. Likewise, the influence of anatomical variables on intubation time was investigated. From 132 bariatric surgery patients with body mass index ≥35 kg.m-2 and aged 18 to 60 years, cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. Patients were randomised into two groups according to whether a Macintosh (n = 64) or an AirtraqTM (n = 68) laryngoscope was used for tracheal intubation. Cormack & Lehane score, time required for intubation, pulse oximetry (SpO2), mean arterial pressure (MAP), and heart rate were assessed. Characteristics and consequences of airway management were evaluated. Intubation failed in two patients in the Macintosh laryngoscope group, and these patients were considered as worst case scenario (intention to treat analysis). The intubation times were 13.7 ± 3.1 seconds and 36.9 ± 22.8 seconds for AirtraqTM and Macintosh laryngoscope groups (P<0.01), respectively. The SpO2 values did not exhibit clinically relevant variation, and MAP was significantly lower in the AirtraqTM group three minutes after tracheal intubation. Cormack-Lehane scores were also lower for the AirtraqTM group. One patient in the Macintosh group with intubation failure was quickly intubated with the AirtraqTM. Cervical circumference (P<0.01) and interincisor distance (P<0.05) influenced the time required for intubation in the Macintosh group but not in the AirtraqTM group. For obese patients in the ramped... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-08-31Bitstream added on 2014-06-13T18:48:56Z : No. of bitstreams: 1 fernandes_at_me_botfm.pdf: 334381 bytes, checksum: 497426c8767cff0fba02faad59ad8e83 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A cirurgia bariátrica videolaparoscópica (CBVL) é “padrão ouro” para o tratamento cirúrgico de obesidade mórbida. Entretanto, o pneumoperitônio pode trazer riscos aos rins, decorrentes da sua duração e da magnitude da pressão intra-abdominal, que acarreta diminuição do fluxo sanguíneo renal, habitualmente expresso como oligúria reversível. Além disso, como outros tipos de cirurgia, a CBVL deflagra resposta inflamatória aguda. A NGAL (lipocalina associada à gelatinase dos neutrófilos) é um marcador precoce, específico e sensível de função renal, assim como um marcador da resposta inflamatória. Os anestésicos gerais, tanto o propofol quanto o sevoflurano, exercem proteção aos rins e atenuam a resposta inflamatória aguda decorrente do trauma cirúrgico. O objetivo deste estudo foi comparar a variação dos níveis séricos da NGAL e sua associação com critérios de lesão renal aguda (LRA) RIFLE no perioperatório de CBVL comparando a anestesia geral venosa total (TIVA) com propofol e a anestesia inalatória com sevoflurano (SEVO). 64 pacientes submetidos à CBVL foram randomizados para dois grupos de anestesia, TIVA e SEVO, 32 pacientes por grupo. Amostras sanguíneas para dosagem de creatinina e NGAL foram colhidas em três momentos: M0, antes da indução anestésica; M1, 6 horas após pneumoperitônio; e M2, 24 horas após o pneumoperitônio. A diurese foi mensurada por 24 horas e critério RIFLE estratificado por período. Diferenças entre as medidas foram comparadas por testes não paramétricos. Não encontramos incidência de lesão renal aguda (LRA) pelo critério RIFLE em nenhum dos grupos; diferenças na incidência de classificação de risco pelo critério RIFLE nos dois grupos; diferença estatisticamente significante nas medidas perioperatórias de NGAL sérica entre os dois tipos de anestesia em nenhum dos... / Videolaparoscopic bariatric surgery (VLBS) is the gold standard for surgical treatment of obesity. However, pneumoperitoneum may pose risks to the kidneys due to a decrease in renal blood flow usually expressed as reversible oliguria. Furthermore, as other types of surgery, VLBS triggers acute inflammatory response. Lipocalin-2 (NGAL) is an early, specific and sensitive biomarker of acute renal injury, as well as a marker of inflammatory response. General anesthetics, both propofol and sevoflurane, exert protection to the kidneys and attenuate the acute inflammatory response from surgical trauma. The objective was to compare the effects of two types of general anesthesia, total intravenous anesthesia (TIVA) versus inhalation anesthesia with sevoflurane (SEVO), on the variation of serum NGAL in the perioperative period of VLBS and its association with RIFLE criteria of acute kidney injury at the same period. Sixty-four patients scheduled for CBVL were randomized for two groups of anesthesia, TIVA or SEVO. Blood samples for creatinine and serum NGAL were collected in three moments (M0 – before anesthesia, M1 - 6 hours after pneumoperitoneum and M2 - 24 hours after pneumoperitoneum) and urine output was measured for 24hours in the post-operative period for RIFLE criteria inclusion. The RIFLE criteria was used to evaluate acute kidney injury (AKI) after 6 an 24 hours of pneumoperitoneum. Differences between groups were compared with non-parametric tests. There was no incidence of AKI by RIFLE Criteria in either group. There were no significant differences in serum NGAL during the perioperative period in both groups. There was no difference in RIFLE criteria classification in either group. Conclusion: We did not... (Complete abstract click electronic access below)

Bakgrund: Sjukligt feta människor upplever ofta ohälsa eller minskad livskvalité i form av fysiska komplikationer, stigmatisering och diskriminering. En metod att hjälpa sjukligt feta personer att gå ner i vikt är obesitaskirurgi. Majoriteten av människorna som väljer obesitaskirurgi är kvinnor. Detta tros bero på att kvinnor blir mer stigmatiserade än män och att de blir psykiskt påverkade vid relativt lågt BMI. Syfte: Syftet med studien var att belysa kvinnliga patienters upplevelser efter obesitaskirurgi. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på elva vetenskapliga artiklar. Resultat: Kvinnorna upplevde att tiden efter operationen förändrade deras liv, vilket upplevdes som både positivt och negativt. Upplevelsen att få en andra chans i livet och upplevelsen av att få en förändrad relation till mat var vanligt förekommande känslor. Slutsats: Operationen hjälper kvinnorna att äta mindre genom den förminskade magsäcken, men ingreppet botar inte de psykosociala problem som de eventuellt har innan operationen. Sjuksköterskor har en viktig uppgift i att stödja och vägleda dessa kvinnor. / Background: Obese people often experience illness and low quality of life which can be expressed in physical complications, stigma and discrimination. Obesity surgery is a method to help obese people to lose weight. The majority of people who chose obesity surgery are women. Women are thought to be more effected mentally by their obesity in lower BMI than men. Aim: The aim of this study was to describe the experiences of female patients after obesity surgery. Method: The study was constructed as a general literature review based on eleven scientific articles. Results: The patients experienced that the time after surgery had changed their lives. The experience was both positive and negative. The experience of getting a second chance in life and the experience of changed relationship to food was common feelings. Conclusion: The surgery helps women to eat smaller portions because of the diminished stomach, but doesn’t cure the underlying psychosocial problems they might have before surgery. Nurses have an important task in supporting and guiding these women.

A case study was conducted to examine the discourse of two groups of participants learning about bariatric surgery: those who used a computer software patient education program and those who used more traditional patient-education materials. Participants were interviewed, given a multiple-choice questionnaire, and given a modified Cloze test over the content. The analysis of the interview discourse showed that participants who used the software application were able to recall and produce answers with more details, examples, and specific information than those who used other materials to learn about their surgery. The implications of these findings could indicate that the multimodal nature of the patient education software program may have been able to help mediate the complex medical information. / Access to thesis permanently restricted to Ball State community only. / Department of English