Bei der Identifikation von Risikofaktoren für die Entstehung und Aufrechterhaltung von Adipositas wurde in den letzten Jahren zunehmend der Forschungsfokus auf die Persönlichkeitsaspekte des Individuums gerückt. Insbesondere das Zusammenspiel von Impulsivität, defizitärer Emotionsregulation und Reaktivität für Nahrungsreize im Sinne von nahrungsspezifischen Aufmerksamkeitsverzerrungen wurde mit unkontrolliertem Essverhalten in Zusammenhang gebracht, das langfristig zu Gewichtszunahme, Adipositas und Misserfolgen in der Gewichtsreduktionsbehandlung führt. Die Adipositaschirurgie (AC) stellt derzeit die effektivste Behandlung bei schwerer Adipositas dar. Dennoch gibt es Patient*innen, die langfristig einen unzureichenden Behandlungserfolg bezüglich Gewichtsverlust und Reduktion von physischen und psychischen Komorbiditäten nach AC aufweisen. Ziel der vorliegenden Dissertation war es, Patient*innen erstmalig vor und nach AC bezüglich ihrer Impulsivität, Emotionsregulation und nahrungsspezifischen Reaktivität zu subtypisieren und zu prüfen, ob bestimmte Persönlichkeitsprofile mit einer erhöhten allgemeinen und essstörungsspezifischen Psychopathologie assoziiert sind und einen prädiktiven Wert für mittelfristig erfasste gewichts- und gesundheitsbezogene Erfolgsparameter der AC haben. Die jetzigen Studienergebnisse stützen die Annahme, dass insbesondere postoperativ vorhandene Impulsivität und Emotionsdysregulation beim Individuum mittelfristig pathologisches Essverhalten begünstigen, das mit unzureichenden Gesundheits-Outcomes nach AC assoziiert ist. Hingegen konnten Aufmerksamkeitsverzerrungen für visuelle Nahrungsreize nicht in Verbindung mit dem 1-Jahres-Outcome der AC gebracht werden. Vielmehr scheinen Menschen mit schwerer Adipositas und Gewichtsreduktionswunsch visuelle Nahrungsreize in kontrollierten Aufmerksamkeitsprozessen bewusst zu vermeiden.

Research documented the effectiveness of obesity surgery (OS) for long-term weight loss and improvements in medical and psychosocial sequelae, and general cognitive functioning. However, there is only preliminary evidence for changes in attentional processing of food cues after OS. This study longitudinally investigated visual attention towards food cues from pre- to 1-year post-surgery. Using eye tracking (ET) and a Visual Search Task (VST), attentional processing of food versus non-food cues was assessed in n = 32 patients with OS and n = 31 matched controls without weight-loss treatment at baseline and 1-year follow-up. Associations with experimentally assessed impulsivity and eating disorder psychopathology and the predictive value of changes in visual attention towards food cues for weight loss and eating behaviors were determined. During ET, both groups showed significant gaze duration biases to non-food cues without differences and changes over time. No attentional biases over group and time were found by the VST. Correlations between attentional data and clinical variables were sparse and not robust over time. Changes in visual attention did not predict weight loss and eating disorder psychopathology after OS. The present study provides support for a top-down regulation of visual attention to non-food cues in individuals with severe obesity. No changes in attentional processing of food cues were detected 1-year post-surgery. Further studies are needed with comparable methodology and longer follow-ups to clarify the role of biased visual attention towards food cues for long-term weight outcomes and eating behaviors after OS.

Background: There are treatments available to manage overweight and obesity (O&O). Intragastric balloons (IGB) are one option; they fill the stomach, increasing the sensation of satiety, limiting the amount of food to be ingested, and thus leading to weight loss. However, data suggest that patients regain weight long-term after an IGB treatment. As IGB is a relatively recent procedure for O&O, there is limited information about patient care practices alongside treatment, and whether could explain success or failure to maintain weight loss long-term.  Objective: The aim of the study was to explore clinical dietitians’ perspectives on patient care practices alongside IGB procedures. Method: Six semi-structured qualitative interviews were recorded, transcribed, and explored using qualitative content analysis method, which resulted in three categories. Results: The results showed that the clinical dietitians had many practices in place to condition patients before treatment. Screening the patient, balloon role information, and setting realistic expectations were considered essential practices. The involvement of a multi-disciplinary team was viewed as a critical factor to ensure engagement and follow-up with patients. The findings showed a high level of variability of frequency and contact during treatment and after balloon removal. Developing patients’ self-efficacy through practices like motivational coaching, dietary education, and behavioural therapy were also common practices.  Conclusion: Although similar practice patterns were identified, the findings highlighted a high level of variability in practices between respondents’ workplaces. This study was a first attempt to explore dietitians’ perceptions on patient care practices in relation to IGB-treatments, and it is too early to determine whether differences in practices have any impact on long-term weight loss maintenance. These could be the focus of new studies. / Bakgrund: Olika behandlingar är tillgängliga för att hantera övervikt och fetma. Intragastriska ballonger (IGB) är ett alternativ; de fyller magen, ökar mättnadskänslan, begränsar mängden av mat som kan intas och leder därmed till viktminskning. Data tyder dock på att patienter långsiktigt går upp i vikt långsiktigt efter IGB-behandling. Eftersom IGB behandlingar är en relativt ny procedur för övervikt och fetma, finns det bara begränsad information om patientvårdsprocesser som används i samband med behandlingen, och om skillnader i dessa skulle kunna förklara framgång eller misslyckande med att upprätthålla viktminskning långsiktigt. Syfte: Syftet med studien var att utforska dietisters perspektiv på patientvårdsprocesser och stödmetoder i samband med IGB-behandlingar. Metod: Sex semi-strukturerade kvalitativa intervjuer spelades in, transkriberades och analyserades enligt kvalitativ innehållsanalysmetoden, vilket resulterade i tre kategorier. Resultat: Resultaten visade att dietister använde många processer/metoder för att förbereda patienten innan behandling. Patientundersökning, ballongsinformation och att sätta realistiska förväntningar ansågs vara väsentliga metoder. Engagemang av ett multidisciplinärt team sågs som en kritisk faktor för att säkerställa engagemang och uppföljning med patienten. Resultaten visade en stor variation av frekvens och kontakt från vårdpersonalen under och efter IGB-behandling. Att utveckla patientens förmåga att ta eget ansvar med metoder som motiverande samtal, kostundervisning och beteendeterapi var också vanliga. Slutsats: Även om liknande processer/metoder identifierades, resultaten visade en stor variation i praktiken mellan respondenternas arbetsplatser. Studien var ett första försök att undersöka dietisters uppfattningar om patientvårdsprocesser i samband med IGB-behandling, och det är för tidigt att avgöra om skillnader i metoderna har någon inverkan på patienternas viktminskning underhåll långsiktigt. Dessa kan vara i fokus för nya studier.

As obesity is a systemic and epidemic disease that affects pulmonary function, it became a new challenge for health professionals who care for respiratory diseases. With the aim of evaluating the aspects of pre-and postoperative obese adults patients undergoing bariatric surgery was determined the prevalence and severity of asthma, the lung age and place of stay in postoperative primary bariatric surgery, being checked medical-surgical complications that would justify admission to the intensive care unit and mortality. Cross-sectional studies were performed in the period from January 2007 to June 2010, in the city of Aracaju (SE). The prevalence of asthma in patients was determined by a pulmonologist using clinical diagnosis as a diagnostic tool, and evaluated 363 obese adults who underwent clinical evaluation and use of spirometry, and classified according to the severity of asthma. The lung age determined by spirometry involved 112 individuals: 78 morbidly obese patients (study group) and 34 non-obese and normal lung function (control group). The lung age and chronological age of individuals in each group were compared separately and between groups. Aldrete and Kroulik score was used for the release of post-anesthetic recovery room (PARR) and defining the location of postoperative routing in 120 patients who underwent primary bariatric surgery. The prevalence of asthma in obese adults, according to the criteria used were: studied obese population: 18.5% (95%:14,5-22,4), women: 20.4% (95% CI: 16,2 to 24.5), male: 13.7% (95%:10,1-17,2), asthma symptoms in the last twelve months 8.0% (95% CI:5,2-10,7) and initial manifestation of symptoms of asthma in childhood / adolescence in 17.4% (95%:13,5-21,3). Among asthmatics, 29 patients (43.3%) had intermittent asthma, 7 patients (10.4%) mild persistent asthma, 25 patients (37.3%) moderate asthma and 6 patients (9%) severe persistent asthma. The difference between lung age and chronological age in the group with morbid obesity was significant (p <0.0001, 95% CI 6.6 to 11.9 years) with an average difference of 9.1 ± 11.8 years. The age difference between the lung study group and control group was significant (p <0.0002, 95% CI 7.5 to 16.9 years) with an average difference of 12.2 ± 2.4 years. The multiple linear regression analysis identified the variables BMI and chronological age (p <0.0001) as significant predictors factors of lung age. The time between hospital admission and beginning of surgery was 140.7 ± 81.8 minutes, the operative time 105.0 ± 28.6 minutes, the length of stay in PARR 125.0 ± 38.0 minutes and hospitalization time 47.7 ± 12.4 hours, with 100% of patients walking in 24 hours. The Aldrete Kroulik table of PARR achieved scores of 10 with 120 minutes in all patients, with 100% survival. The prevalence of asthma in obese adults in the preoperative evaluation of bariatric surgery using the primary medical diagnosis was high, with prevalence of initial manifestation of symptoms of asthma in childhood / adolescence and in females. The severity of asthma in obese adults was among the estimated averages for the general population. The lung age is increased in morbidly obese patients, suggesting early damage and accelerated lung aging. By using the Aldrete and Kroulik table in the PARR of gastric bypass by laparoscopy in primary bariatric surgery, no patient was admitted to the ICU and no major complication was observed. / A obesidade por ser uma doença sistêmica e epidêmica que compromete a função pulmonar, tornou-se um novo desafio para os profissionais de saúde que cuidam de doenças respiratórias. Com o objetivo de avaliar os aspectos do período pré e pós-operatório dos pacientes adultos obesos submetidos à cirurgia bariátrica foi determinada a prevalência e gravidade de asma brônquica, a idade pulmonar e o local de internação no pós-operatório de cirurgia bariátrica primária, sendo verificadas as complicações clínica-cirúrgicas que justificassem internação em unidade de terapia intensiva e mortalidade. Foram realizados estudos transversais, no período entre janeiro de 2007 a junho 2010, no município de Aracaju (SE). A prevalência de asma nos pacientes foi determinada por um pneumologista utilizando o diagnóstico clínico como instrumento diagnóstico, sendo avaliados 363 pacientes obesos adultos, que foram submetidos à avaliação clínica e realização de espirometria, e classificados conforme a gravidade da asma. A idade pulmonar determinada pela espirometria envolveu 112 indivíduos: 78 pacientes com obesidade mórbida (grupo de estudo) e 34 indivíduos não obesos e com função pulmonar normal (grupo controle). A idade pulmonar e a idade cronológica dos indivíduos em cada grupo foram comparadas isoladamente e entre os grupos. Utilizou-se o índice de Aldrete e Kroulik para liberação da sala de recuperação pós-anestésica (SRPA) e definição do local de encaminhamento no pós-operatório de 120 pacientes submetidos à cirurgia bariátrica primária. A prevalência de asma em obesos adultos, conforme os critérios utilizados foram: população de obesos estudada: 18,5 % (IC95%:14,5-22,4), mulheres: 20,4% (IC95%:16,2 24,5), homens: 13,7% (IC95%:10,1 17,2), sintomas de asma nos últimos doze meses 8,0% (IC95%:5,2 10,7) e manifestação inicial dos sintomas de asma na infância/adolescência em 17,4% (IC95%:13,5 21,3). Dentre os asmáticos, 29 pacientes (43,3%) apresentaram asma intermitente, 7 pacientes (10,4%) asma persistente leve, 25 pacientes (37,3%) asma moderada e 6 pacientes (9%) asma persistente grave. A diferença entre idade pulmonar e idade cronológica no grupo com obesidade mórbida foi significativa (p < 0,0001; IC95%: 6,6-11,9 anos), com uma diferença média de 9,1 ± 11,8 anos. A diferença da idade pulmonar entre o grupo de estudo e grupo controle foi significativa (p < 0,0002; IC95%: 7,5-16,9 anos), com uma diferença média de 12,2 ± 2,4 anos. A análise de regressão linear múltipla identificou as variáveis IMC e idade cronológica (p < 0,0001) como fatores preditivos significativos da idade pulmonar. O tempo entre admissão hospitalar e início da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirúrgico 105,0 ± 28,6 minutos, o tempo de permanência na SRPA 125,0 ± 38,0 minutos e tempo de internação hospitalar 47,7 ± 12,4 horas, com 100% dos pacientes deambulando em 24 horas. O índice de Aldrete e Kroulik da SRPA alcançou pontuação de 10 com 120 minutos em todos os pacientes, com sobrevida de 100%. A prevalência de asma em adultos obesos em avaliação pré-operatória de cirurgia bariátrica utilizando o critério diagnóstico médico mostrou-se elevada, com predomínio da manifestação inicial dos sintomas de asma na infância/adolescência e no sexo feminino. A gravidade da asma em obesos adultos esteve entre os valores médios estimados para a população em geral. A idade pulmonar está aumentada em pacientes com obesidade mórbida, sugerindo dano precoce e envelhecimento pulmonar acelerado. Com o uso do índice Aldrete e Kroulik na SRPA de bypass gástrico por videolaparoscopia em cirurgia bariátrica primária, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicação maior foi observada.

A doença hepática gordurosa não-alcoólica (DHGNA) e a esteatohepatite (EHNA) são freqüentes nos obesos. O objetivo foi determinar a prevalência de DHGNA/EHNA e Síndrome Metabólica (SM) nos grandes obesos; definir preditores de EHNA; estabelecer critérios histológicos para o diagnóstico da EHNA. Avaliados 325 pacientes encaminhados à cirurgia bariátrica (IMC = 35 kg/m2), dos quais 146 foram submetidos à análise histológica; as variáveis clínicas e bioquímicas analisadas e correlacionadas com a histologia. A DHGNA ocorreu em 111 (76%) pacientes e a prevalência de EHNA, conforme critério histológico usado, em 25,3% a 55,5%; SM ocorreu em 57,2%. Os preditores da EHNA foram: SM; alterações glicêmicas; hipertrigliceridemia e HAS. Foram preditores de fibrose: idade acima de 30 anos e AST elevada / Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has been associated with obesity. Determine prevalence of NAFLD/NASH and metabolic syndrome (MS) in severe obesity; define clinical predictor of steatohepatitis; establish histological criteria necessary to diagnose NASH. Evaluation of 325 patients submitted to bariatric surgery (BMI = 35 kg/m2), among which 146 were submitted to histological analysis; variables clinical and biochemical were analyzed and correlated to histological characteristics. NAFLD occurred in 111 (76%) patients and NASH, according to histological criteria used, in 25.3% to 55.5%; MS was present in 57.2%. Predictors of NASH: MS; glycaemic alterations; hypertriglyceridaemia and high blood pressure (HBP). Predictors of fibrosis: age above 30 years and high AST

A doença hepática gordurosa não-alcoólica (DHGNA) e a esteatohepatite (EHNA) são freqüentes nos obesos. O objetivo foi determinar a prevalência de DHGNA/EHNA e Síndrome Metabólica (SM) nos grandes obesos; definir preditores de EHNA; estabelecer critérios histológicos para o diagnóstico da EHNA. Avaliados 325 pacientes encaminhados à cirurgia bariátrica (IMC = 35 kg/m2), dos quais 146 foram submetidos à análise histológica; as variáveis clínicas e bioquímicas analisadas e correlacionadas com a histologia. A DHGNA ocorreu em 111 (76%) pacientes e a prevalência de EHNA, conforme critério histológico usado, em 25,3% a 55,5%; SM ocorreu em 57,2%. Os preditores da EHNA foram: SM; alterações glicêmicas; hipertrigliceridemia e HAS. Foram preditores de fibrose: idade acima de 30 anos e AST elevada / Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has been associated with obesity. Determine prevalence of NAFLD/NASH and metabolic syndrome (MS) in severe obesity; define clinical predictor of steatohepatitis; establish histological criteria necessary to diagnose NASH. Evaluation of 325 patients submitted to bariatric surgery (BMI = 35 kg/m2), among which 146 were submitted to histological analysis; variables clinical and biochemical were analyzed and correlated to histological characteristics. NAFLD occurred in 111 (76%) patients and NASH, according to histological criteria used, in 25.3% to 55.5%; MS was present in 57.2%. Predictors of NASH: MS; glycaemic alterations; hypertriglyceridaemia and high blood pressure (HBP). Predictors of fibrosis: age above 30 years and high AST

Made available in DSpace on 2017-06-01T18:09:02Z (GMT). No. of bitstreams: 1 Bibiana Poggi_confrontado.pdf: 581539 bytes, checksum: 0cc3101a9830767f7a227685df53c266 (MD5) Previous issue date: 2007-04-09 / Obesity is considered nowadays a pathology that affects a growing number of people, reason for which it s called the millennium disease. It mobilizes the attention of public healthy services, which invest continuously in research to control it. The bariatric surgery presents as an efficient method to control obesity through the intervention of a multi-professional team, composed by a surgeon, a psychologist, a nutritionist and a nurse, that take care of the patient during the pre-chirurgical phase and, afterwards, during the post-chirurgical one. The aim of our research was to investigate the movement of the oral compulsion in women that were submitted to the bariatric surgery. We searched the subjective aspects that always appear in the losing weight process in which it s necessary a change in the ways of the oral satisfaction. We observed, therefore, the effects of the physical intervention in a compulsional body. In so doing, we restricted our analysis among the women for the reason that, in the Hospital da Polícia Militar de Pernambuco, place where the study was conducted, it was them that claimed more for the surgery and also because the women presented more difficulties after the surgery than the men. It s a research that focuses on the interaction between the theory and the clinics, which referential is the psychoanalytic one. Henceforth, we described the cases of three patients accompanied by the researcher before and after the surgery. Afterwards, we analyzed all the material collected. In all the cases it was verified that the physical intervention, although necessary to the patients weight control, was not sufficient to promote changes in the compulsional body. We concluded proving the importance of the psychotherapeutic process, which enabled the changes in the compulsional body of each patient. / A obesidade apresenta-se como uma patologia que acomete um número crescente de pessoas, recebendo a denominação de doença do milênio. Mobiliza a atenção de programas de saúde pública, que investem continuamente em pesquisas procurando debelá-la. A cirurgia bariátrica apresenta-se como um eficiente método de controle da obesidade, implicando a atuação de uma equipe multiprofissional, composta por cirurgião, psicólogo, nutricionista e enfermeiro, que acompanha o paciente na fase pré-operatória e, igualmente, após a cirurgia. O objetivo da nossa pesquisa consistiu em investigar o movimento da pulsão oral em mulheres que se submeteram à cirurgia bariátrica. Buscamos contemplar os aspectos subjetivos implicados no processo de emagrecimento quando se faz necessária modificação na forma de satisfação oral, pesquisando assim o efeito de uma intervenção física no corpo pulsional. Para tanto, delimitamos nosso estudo nas mulheres uma vez que, no Hospital da Polícia Militar de Pernambuco, local onde realizamos a pesquisa, foram elas que demandaram em maior número à cirurgia e, da mesma forma, apresentaram mais dificuldades durante o período pós-cirúrgico. Trata-se de uma pesquisa que articula a teoria com a clínica, cujo referencial é o psicanalítico, na qual apresentaremos os relatos de três pacientes acompanhadas pela pesquisadora antes e após a cirurgia, para em seguida expormos a análise do material colhido. Nos casos acompanhados tornou-se evidente que a intervenção física, embora necessária ao controle de peso das pacientes, não foi suficiente para promover modificações no corpo pulsional. Foi possível constatarmos a importância do processo psicoterápico para que tais alterações possam ocorrer no corpo pulsional de cada paciente.

This study aimed at exploring the impact of early traumatic experiences on bariatric patients with the intent to give "voice" to their experiences. The impact of morbid obesity and the lack of quality of life among those suffering from this form of chronic illness can be devastating. Meaningful support systems and bariatric surgery are therefore considered as forced behavioural interventions to remediate the impact of childhood trauma and subsequent development of morbid obesity among this group of bariatric patients. Through a process of social constructivism and dialogue between the researcher and the five participants, the co-construction according to themes was supported by a qualitative research approach and the case study method. For the analysis of the themes according to the participants' "voices", the thematic content analysis method was used to analyse the data and was finally linked to supportive literature. It is hoped that the results from this study will contribute to the development of a unique assessment and support programme to those who have to endure the burden of morbid obesity associated with early childhood trauma; and that the process prior to and post bariatric surgery will be an important contribution to finding quality of life and giving new meaning to patients after suffering through their bodies and traumatised minds. / Psychology / D.Litt. et. Phil (Psychology)

INTRODUÇÃO: A secreção do hormônio de crescimento (GH) está diminuída em obesos. Existem controvérsias se esta diminuição é conseqüência ou um dos fatores causais da obesidade. Perda de peso leva a alguma recuperação da secreção de GH. Não há estudos publicados sobre o efeito da derivação gástrica (gastrojejunal) com anastomose em Y-de-Roux (BPG) sobre o perfil de secreção de 24 h de GH. Por outro lado, a ghrelina é um peptídeo secretagogo de GH produzido no estômago, orexigênico, lipogênico e adipogênico, cujos níveis oscilam ao longo do dia e estão diminuídos na obesidade. As variações circadianas de ghrelina têm papel no controle da homeostase energética e secreção de GH. O nível de ghrelina eleva-se com perda de peso induzida por dieta, mas os dados são controversos sobre mudanças desses níveis após cirurgias bariátricas. Este estudo tem por objetivo caracterizar os perfis de secreção de GH e ghrelina em mulheres com obesidade grau III antes e após BPG e suas correlações com variáveis metabólicas. MÉTODOS: Coletas de sangue a cada 20 minutos por 24 horas foram realizadas em obesas mórbidas não diabéticas na pré-menopausa antes e seis meses após BPG. O procedimento foi realizado em balanço calórico neutro por quatro dias. Foram dosados glicose e insulina; GH em todas as amostras e ghrelina às 08:00h, 10:00h, 12:00h, 19:00h e 02:00h. A taxa metabólica de repouso (TMR) foi avaliada por calorimetria indireta e as massas adiposa (MA) e magra (MM) foram medidas por DEXA. RESULTADOS: Houve uma redução de 27% do peso corporal e IMC (de 55,9 ± 6,2 kg/m2 para 40,7 ± 5,8 kg/m2, p<0,001) com elevação de vários parâmetros de secreção de GH (GH basal, GH médio, p<0,05; área, amplitude e número de picos, p<0,001); redução de glicemia (p = 0,03), insulinemia de jejum (p = 0,005) e HOMA (p = 0,004). Não houve diferença nos níveis de ghrelina basal, pós-prandial e médio. O GH médio apresentou correlação negativa com as mudanças no peso (p = 0,003; r = -0,631), IMC (p <0,001; r = -0,731), MA (p = 0,003; r = -0,635), MM (p = 0,02; r = -0,507), circunferência abdominal (p = 0,01; r = -0,555), TMR (p = 0,01; p = -0,539), insulina de jejum (p = 0,014, r = -0,538) e HOMA (p = 0,01; r = -0,560), mas não com a glicemia de jejum (p = 0,13; r = -0,354) e a ghrelina (p = 0,6; r = 0,118). O melhor determinante da secreção de GH foi o IMC sendo responsável por 54% da variação do GH médio (r2 = 0,54). CONCLUSÕES: Há uma recuperação parcial da secreção de GH, reduzida no pré-operatório em obesas mórbidas, após perda de peso induzida seis meses após a cirurgia, indicando que a secreção reduzida não é um fator primário ou causal da obesidade, mas sim uma conseqüência da obesidade e essa recuperação é independente do perfil de secreção de ghrelina / INTRODUCTION: Growth hormone (GH) concentration is decreased in obesity. It is not clear if reduced GH secretion is consequence or cause of the obese state. GH secretion is partially restored by weight loss. There are no published studies about the effect of Roux-en-Y gastric bypass (RYGBP) on GH secretory profile. Ghrelin is a GH releasing peptide produced by stomach, with orexigenic, lipogenic and adipogenic actions. Ghrelin levels oscillate throughout the day and are low in obesity. Circadian changes in ghrelin levels have a role both in energy homeostasis control and GH secretion. Ghrelin levels rise after diet-induced weight loss, but results are controverse in relation to changes in ghrelin levels after bariatric surgeries. In this study, we analyzed GH and ghrelin concentrations in morbidly obese women before and after RYGBP and its relationships with metabolic parameters. METHODS: Blood was sampled at 20-minute intervals during 24 hours in non diabetic pre-menopausal morbid obese women before and six months after RYGBP. The study was done after four days in neutral caloric balance. Fasting glucose and insulin were determined in basal samples. GH concentrations were measured in all samples and ghrelin in serum collected at 08:00h, 10:00h, 12:00h, 19:00h e 02:00h. Resting metabolic rate (RMR) was evaluated by indirect calorimetry and fat mass (FM) and free-fat mass (FFM) were measured by DEXA. RESULTS: A 27% drop in body weight and BMI (55.9 ± 6.2 kg/m2 to 40.7 ± 5.8 kg/m2, p<0.001), augmentation of spontaneous GH secretory episodes (basal and mean levels, p <0.05; area, amplitude and peak frequency, p <0.001); and reduction of fasting glucose (p = 0.03), insulinemia (p = 0.005) and HOMA (p = 0.004) were observed. Neither basal, post-prandial or mean ghrelin were changed. A negative correlation was found between mean GH levels and weight changes (p = 0.003, r = -0.631), BMI (p <0.001, r = -0.731), FM (p = 0.003, r = -0.635), FFM (p = 0.02, r = -0.507), waist (p = 0.01, r = -0.555), RMR (p = 0.01, p = -0.539), fasting insulin (p = 0.014, r = -0.538), as well as HOMA (p = 0.01, r = -0.560), but not between mean GH levels and glucose (p = 0.13, r = -0.354) or ghrelin (p = 0.6, r = 0.118). BMI accounted for 54% of the mean GH variation (r2 = 0.54). CONCLUSIONS: There is a partial recovery of GH secretion after weight loss induced by RYGBP, suggesting that a blunted secretion is not a primary or causal factor of obesity, but a consequence of the obese state. This recovery is independent of ghrelin secretory profile

This study aimed at exploring the impact of early traumatic experiences on bariatric patients with the intent to give "voice" to their experiences. The impact of morbid obesity and the lack of quality of life among those suffering from this form of chronic illness can be devastating. Meaningful support systems and bariatric surgery are therefore considered as forced behavioural interventions to remediate the impact of childhood trauma and subsequent development of morbid obesity among this group of bariatric patients. Through a process of social constructivism and dialogue between the researcher and the five participants, the co-construction according to themes was supported by a qualitative research approach and the case study method. For the analysis of the themes according to the participants' "voices", the thematic content analysis method was used to analyse the data and was finally linked to supportive literature. It is hoped that the results from this study will contribute to the development of a unique assessment and support programme to those who have to endure the burden of morbid obesity associated with early childhood trauma; and that the process prior to and post bariatric surgery will be an important contribution to finding quality of life and giving new meaning to patients after suffering through their bodies and traumatised minds. / Psychology / D.Litt. et. Phil (Psychology)