Adult overweight and obesity is a life-threatening health concern worldwide. Bariatric surgery is a successful treatment for severely obese individuals however, there is a moderate risk for weight regain. This study evaluated perception of food, supportive resistance resources, and nutrition knowledge, which play important roles in successful weight loss post bariatric surgery. Participants completed a three-part questionnaire at three time intervals: prior to surgery, 2 months post-surgery, and 5 months post-surgery. Results show that bariatric patients’ eating behavior significantly changes post bariatric surgery, but a disordered perception of food remains. Bariatric surgery patients believe support from significant others and family are most important and physical activity will help prevent weight regain. Results indicate that bariatric patients’ nutrition knowledge decreases over time and additional nutrition education may be needed within the first-year post-surgery. More research should be conducted in the area of bariatric surgery and how to prevent weight regain.

Submitted by Jailda Nascimento (jmnascimento@pucsp.br) on 2016-08-17T14:49:32Z No. of bitstreams: 1 Lis Marina Lopes Lazzarini.pdf: 1844463 bytes, checksum: 56588b9d80e6c2b7855f75ed7794b7d9 (MD5) / Made available in DSpace on 2016-08-17T14:49:32Z (GMT). No. of bitstreams: 1 Lis Marina Lopes Lazzarini.pdf: 1844463 bytes, checksum: 56588b9d80e6c2b7855f75ed7794b7d9 (MD5) Previous issue date: 2016-03-16 / Obesity is a chronical medical condition with multifactorial etiology whose treatment involves several approaches as nutritional intervention, medication and physical exercises. In some cases, on the other hand, with poor response to these treatments, more effective intervention might be necessary. Thus, bariatric surgery is often used as a efficient technique to support treatment success in some cases of obesity. In Brazil, seventy five percent of bariatric surgery use the gastric bypass known as Roux “Y” reduction gastroplasty – mix type, considering its safety and eficient performance. Even if most people lost significant amount of weight, preliminary researches suggest that considerer amount regained weight and returns to initial comobidities state. To Odom et al, behavior seems to play a modulatory factor for weight regain. Carvalho Junior, corroborates relating weight regain with “eating” in response to negative emotions and passive reactions when patients faces stress situations in daily life and propensy to use food as a humor moderator. Strenghtening patients knowleadge about their condiction after bariatric surgery, could support weight regain concepts, including its prevention. Psycology lights observes emotional mechanisms involved on weight regain processes or not and belives these sufficient for people engagament. This research objetivate investigation of psycological parameters associated with weight regain, maintaining and creating sources to promote education of psycologist services users, developing psycoeducational group programm. A study of cross-sectional observational and qualitative and quantitative type was carried out . To collect psychological data interviews were used and the Brief Assessment Instrument Quality of the World Health Organization Life ( Who Quality of Life- Bref ; WHOQOL- Bref ) . As result on studied group, this research confirm psycologic and psycosocial connection between weight regain in some people after bariatric surgery and enhance specificities in this group comparing to group that weight regain not occur. Analysing speeches could improve fundamental issues exploitations from psycology professionals involved in monitor patients before and after the bariatric surgery / Sendo a obesidade uma condição médica crônica de etiologia multifatorial, o seu tratamento envolve várias abordagens, como nutrição, medicamentos e prática de exercícios. Mas em certos casos, quando não há uma boa resposta a esses tratamentos, faz-se necessária uma intervenção mais eficaz. Dessa forma, a cirurgia bariátrica vem sendo cada vez mais realizada, mostrando-se uma técnica de grande auxílio na condução clínica de alguns casos de obesidade. A técnica cirúrgica denominada by-pass gástrico ou gastroplastia redutora em Y de Roux do tipo mista é a mais praticada no Brasil e corresponde a setenta e cinco por cento das cirurgias realizadas, devido a sua segurança e, principalmente, sua eficácia. Apesar do fato da maioria das pessoas perdem uma quantidade significante de peso, estudos preliminares sugerem que grande quantidade de pacientes tem reganho de peso e retorno de comorbidades pós-cirurgia bariátrica. Odom et al informam que a influência do comportamento parece desempenhar um papel modulador no problema do reganho de peso25. Carvalho Junior afirma que o reganho de peso estaria condicionado ao “comer” diante de emoções negativas e à passividade como resposta a situações de estresse na vida cotidiana e relacionado à tendência para usar a comida como reguladora de humor36. Aprofundar o conhecimento dos pacientes submetidos e acompanhados após a bariátrica poderá subsidiar os conceitos sobre reganho de peso, incluindo sua possível prevenção. Do ponto de vista da Psicologia observa-se que mecanismos emocionais estão envolvidos no reganho ou não e acredita-se que esses seriam motivos suficientes para um envolvimento das pessoas que vivem esse processo. Objetivamos avaliar parâmetros psicológicos associados ao reganho e à manutenção de peso e criar material que favoreça a educação dos usuários do serviço através do desenvolvimento de um programa de grupo psicoeducativo. Foi realizado um estudo do tipo transversal, observacional e quali- quantitativo. Para a coleta de dados psicológicos foram utilizadas entrevistas e o Instrumento de Avaliação Breve da Qualidade de Vida da Organização Mundial de Saúde (Who Quality of Life- Bref; WHOQol- Breve). Confirmamos no grupo estudado a existência das associações psicológicas e psicossociais com o fato de algumas pessoas voltarem a ganhar peso após algum tempo da realização da cirurgia bariátrica e ainda, pudemos ressaltar particularidades desse grupo em relação ao grupo que não apresentou reganho de peso. Temáticas centrais obtidas nas análises de discurso poderão subsidiar assuntos de fundamental exploração dos profissionais psicólogos envolvidos no trabalho com pacientes antes e após a realização da cirurgia bariátrica

In the Czech republic, about 20% of women and 16% of men are obese. The key role in the etiology of obesity plays the imbalance between energy intake and expenditure, which is influenced by many factors, including leptin and adiponectin. Leptin is secreted mainly from adipocytes and it's levels increase with cell fat content and body fat percentage. Leptin itself is supposed to lead to weight loss, both by decreasing appetite and increasing energy expenditure. But high levels of leptin can be a signal of so called leptin resistance, a state in which leptin is losing it's effects. Adiponectin is secreted exclusively from adipose tissue. In obese people, lower levels of adiponectin were proven (i.e. adiponectin levels are in a negative correlation with body fat percentage). That's consistent with the fact that adiponectin is affecting a range of metabolic prosesses and thus improves insulin sensitivity and metabolic profile. For evaluation, we used a database of almost 750 subjects, that was build under the Nugenob study, conducted in 8 cities in 7 european countries. Al the participants were measured their anthropometric and biochemical parameters at the baseline and after 10 weeks of a standardized weight reduction program. The czech center retested the patient once again 1 year after the initial...

Obesity levels are increasing worldwide, and in the United Kingdom the prevalence of overweight and obesity is amongst the highest in the developed world. Obesity is associated with reduced physical function and health-related quality of life, as well as an increased risk of co-morbidities such as type 2 diabetes and hypertension. As a result of high levels of morbid obesity and a failure of conventional methods of weight loss, more people are resorting to invasive weight loss techniques such as bariatric surgery. Bariatric surgery combined with lifestyle modification is currently the most successful weight loss intervention for the treatment of obesity and its associated co-morbidities. However, weight regain is becoming more apparent, generally occurring between 12 and 24 months after surgery. Weight regain is generally attributed to the failure of individuals to adopt or maintain the necessary lifestyle changes. The most common factors leading to weight regain after bariatric surgery are insufficient exercise and returning to pre-operative eating behaviours. Increasing physical activity after surgery positively affects weight loss and physical function outcomes; therefore, adopting an active lifestyle is fundamental. This thesis combines three research studies which collectively provide evidence for understanding the importance of physical activity for optimising physical function and facilitating the prevention of weight regain. Study one is a systematic review and meta-analysis which assessed pre to post-operative changes in physical activity behaviour and physical function outcomes among obese adults receiving bariatric surgery. This demonstrates improvements in objective and self-reported activity and function by 12 months. Study two is an analysis of body mass, co-morbidity and physical function data from pre to post bariatric surgery. This retrospective NHS dataset analysis aimed to identify if and when weight regain occurs, the proportion of co-morbidity resolution, and physical function patterns in patients after bariatric surgery. Weight loss patterns indicate weight stability from 12 to 24 months and weight regain 24 months post-surgery. Study three is a randomised controlled trial, The MOTION Study, which examined the effect of a 12 week exercise intervention on physical function and body composition in patients 12-24 months post bariatric surgery. This trial also examined maintenance of effects at six months. Findings suggest that implementing exercise at the point of weight regain is effective, notably for improving physical function and body composition in this population. This thesis therefore contributes to advancing the understanding of the role of physical activity in enhancing long-term outcomes after bariatric surgery and to informing future post-operative bariatric care.

Background: Roux-en-y gastric bypass (RYGB) surgery produces significant weight loss, however a number of patients experience some and/or complete recidivism of weight years after surgery. Limited research has investigated why patients are experiencing weight regain after surgical interventions. Our objective was to identify appetite-related measures associated with weight regain after RYGB surgery. Methods: Using a cross-sectional design, 29 participants (49.6 ± 9.1 years of age; 29-62 months post-RYGB) were divided into three weight categories; (weight maintainers, n = 9; low weight regainers, n = 10; and high weight regainers, n = 10). Appetite, smell function, eating behaviours and food reward were measured in response to a standardized meal. Results: Weight regain increased significantly in association with time after surgery (rs = 0.768, p = 0.016). High regainers gained on average 8.6 kg/year, compared to low regainers and maintainers, 3.8 ± 0.9 kg/year and 0.9 ± 0.9 kg/year, respectively (p < 0.001). Dietary restraint (using the Three Factor Eating Questionnaire) was significantly higher in weight maintainers and low regainers compared to high regainers using clinical subscales (p < 0.05). Weight regain was associated with higher “liking” of high-fat sweet foods (measured with the Leeds Food Preference Questionnaire) among high weight regainers. Conclusion: Weight regain after RYGB may be associated with higher preferences for high-fat sweet foods, whereas, higher dietary restraint may be associated with lower wanting of high-fat sweet foods among weight maintainers. Findings provide insight into why some patients after RYGB regain weight, while others maintain their weight. Future research is needed to further explore the relationships between appetite-related factors and weight regain after RYGB employing a longitudinal study design.

Made available in DSpace on 2014-06-11T19:32:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-11Bitstream added on 2014-06-13T21:05:19Z : No. of bitstreams: 1 fogaca_kcp_dr_arafcf.pdf: 1112291 bytes, checksum: f3c51513471a3c93b2a06295152462f4 (MD5) / Unimep / A cirurgia bariátrica é apontada como um dos mais efetivos, se não o único recurso terapêutico para obesidade mórbida. Entretanto, a recuperação de peso vem sendo foco de atenção nesses pacientes, especialmente após um ou mais anos de cirurgia; sendo que seus efeitos, magnitude e causas necessitam ser estudados. Esta pesquisa teve como objetivo avaliar a relação de fatores ligados ao consumo e gasto energético com a variação do peso corporal de mulheres em pós-cirúrgico tardio de Derivação Gástrica em Y-de-Roux (DGYR). Foi realizado um estudo transversal do qual participaram 45 mulheres, com idades entre 26 e 61 anos, operadas por derivação gástrica em Y-de-Roux há mais de 24 meses, assistidas na Clínica Bariátrica do Hospital Fornecedores de Cana, Piracicaba – SP. Foi avaliado o consumo alimentar e o gasto energético com atividades físicas a partir do recordatório de 3 dias, a taxa de metabolismo em repouso (TMR) por calorimetria indireta e as concentrações séricas de glicose, insulina e leptina. Para efeito de análise, as mulheres foram agrupadas quanto à recuperação de peso corporal (NR = não recuperação; R = recuperação > 10% do menor peso após a cirurgia), ao índice de massa corporal (IMC) em Não Obesas (NO - IMC < 30 kg/m²) e Obesas (O - IMC > 30 kg/m²) e pela percentagem da Perda do Excesso de Peso (PPEP) Baixa (PPEP < 50%), Moderada (PPEP entre 50% e 75%) e Alta (PPEP > 75%). Para a comparação dos resultados entre os grupos foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguido do teste de Dunn. As correlações entre as variáveis foram testadas pelo coeficiente de Spearman. As análises foram realizadas considerando um nível de significância de 5%. Não foi encontrada relação dos indicadores de perda e manutenção de peso (recuperação de peso, IMC e PPEP) e o consumo de nutrientes. O perfil geral de consumo... / Bariatric surgery is pointed out as one of the most effective, if not the only therapeutic resource to treat morbid obesity. However, there has been growing attention to the weight regain seen in bariatric surgery patients, especially one or more years after surgery. The objective of this study was to assess the factors associated with energy consumption and expenditure and body weight variation in the late postoperative period of women who had undergone Roux-en-Y gastric bypass (RYGB). A cross-sectional study was done with 45 women aged 26 to 61 years who had undergone Roux-en-Y gastric bypass at least 24 months earlier, being treated at the Bariatric Clinic of the Hospital Fornecedores de Cana, Piracicaba, SP. The following were investigated: food intake and energy expenditure with physical activities (3-day recall), resting energy expenditure - REE (indirect calorimetry) and serum concentrations of glucose, insulin and leptin. The women were grouped according to the following for analysis: amount of weight regained (NR = no regain; R = regained >10% of the lowest weight achieved after surgery); body mass index (BMI) into non-obese (NO-BMI < 30kg/m2) and Obese (O – BMI > 30 kg/m2); and percentage of excess weight lost (PEWL) into Low (PEWL < 50%), Moderate (50% < PEWL < 75%) and High (PEWL > 75%). The results of the groups were compared with the Mann-Whitney and Kruskal-Wallis tests, followed by the Dunn test. The correlations between the variables were tested with the Spearman’s coefficient. The level of significance was set at 5%. There was no relationship between weight loss and maintenance indicators (weight regain, BMI and PEWL) and nutrient intake. The general food intake profile did not vary among the volunteers but there was a positive correlation between carbohydrate intake... (Complete abstract click electronic access below)

Orientador: Maria Rita Marques de Oliveira / Banca: Maria Rita Marques de Oliveira / Banca: Vânia Aparecida Leandro Merhi / Banca: Aureluce Demonte / Banca: Celso Vieira de Souza Leite / Banca: José Ernesto dos Santos / Resumo: A cirurgia bariátrica é apontada como um dos mais efetivos, se não o único recurso terapêutico para obesidade mórbida. Entretanto, a recuperação de peso vem sendo foco de atenção nesses pacientes, especialmente após um ou mais anos de cirurgia; sendo que seus efeitos, magnitude e causas necessitam ser estudados. Esta pesquisa teve como objetivo avaliar a relação de fatores ligados ao consumo e gasto energético com a variação do peso corporal de mulheres em pós-cirúrgico tardio de Derivação Gástrica em Y-de-Roux (DGYR). Foi realizado um estudo transversal do qual participaram 45 mulheres, com idades entre 26 e 61 anos, operadas por derivação gástrica em Y-de-Roux há mais de 24 meses, assistidas na Clínica Bariátrica do Hospital Fornecedores de Cana, Piracicaba - SP. Foi avaliado o consumo alimentar e o gasto energético com atividades físicas a partir do recordatório de 3 dias, a taxa de metabolismo em repouso (TMR) por calorimetria indireta e as concentrações séricas de glicose, insulina e leptina. Para efeito de análise, as mulheres foram agrupadas quanto à recuperação de peso corporal (NR = não recuperação; R = recuperação > 10% do menor peso após a cirurgia), ao índice de massa corporal (IMC) em Não Obesas (NO - IMC < 30 kg/m²) e Obesas (O - IMC > 30 kg/m²) e pela percentagem da Perda do Excesso de Peso (PPEP) Baixa (PPEP < 50%), Moderada (PPEP entre 50% e 75%) e Alta (PPEP > 75%). Para a comparação dos resultados entre os grupos foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguido do teste de Dunn. As correlações entre as variáveis foram testadas pelo coeficiente de Spearman. As análises foram realizadas considerando um nível de significância de 5%. Não foi encontrada relação dos indicadores de perda e manutenção de peso (recuperação de peso, IMC e PPEP) e o consumo de nutrientes. O perfil geral de consumo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bariatric surgery is pointed out as one of the most effective, if not the only therapeutic resource to treat morbid obesity. However, there has been growing attention to the weight regain seen in bariatric surgery patients, especially one or more years after surgery. The objective of this study was to assess the factors associated with energy consumption and expenditure and body weight variation in the late postoperative period of women who had undergone Roux-en-Y gastric bypass (RYGB). A cross-sectional study was done with 45 women aged 26 to 61 years who had undergone Roux-en-Y gastric bypass at least 24 months earlier, being treated at the Bariatric Clinic of the Hospital Fornecedores de Cana, Piracicaba, SP. The following were investigated: food intake and energy expenditure with physical activities (3-day recall), resting energy expenditure - REE (indirect calorimetry) and serum concentrations of glucose, insulin and leptin. The women were grouped according to the following for analysis: amount of weight regained (NR = no regain; R = regained >10% of the lowest weight achieved after surgery); body mass index (BMI) into non-obese (NO-BMI < 30kg/m2) and Obese (O - BMI > 30 kg/m2); and percentage of excess weight lost (PEWL) into Low (PEWL < 50%), Moderate (50% < PEWL < 75%) and High (PEWL > 75%). The results of the groups were compared with the Mann-Whitney and Kruskal-Wallis tests, followed by the Dunn test. The correlations between the variables were tested with the Spearman's coefficient. The level of significance was set at 5%. There was no relationship between weight loss and maintenance indicators (weight regain, BMI and PEWL) and nutrient intake. The general food intake profile did not vary among the volunteers but there was a positive correlation between carbohydrate intake... (Complete abstract click electronic access below) / Doutor

Introdução: a cirurgia bariátrica destaca-se como o método mais eficaz no tratamento da obesidade em longo prazo, acarretando remissão significativa das enfermidades associadas ao excesso de peso. Ocorre que os resultados da cirurgia nem sempre são duradouros. Estima-se que 20% a 30% das pessoas que são submetidas ao procedimento bariátrico irão apresentar reganho de peso passados os dois primeiros anos. Objetivo: compreender a experiência de reganho de peso para as pessoas que foram submetidas à cirurgia bariátrica. Método: pesquisa qualitativa de abordagem fenomenológica, realizada em um hospital público de São Paulo. A Amostra foi composta de 17 participantes que apresentaram reganho de peso após a cirurgia bariátrica. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: Como é para você se perceber ganhando peso novamente? O que você acredita que esteja contribuindo para o seu ganho de peso? Como você lida com o reganho de peso? Como você se vê daqui a alguns anos em relação ao seu peso corporal? A organização e a análise dos depoimentos foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. Resultados: o típico da ação vivida pela pessoa que apresenta recidiva de peso após a cirurgia bariátrica mostrou-se como aquela que: atribui o reganho de peso à instabilidade emocional, que a leva a dificuldades no controle do comportamento alimentar; afirma que o estresse, a ansiedade e a solidão contribuem para o reganho de peso; associa a recidiva de peso a alterações anatômicas relacionadas à cirurgia; expressa sentimentos como derrota, culpa e tristeza; refere consequências físicas, psíquicas e sociais advindas da recuperação de peso, medo de engordar demais e ficar sem saída; relata consumo excessivo de álcool; tem como expectativa controlar o peso com vistas a impactar positivamente sua qualidade de vida, para tanto, necessita suporte multidisciplinar para as questões físicas e emocionais envolvidas no reganho de peso; almeja se submeter a uma nova cirurgia bariátrica e a cirurgia plástica para melhorar a autoestima. Conclusões: os achados ilustram o quanto o fenômeno reganho de peso é complexo em seus aspectos biopsicoemocionais e necessita uma escuta individualizada e qualificada, acolhendo as questões subjetivas vividas por aqueles que foram submetidos à cirurgia bariátrica e estão passando pela situação de recuperação de peso. Acredita-se que a discussão proporcionada por esta investigação reforce a necessidade de as equipes de saúde investirem nos encontros com o paciente bariátrico, pautados na relação intersubjetiva que respeite e considere o outro, compartilhando decisões e contribuindo para que os pacientes se tornem ativos na produção de sua saúde e corresponsáveis pelo êxito no alcance e manutenção do peso desejado. / Introduction: bariatric surgery stands out as the most effective method in the long-term treatment of obesity, leading to significant remission of diseases associated with overweight. However, the results of the surgery are not always long lasting. It is estimated that 20% to 30% of the people who undergo the bariatric surgery will regain weight after the first two years. Aim: to understand the experience of weight regain to people who were subjected to bariatric surgery. Method: qualitative research with a phenomenological approach, conducted in a public hospital of Sao Paulo. The sample was composed of 17 participants who presented weight regain after bariatric surgery. To collect the data, an open interview was used with the following guiding questions: How is it to you, to notice yourself gaining weight again? What do you believe is contributing to your weight gain? How do you deal with the weight regain? How do you see yourself in a few years, in relation to your body weight? The organization and analysis of the interviews were conducted following the steps recommended by scholars of the social phenomenology of Alfred Schütz. Results: the typical action experienced by people with weight regain after bariatric surgery showed up as one that: assigns the weight regain to an emotional instability that leads them to difficulties in the control of eating behaviour; states that stress, anxiety and loneliness contributes to weight regain; associates the recurrence of overweight to anatomical changes related to the surgery; expresses feelings of defeat, guilt and sadness; points out physical and mental consequences arising from the weight regain; fears gaining too much weight and losing control; report excessive alcohol consumption; has the expectation of controlling the weight gain in order to positively impact the quality of life, thus, requires multidisciplinary support for issues regarding weight regain; intend to undergo another bariatric surgery and a plastic surgery to improve self-esteem. Conclusions: the findings illustrate how the phenomenon of weight regain is complex in its bio-psycho-emotional aspects and requires an individualized and qualified attention, welcoming of the subjective issues experienced by those who were submitted to a bariatric surgery and are going through a situation of weight regain. It is believed that the discussion on this research reinforces the need of the healthcare teams to invest on a follow-up of bariatric patients, based on an intersubjective relationship that respects and considers the other, sharing decisions and contributing to the patients becoming active in the production of their health and partners in the success of reaching and maintaining their desired weight.

Introdução: a cirurgia bariátrica destaca-se como o método mais eficaz no tratamento da obesidade em longo prazo, acarretando remissão significativa das enfermidades associadas ao excesso de peso. Ocorre que os resultados da cirurgia nem sempre são duradouros. Estima-se que 20% a 30% das pessoas que são submetidas ao procedimento bariátrico irão apresentar reganho de peso passados os dois primeiros anos. Objetivo: compreender a experiência de reganho de peso para as pessoas que foram submetidas à cirurgia bariátrica. Método: pesquisa qualitativa de abordagem fenomenológica, realizada em um hospital público de São Paulo. A Amostra foi composta de 17 participantes que apresentaram reganho de peso após a cirurgia bariátrica. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: Como é para você se perceber ganhando peso novamente? O que você acredita que esteja contribuindo para o seu ganho de peso? Como você lida com o reganho de peso? Como você se vê daqui a alguns anos em relação ao seu peso corporal? A organização e a análise dos depoimentos foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. Resultados: o típico da ação vivida pela pessoa que apresenta recidiva de peso após a cirurgia bariátrica mostrou-se como aquela que: atribui o reganho de peso à instabilidade emocional, que a leva a dificuldades no controle do comportamento alimentar; afirma que o estresse, a ansiedade e a solidão contribuem para o reganho de peso; associa a recidiva de peso a alterações anatômicas relacionadas à cirurgia; expressa sentimentos como derrota, culpa e tristeza; refere consequências físicas, psíquicas e sociais advindas da recuperação de peso, medo de engordar demais e ficar sem saída; relata consumo excessivo de álcool; tem como expectativa controlar o peso com vistas a impactar positivamente sua qualidade de vida, para tanto, necessita suporte multidisciplinar para as questões físicas e emocionais envolvidas no reganho de peso; almeja se submeter a uma nova cirurgia bariátrica e a cirurgia plástica para melhorar a autoestima. Conclusões: os achados ilustram o quanto o fenômeno reganho de peso é complexo em seus aspectos biopsicoemocionais e necessita uma escuta individualizada e qualificada, acolhendo as questões subjetivas vividas por aqueles que foram submetidos à cirurgia bariátrica e estão passando pela situação de recuperação de peso. Acredita-se que a discussão proporcionada por esta investigação reforce a necessidade de as equipes de saúde investirem nos encontros com o paciente bariátrico, pautados na relação intersubjetiva que respeite e considere o outro, compartilhando decisões e contribuindo para que os pacientes se tornem ativos na produção de sua saúde e corresponsáveis pelo êxito no alcance e manutenção do peso desejado. / Introduction: bariatric surgery stands out as the most effective method in the long-term treatment of obesity, leading to significant remission of diseases associated with overweight. However, the results of the surgery are not always long lasting. It is estimated that 20% to 30% of the people who undergo the bariatric surgery will regain weight after the first two years. Aim: to understand the experience of weight regain to people who were subjected to bariatric surgery. Method: qualitative research with a phenomenological approach, conducted in a public hospital of Sao Paulo. The sample was composed of 17 participants who presented weight regain after bariatric surgery. To collect the data, an open interview was used with the following guiding questions: How is it to you, to notice yourself gaining weight again? What do you believe is contributing to your weight gain? How do you deal with the weight regain? How do you see yourself in a few years, in relation to your body weight? The organization and analysis of the interviews were conducted following the steps recommended by scholars of the social phenomenology of Alfred Schütz. Results: the typical action experienced by people with weight regain after bariatric surgery showed up as one that: assigns the weight regain to an emotional instability that leads them to difficulties in the control of eating behaviour; states that stress, anxiety and loneliness contributes to weight regain; associates the recurrence of overweight to anatomical changes related to the surgery; expresses feelings of defeat, guilt and sadness; points out physical and mental consequences arising from the weight regain; fears gaining too much weight and losing control; report excessive alcohol consumption; has the expectation of controlling the weight gain in order to positively impact the quality of life, thus, requires multidisciplinary support for issues regarding weight regain; intend to undergo another bariatric surgery and a plastic surgery to improve self-esteem. Conclusions: the findings illustrate how the phenomenon of weight regain is complex in its bio-psycho-emotional aspects and requires an individualized and qualified attention, welcoming of the subjective issues experienced by those who were submitted to a bariatric surgery and are going through a situation of weight regain. It is believed that the discussion on this research reinforces the need of the healthcare teams to invest on a follow-up of bariatric patients, based on an intersubjective relationship that respects and considers the other, sharing decisions and contributing to the patients becoming active in the production of their health and partners in the success of reaching and maintaining their desired weight.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-02-15T12:32:08Z No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) / Made available in DSpace on 2017-02-15T12:32:08Z (GMT). No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) Previous issue date: 2016-12-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Morbid obesity, a chronic and multifactorial disease, causes metabolic disorders and increases the risk of morbidity. Its prevalence has been increasing, with alarming data in Brazil and elsewhere. Globally, Brazil ranks second in number of bariatric surgeries, but surgical treatment is a challenge for the patients and the teams that provide care for these patients. Given the above, the present study aimed to assess changes in nutritional status and identify nutritional deficiencies before and 10 years after Roux-en-Y gastric bypass. This retrospective study lasted two years and included 166 patients submitted to Roux-en-Y gastric bypass at a private clinic. The statistical analyses included the chi-square, Fisher?s, Mann-Whitney, and Wilcoxon tests, analysis of variance (ANOVA), and generalized estimating equations. The significance level was set at 5%. At the ten-year follow-up, the percentage of excess weight loss (%EWL), body mass index (BMI), and weight regain were 51.64?18.03 (p<0.0001), 32.53?4.83 kg/m2 (p<0.0001), and 41% (p<0.0001), respectively, and the lipid and blood glucose profiles had improved (p<0.0001). Iron-deficiency anemia was found in 37.5% and 45.0% of the patients who attended the 10-year follow-up based on ferritin levels <15 ug/L and <30 ug/L, respectively. The effect of time was significant for hemoglobin, ferritin, iron overload (p<0.0001), and hematocrit (p=0.0007). Vitamin D deficiency was found in 29 patients (82.86%), and high parathormone (PTH), in 13 (41.94%). The effect of time was significant for PTH (p=0.0059). In conclusion, gastric bypass was a surgical success and improved the metabolic profile. Weight regain increased over time. The nutritional outcomes were iron-deficiency anemia and vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of multidisciplinary care and monitoring of nutritional deficiencies for the treatment of morbid obesity. / A obesidade m?rbida considerada uma doen?a cr?nica e multifatorial, que ocasiona desordens metab?licas e aumenta o risco de morbidade, vem crescendo, com dados alarmantes no Brasil e no Mundo. O Brasil ? o segundo Pa?s que mais realiza cirurgia bari?trica, sendo o tratamento cir?rgico, um desafio para os pacientes e para as equipes envolvidas no cuidado destes pacientes. Diante do exposto, o presente trabalho teve como objetivo avaliar a evolu??o do estado nutricional e identificar as defici?ncias nutricionais no pr? e no p?s-operat?rio de pacientes submetidos ao bypass g?strico em Y-de-Roux, com 10 anos de seguimento. O estudo realizado em dois anos, com delineamento retrospectivo longitudinal, envolveu 166 pacientes submetidos ao bypass g?strico em Y-de-Roux, em uma cl?nica privada. Na an?lise estat?stica, utilizou-se os testes Qui-Quadrado, Fisher, Mann-Whitney, Anova, Wilcoxon e Equa??es de Estimativas Generalizadas. O n?vel de signific?ncia adotado foi de 5%. Os resultados deste estudo, ap?s 10 anos de seguimento, demostraram percentual de perda do excesso de peso (%PEP) de 51,64?18,03 (p<0,0001); Indice de Massa Corporal (IMC) de 32,53?4,83 kg/m2 (p<0,0001); reganho de peso de 41% (p<0,0001). O perfil lip?dico e glic?mico diminuiu ao longo de 10 anos de seguimento (p<0,0001). Dos pacientes que permaneceram no estudo at? o final de 120 meses, 37,5% e 45,0%, apresentaram diagn?stico de anemia ferropriva, considerando-se os crit?rios utilizados de ferritina <15 ug/L e ferritina <30 ug/L, respectivamente. O efeito do tempo foi significativo para a hemoglobina, ferritina e sobrecarga de ferro, (p<0,0001) e hemat?crito (p=0,0007). Em rela??o ao metabolismo do c?lcio, 82,86% (29), apresentaram n?veis de defici?ncia de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Em conclus?o, pacientes submetidos ao bypass g?strico, apresentaram sucesso cir?rgico e melhora do perfil metab?lico. O reganho de peso aumentou com o tempo de seguimento. A anemia ferropriva e a defici?ncia de vitamina D, associada ao hiperparatireoidismo secund?rio, foram desfechos nutricionais encontrados Tais achados reafirmam a import?ncia do cuidado multidisciplinar e ? aten??o ?s defici?ncias nutricionais para o tratamento da obesidade m?rbida.