Orientador: Maria Rita Marques de Oliveira / Coorientador: Carlos Ducatti / Banca: Rozangela Verlengia / Banca: Thabata Koester Weber / Banca: Karina Pfrimer / Banca: Ellen Cristini de Freitas / Resumo: Objetivo: verificar a influência do bypass gástrico em Y-de-Roux (BGYR) nas mudanças de composição corporal, gasto energético total (GET) e na acurácia das equações preditivas de GET, nos momentos pré e 6 e 12 meses após a cirurgia bariátrica. Métodos: Participaram da pesquisa 20 mulheres (IMC: 40 e 50 kg/m2; idade de 20 a 45 anos). As variáveis do estudo foram coletada nos momentos pré, 6 e 12 meses pós-cirurgia. O GET, massa livre de gordura (MLG) e massa gorda (MG) foram mensurados pela técnica da água duplamente marcada. O nível de atividade física (NAF) e o gasto de energia em atividade física (GEAF) foram obtidos por meio acelerômetro. O consumo energético foi obtido por três registros alimentares. Foram selecionadas as seguintes equações preditivas de gasto energético: Harris e Benedict (1819), World Health Organization (WHO-1985), Mifflin-St Jeor et al (1990), De Lorenzo et al (2001), por Müller et al (2004), Henry (Oxford - 2005), Dietary Reference Intake (DRI - 2005) e Lazzer et al (2007). Resultados: A perda ponderal (6 meses: -31 ± 4kg; 12 meses: -38 ± 6kg) teve contribuição de 17% e 16% da perda de MLG nos momentos 6 e 12 meses, respectivamente. O valor da razão MLG/MG passou de 0,93 ± 0,12kg do momento pré-cirurgia para 1,54 ± 0,4kg e 1,98 ± 0,6kg nos momentos 6 e 12 meses pós-operatórios (p<0,05). O GET reduziu 20% (-612 ± 317 kcal.dia-1) aos 6 meses -10% (-447 ± 516 kcal.dia-1) aos 12 meses de cirurgia, em relação ao valor pré-cirúrgico (p<0.05). Quando corrig... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To verify the influence of Roux-en-Y gastric bypass (RYGP) on changes in body composition (BC), total energy expenditure (TEE) and in the accuracy of the predictive equations of TEE, at the moments before and six and twelve months after bariatric surgery. Methods: Twenty women (BMI: 40 and 50 kg/m 2 ; aged 20 to 45 years) participated in the study. The study variables were collected at pre, 6 and 12 months postoperatively. TEE, fat-free mass (FFM) and fat mass (FM) were measured by the doubly labeled water technique. The physical activity levels (PAL) and energy expenditure in physical activity (EEPA) were obtained through accelerometer. Energy intake (EI) was calculated using 3 days of dietary diaries. The following predictive energy expenditure equations were selected: Harris and Benedict (1819), World Health Organization (WHO-1985), Mifflin-St Jeor et al (1990), De Lorenzo et al (2001), Müller et al (2004), Henry (Oxford - 2005), Dietary Reference Intake (DRI - 2005), and Lazzer et al (2007). Results: The weight loss (6 months: -31 ± 4kg, 12 months: -38 ± 6kg) had a contribution of 17% and 16% of FFM loss at moments 6 and 12 months, respectively. The FFM/FM ratio increased from 0.93 ± 0.12kg from preoperative time to 1.54 ± 0.4kg and 1.98 ± 0.6kg at moments 6 and 12 postoperative months (p<0.05). The TEE reduced at 6 months 20% (-612 ± 317 kcal.dia-1 ) and -10% (-447 ± 516 kcal.dia-1 ) at 12months after surgery, in relation to the preoperative value (p <0.05). When corrected for lean mass, TEE/FFM showed no significant difference at the end of the first year. From the TEE data measured in relation to the predicted values by an equation developed for these patients, the adaptive thermogenesis was evidenced at 6 months... (Complete abstract click electronic access below) / Doutor

Orientador: Maria Rita Marques de Oliveira / Banca: Vera Mariza Henriques de Miranda Costa / Banca: Telma Maria Braga Costa / Resumo: Apesar de muito estudada, a obesidade continua um tema que requer ainda muitos estudos. Ao classificá-la entre os distúrbios psicossomáticos, abre-se um vasto campo de exploração no sentido de entendê-la como um problema de saúde pública fortemente influenciado pelo meio e pela forma com que o sujeito interage com seu ambiente. O objetivo do trabalho foi caracterizar, a partir de relatos sobre a alimentação, os hábitos de vida, a idade de início e a evolução da obesidade entre mulheres adultas da fila de espera para o tratamento cirúrgico da obesidade pelo Sistema Único de Saúde. Participaram do estudo 35 mulheres com idade média de 39,511,7, variando de 21 a 67 anos, e índice de massa corporal (IMC, em Kg/m2) entre 36,1 e 60,1 kg ∕ m2, recrutadas na Clínica Bariátrica de Piracicaba - SP. Para efeito de análise, as mulheres foram agrupadas segundo o período de início da obesidade: 0 ┤10 anos, 10 ┤20 anos, 20 ┤30 anos e >30 anos. O perfil das candidatas, em termos de massa corporal, tempo de espera na fila para a cirurgia bariátrica, informações pessoais, prevalência de comorbidezes, limitações físicas para execução de tarefas da vida diária, bem como as razões para a procura da cirurgia, foram obtidos a partir de um formulário. A história de vida relativa à alimentação, a atividades físicas e de lazer e a tratamentos realizados para perda ponderal foi levantada com auxílio de instrumento de avaliação cronológica dos eventos, "Linha do tempo", criado para esse fim. A estimativa e a avaliação da adequação do consumo alimentar atual foram realizadas a partir dos dados obtidos em três recordatórios de 24 horas (R24h). Quanto às experiências de vida, não foram percebidas diferenças marcantes entre as mulheres, quando confrontadas conforme o período de início da obesidade. O ambiente obesogênico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Even though obesity has been extensively studied, it is a theme that still requires extensive investigation. Once it became classified as a psychosomatic disorder, a broad field opened up for exploration, i.e., understanding that obesity is a public health problem that is strongly influenced by the environment and by the way individuals interact with the environment. This study used feeding reports to characterize the life habits, age of onset and progression of obesity in adult women recruited from the waiting list for surgical treatment of obesity of the Unified Health System. The participants included 35 women 39.511.7 mean of age, varying from 21 to 67 years, with a body mass index (BMI in kg/m2) of 36.1 to 60.1 kg/m2 seen at the Bariatric Clinic of Piracicaba, SP. Analysis was performed by grouping the women according to the age of onset of obesity: 0 ┤10 years, 10 ┤20 years, 20 ┤30 years and >30 years. A self-administered questionnaire was used to determine the profile of the participants in terms of body mass, time in the waiting list for bariatric surgery, personal information, prevalence of comorbidities, physical limitations that interfere with daily tasks and activities and reasons for seeking surgery. Their life story regarding feeding habits, physical and leisure activities and weight loss treatments was determined with an instrument that assesses the chronological order of events, "Time Line," created for this purpose. Data obtained from three 24-hour recalls (24HR) were used to estimate and verify the adequacy of actual food intake. Regarding life experiences, there were no marking differences among the women at the onset of obesity. Today's obesogenic environment, product of this new century, was the habitat of every one of those women from childhood, with its effects being manifested especially in adult life. These women sought surgical treatment in 2005... (Complete abstract click electronic access below) / Mestre

BACKGROUND AND AIMS: Obesity is associated with vascular endothelial dysfunction, which predisposes obese persons to cardiovascular disease. Fat loss in obese persons can lead to metabolic improvements that promote improved cardiovascular health and decrease risk of stroke or myocardial infarction. The objective of this study was to assess the potential of weight loss achieved by bariatric surgery to improve endothelial function. METHODS: Patients scheduled to undergo bariatric surgery were prospectively followed. Biochemical analyses and vascular function testing were performed preoperatively and again at 1, 3, 6, and 12 months postoperatively. FMD and NMD were measured to assess macrovascular endothelial function and ∆ hyperemic flow was measured to assess microvascular endothelial function. RESULTS: Patients (n = 375) ages 41.76 ± 12.35 years, with baseline BMI of 45.64 ± 8.36, experienced a weight reduction of 82.07 ± 33.98 lbs the year following surgery. FMD % increased by 1.28 ± 5.49, NMD % by 4.26 ± 6.23, and ∆ hyperemic flow % by 262.1 ± 519.97. All vascular function variables demonstrated a significant increase over time (p < 0.05) with ∆ hyperemic flow % experiencing the most significant change (p < 0.0001). No difference was found in improvement in vascular function between high (>13 µIU/ml) and low (≤13 µIU/ml) baseline plasma insulin groups (p values all > 0.05). CONCLUSIONS: Bariatric surgery was associated with an improvement in macrovascular and microvascular endothelial function. Further analyses is needed to determine which clinical parameters are optimal predictors of improvements in vascular endothelial function after bariatric surgery.

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

Submitted by JOANA SANTOS MONTALVÃO null (joana_mbj@hotmail.com) on 2018-08-09T17:28:07Z No. of bitstreams: 1 dissertação oficial eNVIAR.pdf: 1493305 bytes, checksum: 66f090ee5b1fa4de3165184ac6e1bff7 (MD5) / Approved for entry into archive by Minervina Teixeira Lopes null (vina_lopes@bauru.unesp.br) on 2018-08-09T20:20:25Z (GMT) No. of bitstreams: 1 montalvão_js_me_bauru.pdf: 1348149 bytes, checksum: 3ba8400d96ff8669298eb82346473103 (MD5) / Made available in DSpace on 2018-08-09T20:20:25Z (GMT). No. of bitstreams: 1 montalvão_js_me_bauru.pdf: 1348149 bytes, checksum: 3ba8400d96ff8669298eb82346473103 (MD5) Previous issue date: 2018-06-13 / A cirurgia bariátrica (CB) tem se tornado uma prática cada vez mais utilizada no tratamento da obesidade grau III, por auxiliar na redução do peso e eliminação ou diminuição das comorbidades. Por outro lado, pouco se sabe sobre seus efeitos com relação ao funcionamento biopsicossocial. A presente pesquisa consiste de um estudo prospectivo dos efeitos da redução de peso rápida (CB) ou lenta (dieta), nos aspectos emocionais, cognitivos, de autoeficácia e qualidade de vida, em pessoas com obesidade grau III avaliadas em dois momentos em um intervalo de três meses. Participaram do estudo 58 indivíduos com obesidade grau II e III, de ambos os sexos, com idade superior a 20 e inferior a 60 anos, avaliados quantos aos sintomas depressivos e ansiosos, funções executivas, autoeficácia geral, autoeficácia para regular hábitos alimentares e qualidade de vida. No estudo transversal a amostra total (n=58) foi dividida em dois grupos, GJ (Grupo Jovem) e GM (Grupo Maduro) para análise da influência da idade sobre as variáveis. No estudo prospectivo os pacientes participantes foram divididos em dois grupos CB (tratados por cirurgia bariátrica) e o NCB (tratados por dieta). O estudo transversal indicou que o GJ apresentou um melhor desempenho na memória operacional no subsistema visuoespacial quando comparado ao GM, não houve diferenças nos demais quesitos. O estudo prospectivo revelou que os pacientes do grupo CB apresentaram melhoras nos sintomas depressivos e de ansiedade, assim como apresentaram escores mais positivos com relação à avaliação da qualidade de vida e melhoras na memória operacional, assim como, na avaliação da autoeficácia quando comparados aos pacientes do grupo NCB. A melhora do grupo NCB foi restrita à autoeficácia para regular hábitos alimentares. Em conclusão a obesidade grau III parece contribuir para o prejuízo na memória operacional a partir dos 40 anos. A redução de peso rápida tende a reduzir os sintomas ansiosos e depressivos, bem como melhora a autoeficácia para regular hábitos alimentares, a percepção da qualidade de vida, e a memória operacional. O tratamento dietético parece ser responsável pela melhora na autoeficácia para regular hábitos alimentares em indivíduos que esperavam pela cirurgia bariátrica. / Bariatriac surgery (BS) has become an increasingly used procedure in the treatment of class III obesity, as this surgery helps to lose weight while eliminate or reduce comorbidities. On the other hand, little is known about its effects on an individual's biopsychosocial functioning. The present research contrasts fast weight loss (BS) and slow weight loss (diet) effects in emotional, cognitive, self-efficacy and life quality aspects in people with morbid obesity assessed in two moments over a three-month interval. Participants were 58 individuals from both genders, aged 20 to 60 years, with class II and III obesity assessed regarding depression and anxiety symptoms, executive functions, general self-efficacy, self-efficacy to regulate eating habits and quality of life. In the cross-sectional study, the sample was divided into two groups, YG (Young Group) and MG (Mature Group), for age analysis over the variables. In the prospective study, the patients were divided into two groups: BS (treated by bariatic surgery) and NBS (treated by diet). The cross-sectional study indicated that MG had better performance in working memory in the visuospatial subsystem when compared to MG – no differences were found in other inquiries. The prospective study revealed that BS patients had improvements in depression and anxiety symptoms, more positive scores regarding quality oflife, improvements in working memory and self-efficacy assessment when compared to NBS patients. Benefits in NBS group were restrict to self-efficacy to regulate eating habits. Thus, morbid obesity seems to contribute to harm in working memory of 40 year-old people and older. Fast weight loss reduces anxiety and depressive symptoms, as well as enhances self-efficacy to regulate eating habits, life quality perception and visuospatial memory. Dietetic treatment seems to be responsible for improvement in self-efficacy to regulate eating habits in individuals waiting to undergo bariatric surgery.

Introduction: There is proven therapeutic benefit in bariatric surgery for obese patients. Consequently the National Institute of Clinical Excellence UK has provided referral guidelines for bariatric surgery. Successful bariatric surgery will result in massive weight loss and ptotic skin, which can cause significant functional and psychological problems. As the number of cases of bariatric surgery increases, a corresponding number of massive weight loss patients will require plastic surgery. In this novel field of post massive weight loss surgery there is a lack of understanding of the demographics, physical symptoms and psychological health of this new group of patients. The tools to assess them are few and not validated, the patient pathway is disjointed and there is no consensus on standardised provision. Method: A prospective multicentre, observational study of outcomes in 100 patients undergoing bariatric and post massive weight loss plastic surgery at 2 clinical sites was performed. Each patient followed a standard operating protocol. This included undergoing a semi structured interview, completing five patient-report outcome measures, having anthropometric measurements and clinical photographs taken. Conclusion: This observational study identified key psychosocial themes prevalent in massive weight loss patients, during their weight loss journey. It identified there are no validated patient reported outcome measures available specific to this cohort of patients. This work led to the development of a new validated tool for massive weight loss body contouring.

Bakgrund: Sedan år 1945 har obesitas tredubblats globalt och år 2016 hade mer än 650 miljoner människor obesitas. Tillståndet resulterar i minst 2,8 miljoner människors död årligen och överstiger antalet dödsfall relaterat till undernäring. Det förekommer stigmatisering kring obesitas vilket påverkar de utsattas fysiska och psykiska hälsa negativt. Individer med obesitas upplever generellt en sämre livskvalitet. Obesitaskirurgi har blivit ett frekvent verktyg för att stävja obesitasepidemin. En beteendeförändring krävs efter obesitaskirurgi för en bestående viktnedgången. KASAM är centralt vid hälsa och huruvida en individ är kapabel att röra sig mot hälsa vid närvaro av stressorer. Syfte: Att beskriva patienters erfarenheter av livet efter obesitaskirurgi. Metod: En litteraturbaserad studie där datamaterialet bestod av tolv kvalitativa artiklar. Resultat: Ur analysen av datamaterialet framträdde tre huvudkategorier; från kaos till kontroll, ett förändrat tankesätt och ett förändrat liv och nio underkategorier. Konklusion: Livet efter obesitaskirurgi var komplext och det fanns skillnader i hur kapabla deltagare var att förändra sitt beteende. Sjuksköterskan behöver ha ett helhetsperspektiv och individanpassa stödet. / Background: Since 1945 obesity has tripled globally and exceeds more than 650 million people in 2016. It results in at least 2.8 million deaths annually and surpass the deaths followed by starvation. There is stigmatization around obesity which may adversely affect the physical and psychological health of the victims. Obese people generally experiences a poorer quality of life. Bariatric surgery has become an increasingly used tool to curb the ongoing obesity epidemic. A behavioural change is required after surgery in order for the weight loss to persist. A sense of coherence is central to health and whether an individual is capable of moving towards health in the presence of stressors. Aim: To describe patient’s experiences of life after bariatric surgery. Method: A literature based study where the data consisted of twelve qualitative articles. Results: From the analysis three categories emerged; from chaos to control, a changed mindset and a changed life and nine subcategories. Conclusion: Life after bariatric surgery was complex and there were differences in capability regarding changing ones behaviour. Nurses need to have a holistic perspective and individualise the support.

A prevalência mundial da obesidade tem aumentado dramaticamente nos últimos anos. Classificada como doença crônica, a obesidade está associada a uma série de doenças, como hipertensão arterial sistêmica, diabetes mellitus tipo 2 ehipercolesterolemia, aumentando a necessidade de uso de medicamentos. Esta situação contribui para a redução da qualidade e expectativa de vida dos indivíduos. A perda de peso significativa por pacientes com obesidade mórbida pode ser obtida através da realização da cirurgia bariátrica que pode exigir ajustes na farmacoterapia em função da redução das comorbidades e das alterações fisiológicas provocadas pela cirurgia. Objetivo: Analisar o impacto da cirurgia bariátrica sobre o perfil de utilização dos medicamentos, enfocando principalmente as classes terapêuticas, o número de medicamentos e doses administradas antes e após a cirurgia. Métodos: Foi realizado um estudo longitudinal do tipo antes e depois. Utilizando uma amostragem por conveniência foram entrevistados consecutivamente 69 pacientes no pré-cirúrgico imediato e seis meses após a realização do procedimento cirúrgico entre 2008 e 2011. Nas entrevistas foram avaliados a presença de comorbidades e o uso de medicamentos com e sem prescrição médica Resultados: Antes da cirurgia 85,5% dos pacientes apresentaram comorbidades associadas à obesidade, sendo as principais: hipertensão, diabetes e hipercolesterolemia. 84,1% dos pacientes estavam em uso de medicamento sob prescrição médica no período pré-cirúrgico e a média de medicamentos utilizados por paciente foi de 4,8. Após a realização da cirurgia, observamos uma diminuição acentuada para as classes dos antidiabéticos (84%), antilipêmicos (77%) e anti-hipertensivos (49,5%), e a média de medicamentos por paciente foi de 4,4. Por outro lado observou-se um aumento importante na utilização de multivitamínicos e medicamentos para desordens do trato gastrointestinal (TGI). A maioria dos medicamentos que continuaram sendo prescritos após a cirurgia teve sua dose reduzida. Conclusão: A cirurgia bariátrica propiciou a redução da dose e da utilização de medicamentos para a maioria das classes terapêuticas. No entanto, pode ser observado um aumento na utilização de medicamentos para tratar distúrbios associados à realização da cirurgia. / The worldwide prevalence of obesity has increased dramatically in the last years. Classified as a chronic disease, obesity is associated with a number of diseases, such as hypertension, type 2 diabetes mellitus and hypercholesterolemia, increasing the need for drug use. This situation reduces the quality and life expectancy of individuals. The significant weight loss for morbidly obese patients can be obtained by bariatric surgery that may require adjustments in pharmacotherapy due to the reduction of comorbidities and physiological changes caused by surgery. Objective: Analyze the impact of bariatric surgery on the drug use profile, mainly focusing on the therapeutic classes, the number of drugs and doses administered before and after surgery. Methods: We conducted a longitudinal study of type before and after. Using a convenience sampling were interviewed consecutively 69 patients before surgery immediately and six months after the surgical procedure between 2008 and 2011. In the interviews were evaluated the presence of comorbidities and the use of prescription and non-prescription Results: Before surgery 85.5% of patients had comorbidities associated with obesity, the main ones being: hypertension, diabetes and hypercholesterolemia. 84.1% of patients were on prescription drug use in the preoperative period and the average number of drugs used per patient was 4.8. After the surgery, we observed a marked decrease for the classes of antidiabetic (84%), antilipemic (77%) and antihypertensive (49.5%), and the average number of drugs used per patient was 4,4. Moreover we observed a significant increase in the use of multivitamin and medicaments for disorders of the gastrointestinal tract (GIT). Most drugs that continued to be prescribed after surgery was reduced dose. Conclusion: Bariatric surgery led to dose reduction and the use of medications for most therapeutic classes. However, an increase can be observed in the use of drugs to treat disorders associated with surgery.

Submitted by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-20T17:30:25Z No. of bitstreams: 1 COLOMBOPB.pdf: 1144664 bytes, checksum: aaf7cb46d0679a37c23283acb6936bf3 (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-20T17:31:05Z (GMT) No. of bitstreams: 1 COLOMBOPB.pdf: 1144664 bytes, checksum: aaf7cb46d0679a37c23283acb6936bf3 (MD5) / Made available in DSpace on 2017-01-20T17:31:05Z (GMT). No. of bitstreams: 1 COLOMBOPB.pdf: 1144664 bytes, checksum: aaf7cb46d0679a37c23283acb6936bf3 (MD5) Previous issue date: 2015-06 / The general objective of this research was to understand the meaning attributed to obesity and weight loss induced by bariatric surgery in families with more than one operated member. The specific objectives were: to investigate events that have contributed to the history of weight gain; to relate obesity to the family rituals and habits, besides identifying actions and motivations to choose bariatric surgery as an alternative treatment against obesity. The methodology was qualitative. The primary data were initially collected by applying an open interview guide with a trigger question allowing respondents to answer freely. In order to obtain additional information, it was used a survey with socio-demographic and disease data. For this study, it was used sociologic approaches and systems theory aiming to substantiate the analysis and understanding of the data. Relevant results confirm that the operation provides an opportunity to re-build the identity of the person. However, it was realized that the surgery does not provide an extensive change for the entire family, some of them temporarily reorganize themselves to welcome the operated limb but it was not observed changes of patterns, habits and rituals. Thus it is concluded that the change happens at the individual level and, by reflecting the trajectory of the subject "ex-obese" who chose gastroplasty to treat their disease, it is possible to progress in discussions, research and strategies that validate the subjective universe of these people as well as provide resources to become active subjects of own life / Esta pesquisa tem como objetivo geral i) investigar o significado atribuído a obesidade e emagrecimento induzido pela cirurgia bariátrica em famílias com mais de um membro operado e como específicos ii) avaliar eventos que contribuíram para o ganho de peso; iii) relacionar a obesidade a ritos e hábitos familiares e iv) compreender ações e motivações frente à escolha pela cirurgia bariátrica como alternativa de tratamento contra obesidade. A metodologia utilizada foi de natureza qualitativa. Os dados primários foram, inicialmente, coletados mediante aplicação de um roteiro de entrevista aberta com uma pergunta disparadora permitindo que os entrevistados respondessem de forma livre. Para a obtenção de dados complementares foi utilizado um roteiro com dados sociodemográficos e dados da doença. Foi feito uso de aportes sociológicos e da teoria sistêmica, com o intuito de fundamentar a análise e compreensão dos dados. Obtivemos como resultado relevante dados que sugerem que a cirurgia proporciona uma oportunidade para a re-construção identitária da pessoa, sem necessariamente proporcionar uma mudança extensiva para toda a família. Dados sugerem que algumas famílias se reorganizam temporariamente para acolher o membro operado, mas não mudam quanto aos padrões comportamentais, hábitos e rituais. Concluímos que a mudança acontece em nível individual e que, olhando para esse universo subjetivo do “ex-obeso”, podemos pensar em intervenções possíveis para, de forma mais efetiva, cuidarmos do sofrimento dessas pessoas e, assim, juntos desenvolvermos formas de controlar a doença. / Esta pesquisa tem como objetivo geral i) investigar o significado atribuído a obesidade e emagrecimento induzido pela cirurgia bariátrica em famílias com mais de um membro operado e como específicos ii) avaliar eventos que contribuíram para o ganho de peso; iii) relacionar a obesidade a ritos e hábitos familiares e iv) compreender ações e motivações frente à escolha pela cirurgia bariátrica como alternativa de tratamento contra obesidade. A metodologia utilizada foi de natureza qualitativa. Os dados primários foram, inicialmente, coletados mediante aplicação de um roteiro de entrevista aberta com uma pergunta disparadora permitindo que os entrevistados respondessem de forma livre. Para a obtenção de dados complementares foi utilizado um roteiro com dados sociodemográficos e dados da doença. Foi feito uso de aportes sociológicos e da teoria sistêmica, com o intuito de fundamentar a análise e compreensão dos dados. Obtivemos como resultado relevante dados que sugerem que a cirurgia proporciona uma oportunidade para a re-construção identitária da pessoa, sem necessariamente proporcionar uma mudança extensiva para toda a família. Dados sugerem que algumas famílias se reorganizam temporariamente para acolher o membro operado, mas não mudam quanto aos padrões comportamentais, hábitos e rituais. Concluímos que a mudança acontece em nível individual e que, olhando para esse universo subjetivo do “ex-obeso”, podemos pensar em intervenções possíveis para, de forma mais efetiva, cuidarmos do sofrimento dessas pessoas e, assim, juntos desenvolvermos formas de controlar a doença.

abstract: Obesity is a worldwide epidemic accompanied by multiple comorbidities. Bariatric surgery is currently the most efficient treatment for morbid obesity and its comorbidities. The etiology of obesity is unknown, although genetic, environmental, and most recently, microbiome elements have been recognized as contributors to this rising epidemic. The role of the gut microbiome in weight-loss or weight-gain warrants investigation, and bariatric surgery provides a good model to study influences of the microbiome on host metabolism. The underlying goals of my research were to analyze (i) the factors that change the microbiome after bariatric surgery, (ii) the effects of different types of bariatric surgeries on the gut microbiome and metabolism, (iii) the role of the microbiome on the success of bariatric surgery, and (iv) temporal and spatial changes of the microbiome after bariatric surgery. Roux-en-Y gastric bypass (RYGB) rearranges the gastrointestinal tract and reduces gastric acid secretions. Therefore, pH could be one of the factors that change microbiome after RYGB. Using mixed-cultures and co-cultures of species enriched after RYGB, I showed that as small as 0.5 units higher gut pH can aid in the survival of acid-sensitive microorganisms after RYGB and alter gut microbiome function towards the production of weight loss-associated metabolites. By comparing microbiome after two different bariatric surgeries, RYGB and laparoscopic adjustable gastric banding (LAGB), I revealed that gut microbiome structure and metabolism after RYGB are remarkably different than LAGB, and LAGB change microbiome minimally. Given the distinct RYGB alterations to the microbiome, I examined the contribution of the microbiome to weight loss. Analyses revealed that Fusobacterium might lessen the success of RYGB by producing putrescine, which may enhance weight-gain and could serve as biomarker for unsuccessful RYGB. Finally, I showed that RYGB alters the luminal and the mucosal microbiome. Changes in gut microbial metabolic products occur in the short-term and persist over the long-term. Overall, the work in this dissertation provides insight into how the gut microbiome structure and function is altered after bariatric surgery, and how these changes potentially affect the host metabolism. These findings will be helpful in subsequent development of microbiome-based therapeutics to treat obesity. / Dissertation/Thesis / Doctoral Dissertation Microbiology 2016