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.

Course: Degree Project in Supply Chain Management, the Business Administration and Economics Programme, 4FE19E Authors: Matilda Engblom and Katarina Nyberg Supervisor: Arash Kordestani Examiner: Helena Forslund Title: Following the Recipe Brings Franchisees to the Table - A Case Study Consolidating Purchasing and Calculating Cost Savings at Franchisees Background: As a franchisor, Company X does not have insight or control in purchasing at their franchisees. Spend analysis is a tool used to identify current purchased volumes and costs. An aim with spend analysis is to decrease the cost and analyse the spend. There are four different types of consolidation that can consolidate the current purchased volumes and create purchasing cost savings. They are article, volume, supplier and transport consolidation. However, identifying the current situation can be hard in the franchise concept and therefore hard to create purchasing cost savings. It is therefore of need for the franchisor to have insight and control over their franchisees in purchasing. Purpose: The purpose of this study is mainly to identify how the current purchased volumes can be consolidated to create purchasing cost savings for the franchisees of Company X in the Middle East. In addition, calculate the purchasing cost savings that consolidation could lead to. As well as, investigate how a franchisor can regain insight and control in purchasing over their franchisees. Methodology: This case study had a mixed research strategy of explanatory sequential design. Empirical data was collected by both unstructured, semi-structured and structured interviews. The analytical methodology was based on pattern matching. Confidentiality has been of great focus during the study for ethical considerations. Conclusion: The current purchased volumes and costs were identified, enabling different types of consolidation and calculations for purchasing costs. The consolidation model (Figure 28, p. 43) illustrates four different types of consolidation, article, volume, supplier and transportation, which should be followed. Lastly, Table 38 (p. 85) presents actions for regaining insight and control over franchisees.

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

With the growing interest in low-permeability gas plays, foam fracturing fluids are now well established as a viable alternative to traditional fracturing fluids. Present practices in energized fracturing treatments remain nonetheless rudimentary in comparison to other fracturing fluid technologies because of our limited understanding of multi-phase fluid-loss and phase behavior occurring in these complex fluids. This report assesses the fluid-loss benefits introduced by energizing the fracturing fluid. A new laboratory apparatus has been specifically designed and built for measuring the leak-off rates for both gas and liquid phases under dynamic fluid-loss conditions. This report provides experimental leak-off results for linear guar gels and for N2-guar foam-based fracturing fluids under a wide range of fracturing conditions. In particular, the effects of the rock permeability, the foam quality, and the pressure drop are investigated. Analysis of dynamic leak-off data provide an understanding of the complex mechanisms of viscous invasion and filter-cake formation occurring at the pore-scale. This study presents data supporting the superior fluid-loss behavior of foams, which exhibit minor liquid invasion and limited damage. It also shows direct measurements of the ability of the gas component to leak-off into the invaded zone, thereby increasing the gas saturation around the fracture and enhancing the gas productivity during flowback. Our conclusions not only confirm, but add to the findings of McGowen and Vitthal (1996) for linear gels, and the findings of Harris (1985) for nitrogen foams. / text

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...

The dominant theme in Regain is that of death leading to rebirth. This dissertation attempts to explore Giono's narrative techniques within this context. No single chapter will be devoted to a specific technique; instead, the various devices used by the author are discussed as they emerge from the structure of the chapters. Justifying the field of study as defined in the "Introduction", the following three chapters outline the passage of life from death to eventual rebirth. With acknowledgement to Frank Kermode, who writes: "A concord of past, present and future three dreams which, as Augustine said, cross in our minds, as in the present of things past, the present of things present, and the present of things future" ¹, the first three chapters bear his terminology for their headings. Chapter One, "The Present of Things Past", deals with Mameche's loss of her husband and son. Chapter Two, "The Present of Things Present", focuses upon Mameche' s realization of Gaubert's departure, and the decision that she must do something to save the dying village of Aubignane. Chapter Three, "The Present of Things Future", sees Mameche setting out in search of a wife for Panturle, and succeeding. This brings to an end Part One of the novel. Interwoven throughout the chapters are paradigms from Greek mythology, rich in universal symbolism, and the author's belief in man's ability to fuse himself with his surroundings. The conclusion summarizes the findings of this study, attempting to show how an analysis of Giono's narrative technique provides an insight into such a novel as Regain. ¹The Sense of an Ending (London: Oxford University Press, 1966), rpt., 1970, p. 50.

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