Bariatric Surgery

Background: Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. Methods: A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. Results: Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m(2)). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%) as recommended. PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 (P ≤ 0.044). Most of the patients adhered to the recommended supplementation at all time points (≥57.1%). Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid, iron, hemoglobin, and vitamins D and B12 (P ≤ 0.056 for all). Adherence to all recommendations was not significantly associated with excess weight loss ≥60% at M12 (P ≥ 0.195 for all). Conclusion: Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG; however, adherence to those recommendations was not related to better weight loss at short-term follow-up. Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively.

A obesidade tem sido considerada uma das doenças mais sérias e de mais rápida disseminação em países desenvolvidos . Um terço da população adulta nos Estados Unidos está obesa , e no Brasil, onde até recentemente esta condição não era considerada epidêmica, 17,5% da população adulta já é obesa e cerca de 50 % está acima do peso, segundo o Ministério da Saúde. De forma geral o tratamento da obesidade mórbida costuma ser frustrante e atualmente a cirurgia bariátrica é considerada o único tratamento efetivo e duradouro para estes casos.
Uma quantidade substancial de transtornos psiquiátricos ou perfis psicológicos anormais acomete os candidatos à cirurgia bariátrica, aumentando o risco de desfechos pós-operatórios desfavoráveis, que variam desde a perda de peso abaixo da esperada ou o reganho precoce de peso, até a piora da condição psiquiátrica ou psicológica de base.
Embora avaliações psiquiátricas e psicológicas já façam parte da rotina da maioria dos serviços de cirurgia bariátrica, elas se concentram mais na verificação da capacidade do paciente tomar uma decisão responsável e compreender/seguir as orientações médicas (o “laudo tradicional”) do que nas múltiplas interações entre psicopatologia e a evolução do tratamento cirúrgico da obesidade, um terreno no qual há pouco ou nenhum consenso entre os especialistas. Da mesma forma, os critérios psiquiátricos para a contraindicação do tratamento cirúrgico para a obesidade costumam incluir casos graves de alcoolismo ou uso de drogas ilícitas, sintomas ativos de esquizofrenia e retardo mental severo, mas as condutas envolvendo a grande maioria dos candidatos à cirurgia com alguma comorbidade psiquiátrica, que abrange portadores de transtornos do humor, transtornos ansiosos, transtornos do comportamento alimentar e história de ideação e/ou tentativa de suicídio, para citar apenas alguns, são muito variáveis. 
O presente texto tem por objetivo revisar e discutir as relações entre psicopatologia e tratamento cirúrgico da obesidade e se concentra em questões como até que ponto variáveis psicológicas e psiquiátricas influenciam a perda ou o reganho de peso após a cirurgia bariátrica, quais as chances da cirurgia bariátrica piorar ou melhorar condições psiquiátricas pré-existentes ou deflagrar sintomas psiquiátricos em quem nunca os teve e quais seriam as contraindicações psiquiátricas relativas e absolutas para a cirurgia bariátrica.

Background The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectivness and surrounding circumstances of the various types of obesity surgery. Methods A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. Recommendations After the patient’s multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

To examine available behavioral, pharmacological, and surgical weight management interventions for overweight (defined as BMI > 85th to 94th percentile of age and sex-specific norms) and/or obese (BMI > 95th percentile) children and adolescents in clinical and nonclinical community settings. We identified two good quality recent systematic reviews that addressed our research questions. We searched Ovid MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Education Resources Information Center from 2005 (2003 for pharmacological studies) to December 11, 2007, to identify literature that was published after the search dates of prior relevant systematic reviews; we also examined reference lists of five other good-quality systematic reviews and of included trials, and considered experts' recommendations. We identified two good quality systematic reviews and 2,355 abstrac...

The Canadian Thoracic Society (CTS) published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006⁄2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the reco...

A obesidade é um sério problema de saúde pública. Um terço da população adulta nos Estados Unidos sofre com ela, e no Brasil, onde até recentemente esta condição não era considerada epidêmica, 17,5% da população adulta é obesa e cerca de 50 % está acima do peso, segundo o Ministério da Saúde . Múltiplas influências obesogênicas estão por trás da epidemia de obesidade dos grandes centros urbanos e alguns fatores tornam esta condição clínica um desafio para os profissionais envolvidos na sua compreensão e tratamento. Entre elas temos, em um nível fisiológico, a complexidade dos mecanismos centrais e periféricos de controle do comportamento alimentar e do gasto energético e, em um nível comportamental, as diferenças individuais na susceptibilidade às oportunidades ambientais para comer. Este capítulo tem por objetivo discutir os circuitos neuro-humorais associados à alimentação hedônica e homeostática, suas relações, e as razões por trás de suas disfunções levando a ganho de peso, particularmente as alterações inflamatórias associadas à obesidade.

ÖZ Obezite; çağımızın görülme sıklığı hızla artmakta olan kronik ve kompleks bir hastalığıdır. Obezitenin kanser, metabolik sendrom, tip 2 diyabet gibi bazı hastalıkların yanında kardiyovasküler, renal ve muskuloskeletal sistem bozukluklarının, psikolojik rahatsızlıkların ve diğer birçok işlevsel bozukluğun artışında etkisinin olduğu günümüz literatürünce kabul edilmiştir. Obezitenin tedavisinde düzenli fiziksel aktivite eşliğinde sağlıklı diyet uygulamalarının veya medikal tedavilerin sonuç vermediği durumlarda; donanımlı merkezlerde deneyimli ekipler tarafından bariatrik cerrahi uygulamaları gerçekleştirilmektedir. Sürecin başarılı geçmesi hastaya en uygun bariatrik cerrahi uygulamasına karar verilmesi ve süreç boyunca sürekli beslenme ve metabolik takip ile mümkündür. Her bir uygulamanın ise avantajları ve dezavantajları mevcuttur. Bu derlemede bariatrik cerrahinin eski ve yeni uygulamaları hakkındaki genel bilgiler bir araya getirilmiştir.
ABSTRACT Obesity is a chronic and complex disease which is increasing rapidly in recent years. It has been accepted in the current literature that obesity has an effect on the increase of cardiovascular, renal, musculoskeletal system and psychological disorders and many other functional disorders besides some diseases such as cancer, metabolic syndrome, type 2 diabetes. In cases of regular physical activity with healthy diets or pharmacological treatment are not effective in the treatment of obesity, bariatric surgery is performed by experienced teams in well-equipped centers. The success of the process is possible by deciding the most appropriate bariatric surgery for the patient and the nutritional and metabolic monitoring throughout the process. Each application has advantages and disadvantages. In this review, general information about past and current methods of bariatric surgery were collected.