Extensive Training and Counseling Service Applied in Bariatric Surgery: Effects on Eating Characteristics and Physical Activity Levels

Öz

Aim: Today, surgical methods are gradually becoming widespread in the treatment of obesity and it is becoming important that individuals be adapted to their new life style and be supported following surgery. The study aims to prospectively assess two patient groups receiving standard care and extensive training and counseling, in which Sleeve Gastrectomy was implemented, in terms of eating characteristics, physical activity levels. Material and Methods: This pretest-posttest, repeated measures, randomized control prospective study was carried out between March 2017 and May 2018 using an experimental design. Of the participants who underwent laparoscopic Sleeve Gastrectomy, 26 patients (control) received standard care, while 25 patients (intervention) received extensive training and counseling service starting before the operation and lasting for 6 months following it. Eating characteristics were evaluated using the Eating Disorder Examination Questionnaire, and physical activity levels were evaluated using the International Physical Activity Questionnaire Short Form. Results: The median age of the patients was 37 [17], and 78.4% of them were females and 68.6% were married. It was determined that the percentage of change in the median of the Eating Disorder Examination Questionnaire total, eating concern, shape concern and weight concern subscale score of the intervention group was significantly higher than the control group (p<0.05). At the postoperative 6th month follow-up, it was observed that the intervention group had a more active life compared to the control group, and the changes seen in walking and moderate intensity activities were significant compared to the control group (p<0.05). The body mass index of the intervention group, which was 42.34 [6.1] before the operation, dropped to 30.59 [5.66] and the body mass index of the control group dropped from 44.75 [9.66] to 33.66 [8.08] in 6 months (p<0.05). Conclusion: The results of the study supported that the extensive training and counseling program given to bariatric surgery patients was a positively effective program in terms of eating characteristics and physical activity levels.

Anahtar Kelimeler

• bariatric surgery
• counseling
• education of patients
• eating behavior
• physical fitness

Bariatrik Cerrahide Uygulanan Kapsamlı Eğitim ve Danışmanlık Hizmeti: Yeme Özellikleri ve Fiziksel Aktivite Düzeyine Etkisi

Öz

Amaç: Günümüzde obezitenin tedavisinde cerrahi yöntemler giderek yaygınlaşmakta, cerrahi sonrası bireyin yeni yaşam tarzına uyum sağlayabilmesi için desteklenmesi önem kazanmaktadır. Bu çalışmanın amacı, kapsamlı eğitim danışmanlık hizmeti ve standart bakım alan Sleeve Gastrektomi uygulanan iki hasta grubunun yeme özellikleri, fiziksel aktivite düzeyleri yönünden prospektif olarak değerlendirilmesidir. Gereç ve Yöntemler: Randomize kontrollü ön test-son test, tekrarlayan ölçümlü, deneysel model kullanılan çalışma, Mart 2017 - Mayıs 2018 tarihleri arasında yapıldı. Laparoskopik Sleeve Gastrektomi yapılan 26 hasta (kontrol grubu) standart bakım, 25 hasta (girişim grubu) ameliyat öncesinde başlayıp ameliyat sonrası altı ay süren kapsamlı eğitim ve danışmanlık hizmeti aldı. Yeme özellikleri Yeme Bozukluğunu Değerlendirme Ölçeği, fiziksel aktivite düzeyi Uluslararası Fiziksel Aktivite Anketi Kısa Formu ile değerlendirildi. Bulgular: Yaş ortancası 37 [17] olan hastaların %78,4’ü kadın ve %68,6’sı evlidir. Girişim grubunun Yeme Bozukluğu Değerlendirme Ölçeği toplam, yeme endişeleri, beden endişeleri ve kilo endişeleri alt boyut puan ortancalarındaki değişim yüzdesinin kontrol grubuna göre anlamlı düzeyde yüksek olduğu belirlendi (p<0,05). Ameliyat sonrası 6. ay izleminde girişim grubunun kontrol grubuna göre daha aktif bir yaşam sürdüğü, orta şiddetli ve yürüme alanlarında görülen değişimin kontrol grubuna göre anlamlı olduğu görüldü (p<0,05). Girişim grubunun ameliyat öncesi 42,34 [6,1] olan beden kitle indeksi ameliyattan altı ay sonra 30,59 [5,66]’a, kontrol grubunun ise 44,75 [9,66]’ten 33,66 [8,08]’ya düştü (p<0,05). Sonuç: Çalışma sonuçları bariatrik cerrahi hastalarına uygulanan kapsamlı eğitim ve danışmanlık programının yeme özellikleri ve fiziksel aktivite düzeyini olumlu yönde desteklediğini gösterdi.

Anahtar Kelimeler

• danışmanlık
• Şişmanlık cerrahisi
• hastaların eğitimi
• yeme alışkanlığı
• fiziksel zindelik

Kaynakça

1. Chikunguwo SM, Brethauer SA, Schauer PR. Bariatric surgery. In: Bland KI, editor. General surgery. London: Springer Verlag; 2009. p. 557-66.
2. Swinburn BA, Caterson I, Seiden JC, James WPT. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutrition. 2004; 7(1A): 123-46.
3. Allison KC, Stunkard AJ. Obesity and eating disorders. Psychiatr Clin N Am. 2005; 28(1): 55-67.
4. Turan Ş, Aksoy Poyraz C, Özdemir A. Tıkınırcasına yeme bozukluğu. Current Approaches in Psychiatry. 2015; 7(4): 419-35.
5. De Zwaan M, Müller A, Allison KC, Brahler E, Hilbert A. Prevalence and correlates of night eating in the German general population. PLoS ONE. 2014; 9(5): e97667. doi: 10.1371/journal.pone.0097667.
6. Colles SL, Dixon JB, O’Brien PE. Night eating syndrome and nocturnal snacking: association with obesity, binge eating and psychological distress. International Journal of Obesity. 2007; 31(11): 1722-30.
7. Conceição EM, Utzinger LM, Pisetsky EM. Eating disorders and problematic eating behaviours before and after bariatric surgery: characterization, assessment and association with treatment outcomes. Eur Eat Disord Rev. 2015; 23(6): 417-25.
8. Deveci E. Obezite cerrahisi (bariatrik) adayı olan ve olmayan obez bireylerde psikopatoloji, beden bölgelerinden hoşnutsuzluk, tedavi motivasyonu ve yeme özelliklerinin değerlendirilmesi [Yüksek Lisans Tezi]. İstanbul: İstanbul Üniversitesi Sosyal Bilimler Enstitüsü; 2013.

9. Conceição E, Mitchell JE, Vaz A, Bastos AP, Ramaldo S, Silva C, et al. The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eating Behaviors. 2014; 15(4): 558-62.
10. Adami GF, Meneghelli A, Scopinaro N. Night eating and binge eating disorder in obese patients. Int J Eat Disord. 1999; 25(3): 335-8.
11. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007; 39(8): 1423-34.
12. Jakicic JM, Davis KK, Garcia DO, Verba S, Pellegrini C. Objective monitoring of physical activity in overweight and obese populations. Physical Therapy Reviews 2010; 15(3): 163-9.
13. King WC, Belle SH, Eid GM, Dakin GR, Inabnet WB, Mitchell JE, et al. Physical activity levels of patients undergoing bariatric surgery in the longitudinal assessment of bariatric surgery study. Surg Obes Relat Dis. 2008; 4(6): 721-8.
14. Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009; 17(1): 78-83.
15. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010; 20(5): 657-65.
16. Baştürk S. Sleeve gastrektomi'nin orta ve uzun dönem sonuçları, obeziteye eşlik eden komorbiditelere etkileri [Uzmanlık Tezi]. Denizli: Pamukkale Üniversitesi Tıp Fakültesi; 2015.
17. Yücel B, Polat A, İkiz T, Dusgor BP, Elif Yavuz A, Sertel Berk O. The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents. Eur. Eat. Disorders Rev. 2011; 19(6): 509-11.
18. Öztürk M. Üniversitelerde eğitim-öğretim gören öğrencilerde uluslararası fiziksel aktivite anketinin geçerliliği ve güvenirliği ve fiziksel aktivite düzeylerinin belirlenmesi [Yüksek Lisans Tezi]. Ankara: Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü; 2013.
19. Groller KD. Systematic review of patient education practices in weight loss surgery. Surg Obes Relat Dis. 2017; 13(6):1072-85.
20. Mechanick JI, Youdim A, Jones DB, Garvet, WT, Hurley DL, McMohan MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society and American Society for Metabolic & Bariatric Surgery. Endocr Pract. 2013; 19(2): 337-72.
21. Garza SF. Bariatric weight loss surgery: patient education, preparation, and follow-up. Crit Care Nurs Q. 2003; 26(2): 101-4.
22. Mulligan AT, McNamara AM, Boulton HW, Trainor LS, Raiano C, Mullen A. Best practice updates for nursing care in weight loss surgery. Obesity. 2009; 17(5): 895-900.
23. Abilés V, Rodríguez Ruiz S, Abilés J, Mellado C, García A, Pérez de la Cruz A, et al. Psychological characteristics of morbidly obese candidates for bariatric surgery. Obes Surg. 2010; 20(2): 161-7.
24. Mitchell JE, King WC, Courcoulas A, Dakin G, Elder K, Engel S, et al. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord. 2015; 48(2): 215-22.
25. Colles SL, Dixon JB, O’Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity. 2008; 16(3): 615-22.
26. Kalarchian MA, Marcus MD, Wilson GT, Labouvie EW, Brolin RE, LaMarca LB. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg. 2002; 12(2): 270-5.
27. Cassin SE, Sockalingam S, Wnuk S, Strimas S, Royal S, Hawa R, et al. Cognitive behavioral therapy for bariatric surgery patients: preliminary evidence for feasibility, acceptability, and effectiveness. Cognitive and Behavioral Practice. 2013; 20(4): 529-43.
28. Sevinçer GM, Coşkun H, Konuk N, Bozkurt S. Bariatrik cerrahinin psikiyatrik ve psikososyal yönleri. Current Approaches in Psychiatry. 2014; 6(1): 32-44.
29. Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, et al. Practical recommendations of the Obesity Management Task Force of the European Association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2017; 10(6): 597-632.
30. Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011; 123(15): 1683-701.
31. Lier HØ, Biringer E, Stubhaug B, Tangen T. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012; 87(3): 336-42.
32. Jassil FC, Manning S, Lewis N, Steinmo S, Kingett H, Lough F, et al. Feasibility and impact of a combined supervised exercise and nutritional-behavioral intervention following bariatric surgery: a pilot study. Journal of Obesity. 2015; 69382. doi: 10.1155/2015/693829.
33. Nijamkin MP, Campa A, Sosa J, Baum M, Himburg S, Johnson P. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012; 112(3): 382-90.
34. Petasne Nijamkin M, Campa A, Samiri Nijamkin S, Sosa J. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. J Nutr Educ Behav. 2013; 45(6): 620-6.
35. Brown WA, Burton PR, Shaw K, Smith B, Maffescioni S, Comitti B, et al. A pre-hospital patient education program improves outcomes of bariatric surgery. Obes Surg. 2016; 26(9): 2074-81.
36. Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O. Early post-operative complications: incidence, management, and impact on length of hospital stay. a retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013; 23(12):2004-12.
37. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. Journal of the American Medical Association. 2004; 29 (2): 1724-37.
38. Osland E, Yunus RM, Khan S, Alodat T, Memon B, Memon MA. Postoperative early major and minor complications in laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-y gastric bypass (LRYGB) procedures: a meta-analysis and systematic review. Obes Surg. 2016; 6(10):2273-84.