Transcript Folie 1

Bariatric Surgery Affects Eating and Exercising
related
Psychological Variables, but nobody knows…
Elisabeth Ardelt-Gattinger (Salzburg University, OAA)
Markus Meindl (Salzburg University)
Susanne Ring-Dimitriou (Salzburg University,)
Karl Miller (Private Medical School, Salzburg, OAA)
Daniel Weghuber (Private Medical School, Salzburg, OAA)
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Obese Adolescents? …
Never Ending Story
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Replication of the 1961 Study
The obese child was reliably ranked last, even lower than
children with gross physical disabilities, not only by children
from different socioeconomic and ethnic backgrounds, but
even by children who themselves had physical disabilities.
Adults who worked with the physically disabled, who were
themselves obese, and who were from various ethnic and
racial backgrounds, demonstrated the same aversion to
overweight children and adolsecents
(Latner, J. & Stunkard, A. (2013).Getting Worse: The Stigmatization of
Obese Children. Obesity Research,11 (3): 452–456.
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Obese Adolescents? …
Never Ending Story
Obese youths face social stigma which is pervasive and
have serious consequences for mental and physical health
(Puhl, Rebecca M.; Latner, Janet D.(2007). Stigma, obesity, and the health of the nation's
children. Psychological Bulletin, 133(4): 557-580)
Obese adolescents are at greater risk for bullying &
mobbing
Elkington, J.& Hartigan, P. (2012). Group, Leadership, and Individual Antecedents of
Mobbing."Mobbing: Causes, Consequences, and Solutions: 93.
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Success? of conservative therapies
Metaanalyses show that weight loss through
conservative therapy and prevention does
not indicate any big changes (Ebbeling, Pawlik &
Ludwig,2002; Miller & Jacob, 2001; Stice et al., 2009)
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Solution? for fat&mobbed children
“Health at any Size”
(Miller, 2002)
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What about Bariatric Surgery and
HEALTH @ ANY SIZE post
Bariatric surgery is increasingly seen as the treatment
of choice for moderately to morbidly obese patients
with very good success rates regarding weight and
quality of Life.
Its INTERDISCIPLINARY impact on “Health at any
Size” = psychological functioning, healthy eating,
physical fitness, and absence of psychological
comorbidities, however, is still poorly investigated.
(Mechanick, J. et al. (2009). Obesity; Pull CB Curr Opin Psychiatry 2010; van Hout GC et al
Obes Surg 2005; (Pataky Z et al Curr Opin Gastroenterol 2011).
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Evaluation of Adults
The aim of the current study was to comprehensively
evaluate the effect of bariatric surgery on cognitive
variables related to HEALTHY LIVING:
food intake and exercise behaviour.
Since the most frequently used surgical methods were
gastric banding (GB)and gastric bypass (GBP) and since
these methods require different postoperative behavioural
adaptation (O´Brien 2010) we distinguished these two in our
analyses.
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Questionnaires
Toward this end we assessed surgery related changes measured
on a broad set of psychological variables. The one well known
cognitive variables: disinhibition and restraint eating (Stunkard &
Wadden 1989; Canetti et al. 2009; Ouwehand & Papies, 2010).
Assessing new one we used a new well validated evaluation
system (AD-EVA, Ardelt-Gattinger & Meindl, 2010).
Emotional: emotional eating, enjoyment of eating, addiction to
overeating
Motivational: adherence to recommendations, exercise
motivation,
Behavioral: kind of food intake, nutritional preferences
Psychological disorders: Bulimia, Binge Eating Disorder
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Subjects: 120 Adults
A total of 120 morbidly obese patients were
assessed:
Pre: 33m/87f, 18–71 years, BMI 45.70±6.30
kg/m²) and Post: 18-24 months, Ø 20.8; BMI
33.75±6.85 kg/m²).
Gastric bypass (GBP, n=80)
Gastric banding (GB, n=40)
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Across both surgical methods, BMI and 9 out of
12 sub-scales changed significantly towards
more favourable values of eating and exercise
cognitions.
No changes were observed for
- restraint eating
- PWS
- hedonic eating
- preferences for healthy nutrition.
No negative changes of any kind occurred.
„
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Change of variables related to food intake &
exercise behaviour
Quest.
Subscale
n.s.
< 0.01
< 0.01
< 0.01
n.s
< 0.01
< 0.01
n.s.
< 0.05
< 0.01
Mean&SD, t1
Patients t1
28.02±9.86
35.73±10.03
22.18±9.23
31.57±7.56
23.47±4.04
20.19±4.55
34.09±10.75
20.54±4.39
8.20± 8.06
7.44 ±6.55
Mean&SD, t2
Patients t2
28.49±9.81
23.18± 8.07
14.29±6.95
44.31±7.54
23.73±3.48
23.57±3.88
19.77±8.66
19.01(!)±5.17
4.03 ±10.69
2.16 ±5.21
Mean&SD
Norm.weight
25.41±8.61
23.74±6.37
13.67±6.62
43.15±7.09
26.03±3.00
23.22±3.84
20.10±7.92
10.10±3.46
3.49±6.27
2.14±3.47
116
< 0.01
25.24 ±7.29
29.29(!)± 7.29
27.21±6.60
115
115
115
115
118
< 0.01
n.s.
< 0.01
<.0.01
<0.01
98.65 ±17.44
54.13± 7.88
32.92 ±5.68
29.21±9.83
45.52 ±5.89
82.24±18.888
54.44 ±6.94
28.48(!) ±6.11
38.91±8.88
33.54 ±6.69
83.42±19.67
54.82±8.22
30.40±6.52
38.64±5.12 ±
19-25
T
df
Sig.
Restraint Eating
Disinhibition
Emot. Eating
QSEC Flex. Steering
Hedonic eating
Adh. recomm.
QATO Add.overeating
QPED PWS
QCED Bulimia
BED
0.43
12.14
9.34
13.43
0.65
7.81
13.43
1.72
3.01
6.12
117
117
116
116
116
116
116
109
106
106
QEM
Exercise Motiv.
6.78
SPN
Snacks
Healthy food
Fatty food
Quality of Life
9.24
0.50
8.27
10.28
18.06
QPEC
QLS
BMI
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With respect to Differences BP and GB
Post Surgery…
In seven variables a reversal had occurred.
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Differences Bypass and Gastric Banding
Variable
Subscales
F (1/118)
Significance
Restraint
1.77
n.s.
Disinhibition
2.19
n.s.
Emot. Eating
0.34
n.s.
Flex. Steering
16.04
< 0.01
Hedonic Eating
0.08
n.s.
Adherence recommand.
1.89
n.s.
Addiciton
9.09
< 0.01
Precl. Eating Disord.
1.46
n.s.
Bulimia
27.32
< 0.01
Binge Eating
25.37
< 0.01
Quality of Life
Quality of Life
1.34
n.s.
Exercise Motivation
intrin.&extrin.
0.20
n.s.
Snacks
4.22
< 0.05
Healthy
1.81
n.s.
Fatty Food
5.61
< 0.01.
Pathogenic
Eating Cognitions
Salutogenic
Eating Cognitions
Addiction Overeating
Eating Disorder
Nahrungs-präferenzen
BMI
BMI
4.23
< 0.05
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In-/decrease of eating disorder BP and GB
Post Surgery
Reversal of Values – Eating Disorders
(We ask patients who a comorbid with bulimia or BED
to undergo BP)
*=<.05, **=<.01
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Decrease = Improvement for BP only
Post Surgery
Reversal of Values – Nutrition Preferences
*=<.05, **=<.01
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BP seems to require less control
Post Surgery
Reversal of Values – steering variables of eating behavior
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BP are less addicted to overeating
Post Surgery
Reversal of Values – steering variables of addiction
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Interdisc.(!) Evaluationsystem BAREV:
Comparing disciplines and total Sum
BAREV©Hogrefe
Very good and good
Very bad and bad
Sub-total
Medicine: 8 / 20
18 till 36
-18 till -36
Sub-total
Sub-total
Sub-total
Psychology: 6 / 10 Sp. Science: 0 / 1 Nutrition: -1 / 2
8 till 17
2 till 5
2 till 3
-8 till -17
-2 till -5
-2 till -3
Sum total: 13 / 33
Sum total
≥30
Bypass / Gastric Banding
20 till 29
6 points – good success
8 till 19
5 points – modest success
7 till -7
4 points – stagnation
-8 till -19
3 points – modest worsening
-20 till -29
2 points – strong worsening
≤ -30
1 point – very strong worsening: alarming medical, psychological, sport- and dietary
status
Interdisciplinary Quality Control System
7 points – very good success: excell. medical, psychological, sport- & dietary status
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8 Case Studies (5m/3f; 14 – 17 years)
Pre: BMI-sds: 3.55± 0.44 and Post: 18-24 months Bypass, Ø
1.49 ± .86)
5 adolescents
- BMI and 8 out of 12 sub-scales changed significantly towards
more favourable values of eating and exercise cognitions.
No changes were observed for
- restraint eating, PWS, preferences for healthy nutrition.
No negative changes of any kind occurred.
1 Girl ‘forgot’ her vitamin B intake – major depression, 1 Boy
developed ‘Sports – Bulimia’, 1 Boy – still high in addiction,
insomnia – successful therapy
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Bypass seems to be…
Bypass seems to be a good option to cure successful
weight loosing adults of addiction,eating disorders etc.
It seems e good option to prefer healthier nutrition and
to become intrinsicly motivated for physical activity.
• We do not know enough about results of adults
But they may need more support post surgery
for their HEALTH@any SIZE
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2year versus minimal post bariatric follow up
program (Hellbardt et al, 2014)
Both: BMI, assoc. diseases & concomitant medication sign. reduced,
BUT
Evaluation of 2 year program
3,6,9,12,18 and 24 months
Minimal follow up 3rd & 18th month
- Deficiency symptoms prevented
due to supplement.& regular lab.
control
- Control by general practitioner NO data
about problems and deficiency
symptoms could be drawn
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Design of Youth Interdisciplinary Post Bariatric
Program YIPBP OAA
Appointment
Medicine
Nutrition
Physical
fitness/activity
GUIDANCE and MONITORING
glucose clamp), surgical,
Dietary assessment (incl. nutrition
preferences), screening for eating
disorders, craving, etc. –
orthopedic assessment
AD_EVA test tool
Metabolic (including oGTT,
pre OP
OP
Transition to a normal diet, advice
regarding protein demand and
supplements
3 weeks post OP
Transition from mash and soft to
ordinary food should be completed
PA-Questionnaire
Spiroergometry
(Cardiopulmunary Fitness)
Individualized Training
7,11,15 weeks post OP
Medical & surgical visit
surgical visit
Metabolic (12 mo including
6, 12 months post OP
2 year post OP
oGTT), vitamin/trace element
AD_EVA (NLP, QSM, FEV_salut, QCEQ) → BAREV
Sprioergometry (CPF)
Long term feeding
status, surgical visit
Metabolic (including oGTT),
vitamin/trace element status,
3 year post OP
(starts 2015)
surgical visit
AD_EVA (NLP, QSM, FEV_salut, QCEQ) → BAREV
Spiroergometry (CPF)
Individualized nutrition plans,
long term feeding
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Replication AND 2 years Follow up for
adolescents
We urgently need
-
replication of our studies for children / adolescents
especially
- mandatory participation in
2 years follow up
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