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      Psychological variables: determinants of the body image adjustment of obese subject to gastric bypass Translated title: Variables psicológicas: determinantes de la adaptación a la imagen corporal del obeso sometido a by-pass gástrico

      review-article
      Gen
      Sociedad Venezolana de Gastroentereología
      Obesidad, By-Pass Gástrico, imagen corporal, Obesity, Gastric bypass, body image, psychological variables

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          Abstract

          Morbid obesity as an entity that is associated to numerous clinical complications, an increased mortality and a deterioration of the quality of life, the World Health Organization (WHO) recommends surgical treatments as an alternative. In this sense, the physical and psychological benefits associated with bariatric surgery are well documented. However, the surgery can generate negative effects. The structural changes in the digestive system, coupled with the disruption of the body image especially patients who undergo bypass gastric, reinforce the idea that everything is not positive. Given this reality, this theoretical review is to emphasize the importance of studying the role that psychological variables in adapting to the new body image in these patients.

          Translated abstract

          Al ser la obesidad mórbida una entidad que se asocia a numerosas complicaciones clínicas, a un aumento de la mortalidad y a un deterioro de la calidad de vida de quien la sufre; la Organización Mundial de la Salud (OMS), recomienda considerar como alternativa los tratamientos quirúrgicos. En este sentido, los beneficios físicos y psicológicos vinculados a la cirugía bariátrica están bien documentados. No obstante, la cirugía conlleva efectos negativos en un alto porcentaje de individuos. Los cambios estructurales que produce en el circuito digestivo, sumado a la desorganización de la imagen corporal que sufren los pacientes que se someten especialmente al By-Pass Gástrico, refuerzan la idea de que no todo es positivo. Ante esta realidad, la presente revisión teórica trata de debe de subrayar la importancia de estudiar el papel que tienen las variables psicológicas en la adaptación a la nueva imagen corporal en estos pacientes.

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          Most cited references81

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          Behavioral predictors of weight regain after bariatric surgery.

          After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB). In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared. Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model. Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.
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            American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient.

            American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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              Uma abordagem epidemiológica da obesidade

              A obesidade, doença integrante do grupo de Doenças Crônicas Não-Transmissíveis, é o acúmulo excessivo de gordura corporal em extensão tal, que acarreta prejuízos à saúde dos indivíduos. A etiologia da obesidade é um processo multifatorial que envolve aspectos ambientais e genéticos. Atualmente, a obesidade é um problema de saúde pública mundial, tanto os países desenvolvidos como os em desenvolvimento apresentam elevação de sua prevalência. A transição nutricional é um processo de modificações seqüenciais no padrão de nutrição e consumo, que acompanha mudanças econômicas, sociais e demográficas, e mudanças do perfil de saúde das populações. Neste novo perfil, a urbanização determinou uma mudança nos padrões de comportamento alimentar que, juntamente com a redução da atividade física nas populações, vem desempenhando importante papel. O aumento da prevalência da obesidade no Brasil é relevante e proporcionalmente mais elevado nas famílias de baixa renda. O quadro epidemiológico nutricional do Brasil deve apontar para estratégias de saúde pública capazes de dar conta de um modelo de atenção para desnutrição e obesidade, integrando conseqüências e interfaces das políticas econômicas dentro do processo de adoecer e morrer das populações. A presente revisão de literatura tem como objetivo enfatizar os aspectos epidemiológicos do sobrepeso e da obesidade em adultos, como importante agravo no âmbito da saúde pública.
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                Author and article information

                Contributors
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas, Distrito Capital, Venezuela )
                0016-3503
                2477-975X
                December 2016
                : 70
                : 4
                : 139-143
                Affiliations
                [01] Santiago de Chile orgnamePontificia Universidad Católica de Chile Chile
                Article
                S0016-35032016000400006
                87ccfb97-5633-4a92-ab11-4114e99b399e

                http://creativecommons.org/licenses/by/4.0/

                History
                : 26 October 2016
                : 13 September 2016
                : 02 November 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 55, Pages: 5
                Product

                SciELO Venezuela


                Obesidad,By-Pass Gástrico,imagen corporal,Obesity,Gastric bypass,body image,psychological variables

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