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Quality of Life as a function of self image and social support in morbidly obese patients before and after bariatric surgery: Is there a need for PCA therapy?

January 16, 2015| Papers Haven

Quality of Life as a function of self image and social support in morbidly obese patients before and after bariatric surgery: Is there a need for PCA therapy?

Paper details
BACKGROUND OF THE STUDY

introduction

Obesity is a growing health concern worldwide in which excess body fat has accumulated to the extent that impacts the life of individuals both physically and psychologically. It is defined by body mass index (BMI).

BMI

• is closely related to both percentage body fat and total body fat.

• is defined as the subject’s weight divided by the square of their height and is calculated as follows. BMI= m : h2, where m and h are the subject’s weight and height respectively.

A BMI of ≥40 is classified as morbid obesity and reduces life expectancy

by 8 to 10 years. (Prospective Studies Collaboration. (2009). Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet, 373(9669), 1083–1096. doi:10.1016/S0140-6736(09)60318-4)

Morbid obesity is a multifactorial disease, which involves metabolic factors, dietetic habits and psychosocial factors.

It is associated with certain psychiatric disorders, especially with eating disorders.

Additionally, morbidly obese persons are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior.

Bariatric surgery is now recognized as the most effective treatment for morbid obesity, and usually results in improvement or resolution of the medical

and psychosocial comorbidities associated with morbid obesity.1,2

However, research has shown that eating pathology is commonly seen in BS patients before surgery, and may persist or emerge after surgery.1-6

After bariatric surgery, a variable percentage of patients fail to dietetic habits or associated psychopathology.

1. Buchwald H. 2004 ASMBS Consensus Conference: Consensus statement Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third party payers. Surg Obes Relat Dis 2005;1:371–381.

2. van Hout G. Psychosocial effects of bariatric surgery. Acta Chir Belg 2005;105:40–43.

3. Marino JM, Ertelt TW, Lancaster K, Steffen K, Peterson L, de Zwaan M, et al. The emergence of eating pathology after

bariatric surgery: A rare outcome with important clinical implications. Int J Eat Disord 2012;45:179–184.

4. Segal A, Kussunoki DK, Larino MA. Post-surgical refusal to eat: Anorexia nervosa, bulimia Nervosa or a new eating disorder? A Case Series. Obes Surg 2004;14:353–360.

5. Atchison M, Wade T, Higgins B, Slavotinek T. Anorexia nervosa following gastric reduction surgery for morbid obesity. Int J Eat Disord 1998;23:111–116.

6. Stunkard AJ, Allison KC. Two forms of disordered eating in obesity: Binge eating and night eating. Int J Obes 2003;27:1–12.)

Obese individuals are more likely than normal-weight persons to be diagnosed with a:

• mood disorder

• anxiety disorder

• alcohol use disorder

• personality disorder

(based on data from the National Epidemiologic Survey on Alcohol and Related Conditions in the US, n = 43,093, Petry et al., 2008)

Depression

In a meta-analysis to investigate the direction between depression and obesity that combined 15 studies, N=58 745:

• Obese persons had a 55% increased risk of developing depression over time

• Depressed people had a 58% risk of becoming obese

Luppino et al, 2010

Bariatric Surgery

Factors associated with psychological functioning post-surgery:

self-esteem, social support, type of coping, body image

(Ortega et al, 2012)

Bariatric surgery candidates report higher than normal suicidal ideation and behaviour prior to surgery.1

A review of 28 studies including 40,947 patients examining suicide in post-bariatric surgery patients in North America and Europe found:

Suicide rate after bariatric surgery = 4.1/10,000

compared to World Health Organization data = 1.0/10,000.2

1. Chen et al., 2012

2. Peterhansel et al, 2013

Possible Reasons for increased Suicide after Bariatric Surgery

Psychological & Behavioural

• Dissatisfaction with results

• Loose skin

• Psychopathology especially depression

• Hopelessness

• Poor body image

• Increased alcohol use

• Interpersonal stressors

Physiological

• Malabsorption of antidepressants

• Gastrointestinal peptide changes, especially ghrelin

• Dissection of vagus nerve

Mitchell et al, 2013

Improved understanding of the prevalence of psychopathology among morbidly obese patients before and after BS is an important area of study.

Evidence suggests high rates of psychiatric disorders in bariatric surgery candidates (e.g. Mitchell et al., 2012), although no rigorous studies have examined the prevalence in a Greek sample.

The purpose of this paper is to investigate the psychological characteristics in a Greek sample of bariatric surgery candidates, before and after BS in terms of Quality of life; as well as to explore the need of Person-Centered Counseling support.

BACKGROUND OF THE STUDY

research questions/objectives

Is self image and social support important factors in the quality of life of morbidly obese people?

Do bariatric surgery helps to resolve the psychosocial issues?

In research it has been shown that BS candidates fail to overcome their psychological problems after surgery; can Person-Centered Counseling help to reduce them?

Keywords:

Morbid Obesity; Bariatric surgery; Quality of Life; Self Image; Social Support; Person-Centered Counseling

METHODS

sample

The target population for this study will be Greek adults, BS candidates, before and after undergo bariatric surgery.

The following criteria will be used to select the individuals to participate in the study:

1. For group A (BS candidates before surgery) they must be 18+ and

have a BMI ≥ 40

2. For group B (BS candidates after surgery) they should be at least 3 months out of surgery and 18+

3. For group C (BS candidates before & after surgery) meeting the above criteria for before and after.

The sample will be found via 2 different ways:

1. Through Bariatric Surgeons who will ask their patients to paricipate

2. Through Internet forums and FB closed groups, created to support BS candidates before and after surgery

METHODS

instruments

The survey will be administered electronically via http://surveymonkey.com

The participants will be asked to electronically sign the informed consent in order to participate. If the individuals click “I agree” then they will proceed to the survey. The participation will be voluntary.

There will be a note as to the length of time to complete the survey.

It should not take more than 20 minutes to complete.

It will have four questions per webpage in order to speed up the survey.

Individuals will be sent an invitation via FB inbox or email to complete the survey.

The email and message contains the address to the survey site which includes an electronic informed consent.

After the completion of the survey I will download from the survey monkey server the individuals involved in this project and they will be removed from the

Database.

Questionnaries:

WHOQOL-BREF (World Health Organization Quality of Life)

It comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. The WHOQOL-BREF is a shorter version of the original instrument that may be more convenient for use in large research studies or clinical trials.

B-WISE

Is a 12-item self-report questionnaire. It evaluates body weight, image and self-esteem.

Dass-42

The Depression Anxiety Stress Scales, which is made up of 42 self-report items to be completed over five to ten minutes, each reflecting a negative emotional symptom.

The Depression scale has subscales assessing dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia and inertia.

The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety and subjective experience of anxious affect.

The Stress scale’s subscales highlight levels of non-chronic arousal through difficulty relaxing, nervous arousal and being easily upset/agitated, irritable/over-reactive and impatient.

METHODS

statistical methods

The analysis will be completed using IBM’s SPSS (Statistical Package for Social Sciences) for MacOs, Statistics Standard 22

APPENDICES

references

Jeremy F. Kubik, Richdeep S. Gill, Michael Laffin, and Shahzeer Karmali, “The Impact of Bariatric Surgery on Psychological Health,” Journal of Obesity, vol. 2013, Article ID 837989, 5 pages, 2013. doi:10.1155/2013/837989

Dixon JB, Dixon ME, O’Brien PE. Depression in Association With Severe Obesity: Changes With Weight Loss. Arch Intern Med. 2003;163(17):2058-2065. doi:10.1001/archinte.163.17.2058

Coriddi MR, Koltz PF, Chen R, Gusenoff JA. Changes in quality of life and functional status following abdominal contouring in the massive weight loss population. Plast Reconstr Surg. 2011:128;520–526.

Pecori L, Serra Cervetti GG, Marinari GM, Migliori F, Adami GF. Attitudes of morbidly obese patients to weight loss and body image following bariatric surgery and body contouring. Obes Surg. 2007;17:68–73.

Thonney B, Pataky Z, Badel S, Bobbioni-Harsch E, Golay A. The relationship between weight loss and psychological functioning among bariatric surgery patients. Am J Surg. 2010; 199:183–188.

World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.

Hafner RJ, Watts JM, Rogers J. Quality of life after gastric bypass for morbid obesity. Int J Obes. 1991;15:555–560.

Conceição, E., Orcutt, M., Mitchell, J., Engel, S., LaHaise, K., Jorgensen, M., Woodbury, K., Hass, N., Garcia, L. and Wonderlich, S. (2013), Eating disorders after bariatric surgery: A case series . Int. J. Eat. Disord., 46: 274–279. doi: 10.1002/eat.22074

Engel SG, Crosby RD, Kolotkin RL, Hartley gg, Williams GR, Wonderlich SA et al. Impact of weight loss and regain on quality of life: mirror image or differential effect? Obes Res 2003; 11: 1207–1213.

Alejandro Magallares & Georg Schomerus (2014): Mental and physical healthrelated quality of life in obese patients before and after bariatric surgery: A meta-analysis, Psychology, Health & Medicine, DOI: 10.1080/13548506.2014.963627

Prospective Studies Collaboration. (2009). Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet, 373(9669), 1083–1096. doi:10.1016/S0140-6736(09)60318-4).

Buchwald H. 2004 ASMBS Consensus Conference: Consensus statement Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third party payers. Surg Obes Relat Dis 2005;1:371–381.

Van Hout G. Psychosocial effects of bariatric surgery. Acta Chir Belg 2005;105:40–43.

Marino JM, Ertelt TW, Lancaster K, Steffen K, Peterson L, de Zwaan M, et al. The emergence of eating pathology after

bariatric surgery: A rare outcome with important clinical implications. Int J Eat Disord 2012;45:179–184.

Segal A, Kussunoki DK, Larino MA. Post-surgical refusal to eat: Anorexia nervosa, bulimia Nervosa or a new eating disorder? A Case Series. Obes Surg 2004;14:353–360.

Atchison M, Wade T, Higgins B, Slavotinek T. Anorexia nervosa following gastric reduction surgery for morbid obesity. Int J Eat Disord 1998;23:111–116.

Stunkard AJ, Allison KC. Two forms of disordered eating in obesity: Binge eating and night eating. Int J Obes 2003;27:1–12.)

Rachel Strimas, Michelle M. Dionne, Stephanie E. Cassin, Suzan Wnuk, (2014). Psychopathology in severely obese women from a Canadian bariatric setting, Ethnicity and Inequalities in Health and Social Care, Vol. 7 Iss: 2, pp.72-85

John Roger Andersen, Anny Aasprang, Tor-Ivar Karlsen, Gerd Karin Natvig, Villy Våge, Ronette L. Kolotkin, Health-Related Quality of Life following

Bariatric Surgery: A Systematic Review of Prospective Long-Term Studies, Surgery for Obesity and Related Diseases, doi: org/10.1016/j.soard.2014.10.027

Kavazidou, E., Proios, M., Liolios, G., Nimatoudis, I., Tsatsoulis, A. Fachantidou-Tsiligiroglou, A. & Doganis, G. (2012) Relationship between eating and social behaviours in a normal population. Graduate Journal of Sport, Exercise & Physical Education Research, 1: 31-46.

• Questionnaries

• First Contact Letter

• Informed Consent Form

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