A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/704136
22 Journal Watch Bariatric Times • July 2016 Patient expectations of bariatric and body contouring surgery. P oulsen L, Klassen A, Jhanwar S, Pusic A, Roessler KK, Rose M, Sørensen JA. Plast Reconstr Surg Glob Open. 2016;4(4):e694. Synopsis: The aim of this study was to identify patient expectations along the weight loss journey and/or body contouring surgery. This qualitative study took an interpretive description approach. Between September 2009 and February 2012, 49 patients were interviewed postbody contouring surgery. Data were analyzed using a line-by-line approach whereby expectations were identified and labeled as expected, unexpected, or neutral. Participants described expectations according to appearance, health-related quality of life, and patient experience of care. The authors found that two areas stood out in terms of unmet expectations: appearance and physical health (i.e., recovery from body contouring surgery). Most participants who underwent bariatric surgery expected neither the extent of excess skin after weight loss nor how the excess skin would make them look and feel. For recovery, participants did not expect that it would be as long or as hard as it was in reality. The authors concluded that a full understanding of outcomes and expectations for this patient population is needed to enhance patient education and improve shared medical decision making. Education materials should be informed by the collection of evidence-based patient- reported outcome information using measures such as the BODY-Q. A patient-reported outcome scale measuring patient expectations is needed for obese and bariatric patients. PMID: 27200256 A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity. Kvalem IL, Bergh I, von Soest T, R osenvinge JH, Johnsen TA, Martinsen EW, Mala T, Kristinsson JA. BMC Obes. 2016 Feb 5;3:6. Synopsis: The researchers conducted a study to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioral and psychosocial characteristics considered predictors of their adoption of and adherence to long- term lifestyle recommendations. Baseline clinical and questionnaire data from the prospective "Oslo Bariatric Surgery Study" were used to examine potential differences between bariatric surgery patients (n = 301) and patients receiving conservative weight loss treatment (n = 261). The surgical group was characterized by their younger age (43.8 vs. 46.2 years, p <0.01), higher percentage of women (79.1 vs. 70.1 %, p <0.05), and higher body mass index (BMI; 45.0 vs. 41.9 kg/m(2), p <0.001). A multiple logistic regression analysis, adjusting for group differences in BMI, gender, and age, showed that the surgical group had higher self-efficacy (Odds ratio; OR = 3.44, 95 % Confidence interval; CI 1.65, 7.14), more positive outcome expectations (OR = 1.53, 95 % CI 1.23, 1.89), and plans that were more explicit for changing their eating behaviors (OR = 1.80, 95 % CI 1.06, 1.93). The surgical patients were also less ready to change physical activity levels (OR = 0.59, 95 % CI 0.48, 0.73), had tried more types of unhealthy weight loss methods in the past (OR = 1.16, 95 % CI 1.01, 1.33), drank soda more frequently (OR = 1.24, 95 % CI 1.02, 1.50), had fewer binge eating episodes (OR = 0.38, 95 % CI 0.20, 0.71), and had more depressive symptoms (OR = 1.19, 95 % CI 1.09, 1.29). The researchers concluded that patients opting for bariatric surgery had more positive expectations of the treatment outcomes and stronger b eliefs in their ability to achieve these outcomes. Those starting conservative treatment had stronger beliefs in readiness to change physical activity levels. Future studies should explore the effect of interventions for bariatric surgery patients, promoting postoperative physical activity and stress realistic outcome expectations. The potential effects of incorporating this knowledge in intervention strategies remain to be explored. PMID: 26885374 Expectations and patients' experiences of obesity prior to bariatric surgery: a qualitative study. Homer CV, Tod AM, Thompson AR, Allmark P, Goyder E. BMJ Open. 2016 Feb 8;6(2):e009389. Synopsis: The authors conducted a qualitative study among areas served by two bariatric surgery multidisciplinary teams in the north of England to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioral and self-management interventions. The authors used modified photovoice methods and triangulating photography with semistructured indepth interviews that were analyzed using framework techniques. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams. The study included 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. The authors found that problems included stigmatization, shame, poor health, physical function, and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants e xpected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of 'normality'. Participants had received previous support from clinicians and in weight management services; however, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatization had not been addressed. The authors concluded that the unrealistic expectations identified through their study may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatization, and modifying patient's expectations and goals for the postoperative period. PMID: 26857104 The gap between expectations and reality of exercise-induced weight loss is associated with discouragement. Thomas DM, Kyle TK, Stanford FC. Prev Med. 2015;81:357-60. Synopsis: The aim of this study was to identify individuals who become discouraged when exercise fails to achieve weight loss. Representative samples of U.S. adults were recruited using Google Consumer Surveys in August to October 2014. Respondents were asked about beliefs and potential discouragement regarding the role of exercise and weight loss. An analysis of variance was performed to predict individuals that become discouraged if exercise does not lead to weight loss. The results revealed that the belief that exercise is a very effective way to lose weight was common (71% of respondents). Stronger belief that exercise is an effective way to lose weight (p<0.001) in individuals with A q u i c k l o o k a t t h e n o t e w o r t h y a r t i c l e s i n b a r i a t r i c a n d m e t a b o l i c r e s e a rc h THIS MONTH'S TOPIC: PATIENT EXPECTATIONS FOR WEIGHT LOSS Journal Watch