RESUMO
La obesidad es un problema de salud mundial asociado con el desarrollo de enfermedades crónico degenerativas. La cirugía bariátrica es el tratamiento que ha mostrado mayor efectividad para la obesidad severa; el paciente debe modificar su estilo de vida para mantener la pérdida de peso a largo plazo. Se ha visto que las intervenciones cognitivo conductuales han sido efectivas para lograr este cambio en el paciente. El presente estudio busca evaluar la efectividad de una intervención cognitivo conductual grupal en la pérdida de peso y calidad de vida antes de la cirugía. Se incluyeron nueve pacientes con obesidad mórbida candidatos a cirugía bariátrica sin comorbilidades psiquiátricas. Se realizó una evaluación inicial de calidad de vida que medía peso e IMC (Índice de Masa Corporal, por sus siglas en español). Los pacientes fueron sometidos a una intervención grupal con el objetivo de promover la pérdida de peso mediante técnicas cognitivo conductuales. El promedio de pérdida de peso fue de 5.7 kg en las cinco semanas que duró el tratamiento, mostrando significancia estadística de .001; a su vez, con la pérdida de peso disminuyó el IMC con una significancia estadística de .002. En cuanto a calidad de vida, hubo mejoría significativa en la percepción corporal y en la actitud al tratamiento.
Obesity is a global health problem associated with the development of chronic degenerative diseases. Bariatric surgery has proven to be the most effective treatment for severe obesity. Despite surgery, patients must change their lifestyle in order to maintain weight loss in the long term. It has been reported that cognitive behavioral interventions have been effective to promote a lifestyle change and weight loss in obese patients. The aim of this study was to assess the effectiveness of a cognitive behavioral group intervention on weight loss and quality of life before surgery. Participants were nine morbidly obese patients, without psychiatric comorbidities, candidates for bariatric surgery. An initial assessment of quality of life that measured weight and BMI (Body Mass Index, for its English acronym) was performed. Patients underwent a group intervention in order to promote weight loss through cognitive behavioral techniques. The average weight loss was 5.7 kg during the five weeks of treatment, showing statistical significance of .001. In turn, along with weight loss, there was a decrease in BMI, with a statistical significance of .002. Regarding quality of life, there was significant improvement in body perception and attitude toward treatment.
A obesidade é um problema de saúde mundial associado com o desenvolvimento de enfermidades crônico degenerativas. A cirurgia bariátrica é o tratamento que mostrou maior efetividade para a obesidade severa; o paciente deve modificar seu estilo de vida para manter a perda de peso a longo prazo. Observa-se que intervenções cognitivo conductuais têm sido efetivas para conseguir esta mudança no paciente. O presente estudo busca avaliar a efetividade de uma intervenção cognitivo conductual grupal na perda de peso e qualidade de vida antes da cirurgia. Incluíram-se nove pacientes com obesidade mórbida candidatos a cirurgia bariátrica sem co-morbilidades psiquiátricas. Realizou-se uma avaliação inicial de qualidade de vida que media peso e IMC (Índice de Massa Corporal). Os pacientes foram submetidos a uma intervenção grupal com o objetivo de promover a perda de peso mediante técnicas cognitivo conductuais. A média de peso perdido foi de 5.7 kg nas cinco semanas que o tratamento durou, mostrando significância estatística de .001; ao mesmo tempo a perda de peso fez com que o IMC diminuísse com uma significância estatística de .002. Com respeito à qualidade de vida, houve melhoria significativa na percepção corporal e na atitude com respeito ao tratamento.
Assuntos
Humanos , Adulto , Qualidade de Vida , Medicina Bariátrica , Obesidade/psicologiaRESUMO
La obesidad ha sido declarada por la OMS como una epidemia y es factor de riesgo para diversas enfermedades tanto físicas como psicológicas, por lo que supone una creciente carga económica para los sistemas de salud. Actualmente el tratamiento que mayor efectividad ha mostrado para tratar la obesidad severa es la cirugía bariátrica; sin embargo, a pesar de los cambios anatómicos realizados por la cirugía, no todos los pacientes se ven beneficiados por la misma. Se ha reportado que el 20% de estas cirugías fracasan y generalmente este fracaso es atribuido a causas psicológicas. El número de cirugías bariátricas realizadas en el mundo está aumentando exponencialmente y dentro de las guías norteamericanas se sugiere el tratamiento Interdisciplinariasciplinario, incluyendo en este el tratamiento psicológico. El trabajo que se informa busca describir el rol del psicólogo en un equipo Interdisciplinariasciplinario de cirugía bariátrica.
Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that it's etiology is influenced by biological, psychological, environmental and other factors. It is a risk factor for many diseases not only physical (diabetes, hypertension, hypercholesterolemia, an so on) but also psychological (depression, anxiety, eating behavior disorders, etc.); reason for which it's supposed to be a raising charge for worldwide health systems. Among the approved treatments for overweight and obesity are included: nutritional (caloric restriction), increase physical activity and behavioral therapy. When talking about patients with severe obesity (BMI 
40), the most effective treatment that has been proven is bariatric surgery, indicated for patients with a BMI 40 or 35 in case of presenting co morbidities. It has been described that surgical treatment for obesity promotes mayor weight loss, generates significant improvement of the co morbidities associated with the obese condition and helps to prolong life expectancy and to increase quality of life. Despite all of the advantages that this treatment has proven to offer, not all of the patients benefit from it, even with the anatomical changes made by the surgery, some of the patients don't get to loose a significant amount of weight; differences in the variations of weight after the surgery at short and long term have been reported. It has been reported that approximately 20% of bariatric surgeries fail due to poor weight loss and that this failure is generally attributed to psychological or behavioral causes. Nowadays the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines suggest that surgical treatment for obesity must be performed in a Interdisciplinariasciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologist's role in this team consists on initially evaluating surgery candidates in order to determine if there is existing psychopathology and their ability to implement the lifestyle changes needed before and after the procedure, to give psico educational interventions in order to prepare patients for these changes and to make an informed decision about this treatment. This preparation helps patients having realistic expectations about the surgery results, helps to decrease the uncertainty that generates anxiety. For this reason, psychologist´s work should be focused on motivation and adherence on lifestyle changes by psycho educational and cognitive behavioral specific interventions. In conclusion, the goal of the psychologist in the bariatric surgery team is to identify possible contraindications for the surgery and to identify possible post-surgical challenges as well as to give behavioral specific strategies in order to cope with those challenges. The prevalence of obesity is rising across the world and, in order to treat it, the increase in the number of bariatric surgeries performed. As ASMBS guidelines suggest a Interdisciplinariasciplinary approach where the psychologist plays a fundamental role in order to get a better prognosis after the surgery, it is important to increase the number of psychologists with the necessary skills to work with these patients, and with knowledge about obesity and bariatric surgery. The present research aims to describe the psychologist's role in a bariatric surgery Interdisciplinariasciplinary clinic and some of the strategies described for psychological obesity treatment suggested to be used before and after the surgery, in order to promote a lifestyle change.