Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis.

BACKGROUND: Obesity poses a severe health problem worldwide, with an estimated impact on 17.5% of the adult population by 2035. Among the endoscopic applications for treating this comorbidity, intragastric balloons are the most widely used. The new liquid-filled swallowable balloon meets the requirements of major guidelines and allows significant weight loss with few adverse events. This systematic review and meta-analysis aims to demonstrate the efficacy and safety profile of this new device for weight loss. METHODS: We conducted a search from 2016 to 2024 to assess the efficacy of the swallowable intragastric balloon for weight loss, including improvements in metabolic profiles and anthropometric measurements. Additionally, we evaluated potential adverse events related to the device to demonstrate its safety. RESULTS: Eleven observational studies totalling 2107 patients were included, showing a reduction of 4.75 in BMI (95% CI: -5.02; -4.47), a mean total weight loss of 12.47% (95% CI: -13.77; -11.17), a mean excess weight loss of 48.04% (95% CI: -50.61; -45.48), and a rate of serious adverse events of 0.90%. An improvement in the metabolic profile was observed for three parameters: HDL, triglycerides, and glycaemia. CONCLUSION: The swallowable liquid-filled intragastric balloon is safe and effective for managing weight loss within a four-month follow-up period.

Swallowable Intragastric Balloon: First Consecutive Experience in Argentina.

Background: Swallowable balloons are innovative devices for the treatment of obesity. Endoscopy or anesthesia for implantation is not required. They are generally well tolerated and experience reports satisfactory results in relation to weight loss. The objective of this study was to analyze the first experience with the implementation of a swallowable balloon in Argentina. Methods: It is a descriptive retrospective observational study on the treatment of obesity in patients who underwent swallowable balloons in Argentina, admitted to one center, in a period time of 12 months with a follow-up of 6 months. Results: A total of n = 153 patients were recruited between June 2021 and May 2022, 78% were women and 22% men. The average age was 39 years. Average body mass index was 29.5 kg/m2. Balloon implantation was performed with complete swallowing by the patients in 19.4% of the cases, swallowing with operator assistance in 55.5%, and swallowing with stylet assistance in 25%. The adverse effects reported were abdominal pain (80%), nausea (60%), vomiting (38%), headache (36%), gastroesophageal reflux (29%), constipation (11%), and diarrhea (7%). No deaths were reported. A mean 4-month weight loss of 12% was reported. Conclusion: Swallowable balloon for the treatment of obesity is effective, safe, and well tolerated. Adverse effects are not severe.

Nutritional and food education as a complementary treatment approach in severe obese individuals.

Background: The treatment for obesity, specifically severe obesity, is a challenge for health professionals and services. It requires a multidisciplinary and holistic approach covering the complexity and difficulties of incorporating healthy habits to prevent associated diseases and mortality. Individual intervention's methods are not enough to change eating habits. Objective: To describe and investigate the contribution of nutritional and food education as a complementary therapeutic approach in the treatment of individuals with severe obesity and their family members. Methods: A multidisciplinary team adopted a group approach. A different topic was addressed at each therapeutic meeting to assist in the nutritional treatment of obesity, such as diet and healthy habits i.e. barriers to lifestyle changes. The topics were developed based on different methodological and teaching approaches to facilitate adherence to non-drug treatment. Results: Overall, there was a greater understanding towards the adoption of healthy eating habits of the whole family, greater motivation to adhere to dietary changes and adoption of a more physical active lifestyle. This interventional educational support methodology had been accepted in such a positive way for patients and their relatives. Family member participation expands the possibilities of establishing necessary and lasting changes in the lifestyle of not only the patients, but their whole families. Conclusion: Health education actions constitute an important complementary therapeutic approach in promoting health and preventing complications in individuals with severe obesity. This article can be useful to enlarge the debate on the subject and face the challenges related to the effective treatment of obesity, notably severe obesity.

The Social Distance Impacts from COVID-19 Pandemic on the Development of Two Orders of a Concurrent Training Programme for Morbidly Obese Patients.

BACKGROUND: Although there is relevant information regarding the consequences of the coronavirus SARS-CoV-2 (COVID-19), little is known about the impact of the imposed social confinement (at home) on the development of exercise training programmes in populations with morbid obesity. AIM: To describe the effects of the imposed COVID-19 confinement on the cardiometabolic health benefits acquired through a concurrent training programme that started before the pandemic in populations with morbid obesity. METHODS: This was an experimental randomized clinical study, in which sedentary morbidly obese women were assigned 1:1 to a high-intensity interval training (HIIT) plus resistance training (RT) group (HIIT + RT; n = 11; BMI 42.1 ± 6.6) or to the same exercise dose, but in different order group of RT plus HIIT group (RT + HIIT; n = 7; BMI 47.5 ± 8.4). Both groups undertook two sessions/week. When COVID-19 confinement at home started, a post-test was applied in January 2020 (Post1) and after 20 months (Post2). The main outcomes were waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP), high-density lipids (HDL-c), triglycerides (Tg), and fasting plasma glucose (FPG). RESULTS: In the HIIT + RT group, the WC showed significant increases from Post1 to Post2 (Δ + 3.1 cm, p = 0.035); in the RT + HIIT group, it decreased from Post1 to Post2 (Δ - 4.8 cm, p = 0.028). In the HIIT + RT group, SBP showed significant increases from Post1 to Post2 (Δ + 6.2 mmHg, p = 0.041); the RT + HIIT group decreased SBP from Pre0 to Post1 (Δ - 7.2 mmHg, p = 0.026) and increased DBP from Pre0 to Post1 (Δ + 8.1 mmHg, p = 0.015). Tg in the HIIT + RT group decreased from Pre0 to Post1 (Δ - 40.1 mg/dL, p = 0.023) but increased from Post1 to Post2 (Δ + 86.3 mg/dL, p < 0.0001). CONCLUSIONS: The COVID-19 social confinement worsened metabolic syndrome (MetS) outcomes that had improved from 20 weeks' RT + HIIT during the training period, such as WC, SBP, and Tg from HIIT + RT, when, worryingly, SBP increased to another more serious clinical classification in both groups.

Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial.

The objective of this study was to analyze the effectiveness of two nonpharmacological interventions-traditional Brazilian diet (DieTBra), and extra-virgin olive oil (EVOO)-in terms of the reduction in pain and pain intensity in individuals with severe obesity. We conducted a 12-week parallel randomized clinical trial with 149 individuals (body mass index (BMI) ≥ 35 kg/m2) who were randomized into three groups: supplementation with EVOO (n = 50), DieTBra (n = 49), and EVOO + DieTBra (n = 50). Of the total, 133 individuals with a mean BMI of 46.04 kg/m2 completed the study. By the end of the follow-up, there was a reduction in severe pain in the EVOO + DieTBra group (p = 0.003). There was a significant reduction in severe pain in the EVOO + DieTBra group (-22.7%); pain in the wrist and hand (-14.1%), upper back (-26.9%), and knees (-18.4%) in the DieTBra group; and reduction in hip pain (-11.1%) with EVOO consumption. We conclude that EVOO and DieTBra, either alone or in combination, are effective interventions to reduce pain intensity and pain in different regions in individuals with severe obesity, and have great potential for clinical application.

The health care experience of individuals with morbid obesity assisted in public healthcare services.

OBJECTIVE: To understand the health care experience of individuals with morbid obesity assisted in public healthcare services. METHOD: This was a qualitative study based on Alfred Schütz's social phenomenology, carried out in the medical-surgical clinic of a public hospital in São Paulo, Brazil. Interviews with open questions were conducted between January and April 2017. RESULTS: Seventeen individuals with morbid obesity participated in the study. The findings revealed care(lessness) experiences of obese individuals in the Brazilian Healthcare System in terms of structure/logistics and human resources. Study participants shared care expectations about health care management and staff, and further considered the Primary Health Care service as a scenario of power to have their obesity-related care needs met. CONCLUSION: The findings need to be carefully (re)examined by the healthcare system's micro- and macro management, as well as by health teaching and research personnel, in order to integrate, follow up and qualify care actions towards the prevention and control of obesity in public healthcare services.

Intragastric balloon placement in the treatment of overweight and obesity: Experience at a Mexican referral center. / Colocación de balón intragástrico en el tratamiento del sobrepeso y obesidad: experiencia de un centro de referencia en México.

INTRODUCTION AND AIM: Intragastric balloon therapy is a temporary, minimally invasive method for inducing weight loss. Any balloon with a volume of 400mL induces satiety and delayed gastric emptying. The aim of the present study was to demonstrate its safety and efficacy. MATERIALS AND METHODS: We analyzed the safety and effectiveness of balloon placement in relation to weight loss in 128patients. Subgroups were compared through the Student's t test, ANOVA test, and the chi-square test, depending on the type of variable and the number of groups evaluated. Statistical significance was set at a P≤.05 to evaluate weight loss. RESULTS: Mean weight loss after balloon therapy was 10.7kg, with only 2 cases of complications due to oral feeding intolerance. Mean length of time with the balloon was 8months. There were no complications after 6months, but no further weight loss either (P=.540). Final weight loss versus initial weight loss was significant (P=.000). There was greater weight loss in the group that attended the bimonthly control appointments than in the group that did not: 12.7kg vs. 7.26kg (P=.000). CONCLUSIONS: The rates of the adverse events of intolerance and complications were very low in our study, compared with results in the literature: 1.6% vs. 4.7% and 0% vs. 3%, respectively. Intragastric balloon placement had better results when the patients attended the control appointments. Intragastric balloon therapy is a safe and efficacious method for reducing weight in patients with overweight and obesity.

Effect of Surgical Versus Medical Therapy on Diabetic Kidney Disease Over 5 Years in Severely Obese Adolescents With Type 2 Diabetes.

OBJECTIVE: To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS: A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ≥135 mL/min/1.73 m2) and elevated UAE (≥30 mg/g) were assessed annually. RESULTS: Participants with T2D from Teen-LABS (n = 30, mean ± SD age, 16.9 ± 1.3 years; 70% female; 60% white; BMI 54.4 ± 9.5 kg/m2) and TODAY (n = 63, age 15.3 ± 1.3 years; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS: Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.

Interplay between the Adaptive Immune System and Insulin Resistance in Weight Loss Induced by Bariatric Surgery.

Low-grade chronic inflammation plays a pivotal role among other pathophysiological mechanisms involved in obesity. Innate and adaptive immune cells undergo systemic proinflammatory polarization that gives rise to an increased secretion of proinflammatory cytokines, which in turn leads to insulin resistance. Bariatric surgery is currently the most effective treatment for obesity, as it brings on significant weight loss, glucose metabolism improvement, and a decrease in systemic inflammation biomarkers. After bariatric surgery, several changes have been reported to occur in adaptive immunity, including reduction in CD4+ and CD8+ T cell counts, a decrease in the Th1/Th2 ratio, an increase in B regulatory cells, and reduction in proinflammatory cytokine secretion. Overall, there seems to be a major shift in several lymphocyte populations from a proinflammatory to an anti-inflammatory phenotype. Furthermore, increased antioxidant activity and reduced lipid and DNA oxidation products have been reported after bariatric surgery in circulating mononuclear cells. This paper highlights the shift in the adaptive immune system in response to weight loss and improved insulin sensitivity, as well as the interplay between immunological and metabolic adaptations as a result of bariatric surgery. Finally, based on data from research, we propose several mechanisms such as changes in adaptive immune cell phenotypes and their by-products, recruitment in adipose tissue, reduced oxidative stress, and modification in metabolic substrate availability as drivers to reduce low-grade chronic inflammation after bariatric surgery in severe obesity.

Perímetro de cuello y éxito del tratamiento de pacientes con obesidad: estudio de vida real.

INTRODUCTION: Evaluation of the patient with obesity is a challenge due to the technical difficulties to carry out measurements. OBJECTIVE: To assess the association between neck circumference (NC) and waist circumference (WC) with cardio-metabolic risk markers, as well as treatment success in patients with morbid obesity. METHOD: Four-hundred and seventy patients of 39.3 ± 11.4 years of age and with a body mass index (BMI) of 44.1 ± 8.4 were studied; 73.5% were females. Baseline and final BMI, WC, NC, hip circumference and cardio-metabolic markers were assessed. Success was defined as weight loss ≥ 5%. RESULTS: Significant correlations were found between WC and NC, and between these and cardio-metabolic risk markers, as well as between changes in WC and NC and treatment success. NC predicted success in logistic regression models. CONCLUSIONS: The association of WC and NC with cardio-metabolic risk indicators and the association of NC with treatment success in patients with morbid obesity was documented. Given the simplicity for obtaining it, NC might replace WC in the assessment and follow-up of patients with class III obesity.

INTRODUCCIÓN: La evaluación del paciente con obesidad es un reto debido a las dificultades técnicas para efectuar las mediciones. OBJETIVO: Evaluar la asociación entre el perímetro de cuello (PCu) y el de cintura (PC) con marcadores de riesgo cardiometabólico y el éxito del tratamiento de pacientes con obesidad mórbida. MÉTODO: Se estudiaron 470 pacientes de 39.3 ± 11.4 años e índice de masa corporal de 44.1 ± 8.4; 73.5 % era del sexo femenino. Se evaluó índice de masa corporal, PC, PCu, perímetro de cadera y marcadores cardiometabólicos basales y finales. Se definió como éxito a una pérdida ponderal ≥ 5 %. RESULTADOS: Se encontraron correlaciones significativas entre PC y PCu y entre estos y marcadores de riesgo cardiometabólico, así como entre los cambios en PC y PCu y el éxito en el tratamiento. El PCu predijo el éxito en modelos de regresión logística. CONCLUSIONES: Se documentó la asociación entre PC y PCu con indicadores de riesgo cardiometabólico y la asociación del PCu con éxito en el tratamiento en pacientes con obesidad mórbida. Dada la sencillez de su obtención, el PCu podría sustituir al PC en la evaluación y seguimiento de pacientes con obesidad clase III.

Effects of Inspiratory Exercise With Linear and Nonlinear Load on Respiratory Variables Post-Bariatric Surgery.

BACKGROUND: Obesity leads to changes in respiratory function, causing reduced lung volumes and mechanical disadvantage of the respiratory muscles. We sought to evaluate the effect of breathing exercises using devices that impose linear and nonlinear load on reversing diaphragm dysfunction and the prevalence of atelectasis after bariatric surgery. METHODS: This was a blind randomized clinical trial. Preoperatively, we assessed the subjects' maximum inspiratory pressure by measuring nasal inspiratory pressure and respiratory muscle endurance with an incremental test based on sustained maximum inspiratory pressure (sustained PImax) and the prevalence of atelectasis by chest radiograph. Subjects were then randomized into 2 groups: a linear load pressure group and nonlinear load pressure group; both groups received conventional respiratory physiotherapy. Subjects were reassessed on the second day after bariatric surgery. RESULTS: We included 40 morbidly obese women (body mass index > 40 kg/m2), age 25-55 years, who underwent bariatric surgery by laparotomy. The groups were homogeneous with respect to age (P = .11), body mass (P = .12), height (P = .75), body mass index (P = .75), nasal inspiratory pressure (P = .48), sustained PImax (P = .89), and absence of atelectasis at baseline. In the reassessment, both groups showed significant reduction in nasal inspiratory pressure (P < .001) and maintenance of sustained PImax (linear load pressure P = .51; nonlinear load pressure P = .055). The prevalence of atelectasis was 15% for linear load pressure and 25% for nonlinear load pressure, with no significant difference between groups (P = .69). CONCLUSION: Both groups were able to maintain respiratory muscle endurance after bariatric surgery. In addition, the treatment contributed to controlling atelectasis so that it did not cause clinical repercussions to the subjects. (ClinicalTrials.gov registration NCT02298517).

Preventing metabolic syndrome in morbid obesity with resistance training: Reporting interindividual variability.

BACKGROUND AND AIMS: Resistant training (RT) improves health markers in obesity, but its effects in morbid obesity are unknown. We aimed to determine the effects of a RT-program in preventing/attenuating the metabolic syndrome (MetS) in patients with morbid obesity. A second aim was to report the interindividual variability in terms of improvements in MetS markers and other related co-variables. METHODS AND RESULTS: Twenty-one adults with obesity or morbid obesity were divided into two groups based on body mass index (BMI): a control obesity (CO, n = 7, BMI ≥35 < 40.0 kg/m2) and a morbid obese group (MO, n = 14, BMI ≥40 kg/m2). Participants completed a 20-week RT-program (3 sessions/week, 4-8 exercise) using free weights. Participants were assessed for MetS markers (waist circumference, systolic and diastolic blood pressure [BP], fasting glucose, high-density lipoproteins, and triglycerides) and other co-variables (total cholesterol, low-density lipoprotein, one-maximum repetition of biceps curl, and handgrip strength, 6 min walking test). Significant reductions in MetS markers were observed in both CO and MO groups (P < 0.05 to P < 0.0001), but significant reductions in diastolic BP and increases in HDL-C were noted only in the MO group (P < 0.0001). Changes in waist circumference, and systolic and diastolic BP were significantly greater only in the MO group (P < 0.001), but the CO group presented a greater fasting glucose decreases (P < 0.0001). The prevalence of non-responders between CO and MO groups was similar in the MetS outcomes. CONCLUSIONS: RT promotes greater improvements in overall MetS outcomes waist circumference, BP, and plasma triglycerides in patients with morbid obesity than in obese peers, with no overall differences in the prevalence of non-responders. CLINICAL TRIAL NUMBER: NCT03921853 at www.clinicaltrials.gov.

Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System.

PURPOSE: Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system. MATERIALS AND METHODS: A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate. RESULTS: Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs. CONCLUSION: The study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.

A Review of Modifiable Risk Factors for Severe Obesity in Children Ages 5 and Under.

Early-onset severe obesity in childhood presents a significant clinical challenge signaling an urgent need for effective and sustainable interventions. A large body of literature examines overweight and obesity, but little focuses specifically on the risk factors for severe obesity in children ages 5 and younger. This narrative review identified modifiable risk factors associated with severe obesity in children ages 5 and younger: nutrition (consuming sugar sweetened beverages and fast food), activity (low frequency of outdoor play and excessive screen time), behaviors (lower satiety responsiveness, sleeping with a bottle, lack of bedtime rules, and short sleep duration), and socio-environmental risk factors (informal child care setting, history of obesity in the mother, and gestational diabetes). The lack of literature on this topic highlights the need for additional research on potentially modifiable risk factors for early-onset severe obesity.

Abdominoplastia en pacientes posbariátricos. Técnicas más usadas / Abdominoplasty in postbariatric patients. Most used techniques

Con el gran avance y caudal de cirugía bariátrica y metabólica en los últimos años ofrecida a los pacientes con obesidad mórbida, el cirujano plástico debería estar preparado para poder realizar las reconstrucciones quirúrgicas necesarias de estos pacientes una vez que estabilizan su peso. El presente trabajo hace referencia a las técnicas más usadas en abdominoplastia de los pacientes post-bariátricos, teniendo en cuenta la evaluación prequirúrgica tanto física como el entorno psicológico, asi como la prevención y el estudio de sus posibles complicaciones.

Abstract: With the great advance and volume of bariatric and metabolic surgery in recent years offered to patients with morbid obesity, the plastic surgeons hould be prepared to be able to perform the necessary surgical reconstructions of these patients once they stabilize their weight. The present work refers to the most used techniques in abdominoplasty of postbariatric patients, taking into account the pre-surgical evaluation both physical and psychological environment, as well as the prevention and study of its possible complications.

An Open-Label Clinical Trial of Hypothalamic Deep Brain Stimulation for Human Morbid Obesity: BLESS Study Protocol.

BACKGROUND: Human morbid obesity is increasing worldwide in an alarming way. The hypothalamus is known to mediate its mechanisms. Deep brain stimulation (DBS) of the ventromedial hypothalamus (VMH) may be an alternative to treat patients refractory to standard medical and surgical therapies. OBJECTIVE: To assess the safety, identify possible side effects, and to optimize stimulation parameters of continuous VMH-DBS. Additionally, this study aims to determine if continuous VMH-DBS will lead to weight loss by causing changes in body composition, basal metabolism, or food intake control. METHODS: The BLESS study is a feasibility study, single-center open-label trial. Six patients (body mass index > 40) will undergo low-frequency VMH-DBS. Data concerning timing, duration, frequency, severity, causal relationships, and associated electrical stimulation patterns regarding side effects or weight changes will be recorded. EXPECTED OUTCOMES: We expect to demonstrate the safety, identify possible side effects, and to optimize electrophysiological parameters related to VMH-DBS. No clinical or behavioral adverse changes are expected. Weight loss ≥ 3% of the basal weight after 3 mo of electrical stimulation will be considered adequate. Changes in body composition and increase in basal metabolism are expected. The amount of food intake is likely to remain unchanged. DISCUSSION: The design of this study protocol is to define the safety of the procedure, the surgical parameters important for target localization, and additionally the safety of long-term stimulation of the VMH in morbidly obese patients. Novel neurosurgical approaches to treat metabolic and autonomic diseases can be developed based on the data made available by this investigation.

Prevalência da compulsão alimentar periódica e desenvolvimento de obesidade grave / Prevalence of periodic binge eating and the development of severe obesity

Objetivo: Avaliar a prevalência de compulsão alimentar periódica. Métodos: Estudo descritivo transversal, com 49 pacientes candidatos à cirurgia bariátrica, em acompanhamento pré-cirúrgico, submetidos à anamnese direcionada e aos quais foi aplicada a Escala de Compulsão Alimentar Periódica. Resultados: A média de idade foi de 39,18±10,38 anos, sendo a maioria do sexo feminino (79,59%). O peso e o índice de massa corporal médios da amostra foram respectivamente 131,89±25,78kg e 49,72±6,79kg/m². As comorbidades mais prevalentes foram hipertensão arterial sistêmica (55,10%) e diabetes mellitus (30,61%). Dos 49 entrevistados, 10 (20,40%) apresentaram pontuação compatível com compulsão alimentar periódica, sendo moderada em 8 (16,32%) e grave em 2 pacientes (4,08%). Houve relação entre a presença de compulsão alimentar periódica e menor tempo de obesidade. Conclusão: A prevalência de compulsão alimentar periódica nos pacientes candidatos à cirurgia bariátrica analisados foi semelhante ao descrito na literatura e parece haver relação inversa entre compulsão alimentar e velocidade de ganho de peso. São necessários estudos maiores para confirmar nossos achados.

Objective: To evaluate the prevalence of binge eating disorder. Methods: Cross-sectional descriptive study with 49 patients that are candidates for bariatric surgery in the presurgical monitoring, who underwent directed anamnesis and then had the Binge Eating Scale (BES) applied. Results: The average age was 39.18±10.38 years, with most of them being female (79.59%). Average weight and body mass index (BMI) were respectively 131.89±25.78kg, and 49.72±6.79kg/m². The most prevalent comorbidities were hypertension (55.10%) and Diabetes Mellitus (30.61%). Of the 49 patients interviewed, 10 (20.40%) had a score that was consistent with binge eating disorder, moderate in 8 (16.32%), and severe in 2 patients (4.08%). There was a relation between the presence of binge eating disorder and shorter time of obesity. Conclusion: The prevalence of binge eating disorder in patients eligible for bariatric surgery in this study was similar to that described in the literature, and there seems to be an inverse relation between binge eating and weight gain velocity. Further, larger studies are necessary to confirm these findings.

Estimated Costs of Clinical and Surgical Treatment of Severe Obesity in the Brazilian Public Health System.

BACKGROUND: Obesity is a major global epidemic and a burden to society and health systems. This study aimed to estimate and compare the anual costs of clinical and surgical treatment of severe obesity from the perspective of the Brazilian Public Health System. METHODS: An observational and cross-sectional study was performed in three reference centers. Data collection on health resources utilization and productivity loss was carried out through an online questionnaire. Participants were divided in clinical (waiting list for a bariatric surgery) and surgical groups (open Roux-en-Y gastric bypass), and then allocated by the time of surgery (up to 1 year; 1-2 years; 2-3 years; and >3 years). Costs of visits, medications, exams, and surgeries were obtained from government sources. Data on non-medical costs, such as transportation, special diets, and caregivers, were also colleted. Productivity loss was estimated using self-reported income. Costs in local currency (Real) were converted to international dollars (Int$ 2015). RESULTS: Two hundred and seventy-four patients, 140 in surgical group and 134 in clinical group were included. In first postoperative year, the surgical group had higher costs than clinical group (Int$6005.47 [5000.18-8262.36] versus 2148.14 [1412.2-3506.8]; p = 0.0002); however, from the second year, the costs decreased progressively. In the same way, indirect costs decreased significantly after surgery (259.08 [163.63-662.72] versus 368.17 [163.62-687.27]; p = 0.06). CONCLUSION: Total costs were higher in the surgical group in the first 2 years after surgery. However, from the third year on, the costs were lower than in the clinical group.

Tratamento multiprofissional para adultos obesos grau III / Tratamiento multidisciplinario para los adultos obesos grado III / Multidisciplinary treatment for third degree obese adult

Introdução: as doenças e agravos não transmissíveis vêm aumentando e, no Brasil, são as principais causas de óbitos em adultos, sendo a obesidade um dos fatores de maior risco para o adoecimento neste grupo. Objetivo: identificar as evidências disponíveis na literatura sobre o tratamento multiprofissional para adultos obesos grau III e a inserção da enfermagem nesse contexto. Métodos: a coleta de dados foi realizada nas bases de dados LILACS, IBECS, MEDLINE e BDENF nos anos de 2004 a 2014 em inglês, português, espanhol e francês. Foram encontradas 385 publicações, das quais 9 atenderam aos critérios de seleção. Resultados: foi possível identificar como é realizado o tratamento para obesos grau III e a importância de uma equipe multiprofissional para o sucesso do mesmo. A prevalência dos artigos encontrados faz referência direta à assistência de enfermagem aos pacientes obesos em processo de pré, trans e pós-operatório, seja para cirurgia bariátrica, ou outros processos cirúrgicos. Conclusões: o trabalho em equipe é essencial para auxiliar a minimizar os danos à saúde de pacientes obesos mórbidos e iniciar um processo de mudança de estilo de vida(AU)

Introducción: las enfermedades no transmisibles han ido en aumento y, en Brasil, son las principales causas de muerte en los adultos, la obesidad es uno de los mayores factores de riesgo para la enfermedad en este grupo. Objetivo: identificar la evidencia disponible en la literatura sobre el tratamiento multidisciplinar para adultos obesos grado III y la inserción de enfermería en este contexto. Métodos: los datos fueron recogidos en las bases de datos LILACS, IBECS, MEDLINE y BDENF en 2004 a 2014 en inglés, Portugués, español y francés. Se encontraron 385 publicaciones, de las cuales 9 se reunieron los criterios de selección. Resultados: fue posible identificar cómo el tratamiento para obeso grado III y la importancia de un equipo multidisciplinario para el éxito. Hubo prevalencia de artículos con referencias directas a la atención a pacientes obesos en el proceso de pre, trans y postoperatorio para la cirugía bariátrica, o de otros procedimientos quirúrgicos de enfermería. Conclusiones: el trabajo en equipo es esencial para ayudar a minimizar el daño a la salud de los pacientes con obesidad mórbida e iniciar un proceso de cambio de estilo de vida(AU)

Introduction: Noncommunicable diseases have been increasing. In Brazil, thay are the main cause of death in adults; obesity is one of the major risk factors for disease in this group. Objective: To identify the evidence available in the literature about multidisciplinary treatment for third degree obese adults and the nursing's insertion into this context. Methods: Data were collected from the LILACS, IBECS, MEDLINE and BDENF databases from 2004 to 2014, in English, Portuguese, Spanish, and French. We found 385 publications, out of which 9 met the selection criteria. Results: It was possible to identify the treatment for the third degree obese and the importance of a multidisciplinary team for success. There was prevalence of articles with direct references to the care of obese patients in the pre-, trans- and post-operative process for bariatric surgery, or other nursing surgical procedures. Conclusions: Teamwork is essential to help minimize health damage of morbidly obese patients and to initiate a process in lifestyle change(AU)

Utilização de balão intragástrico e perda de peso em pacientes em um centro de referência no Rio Grande do Sul / Use of intragastric balloon and weight loss in patients at a reference center in Rio Grande do Sul

Objetivo: Estudar a relação entre perda de peso e a utilização de balão intragástrico. Método: Estudo transversal prospectivo desenvolvido com 50 usuários de balão intragástrico em um centro de referência em aparelho digestório no Rio Grande do Sul. Foi calculado o índice de massa corporal (IMC), dividindo-se o peso (quilograma) pela altura (metro) elevada ao quadrado e considerado normal IMC<25; como sobrepeso 25-29,9;IMC 30-34,9 como obesidade grau I; IMC 35-39,9 como obesidade grau II e IMC>40 obesidade grau III, conforme Organização Mundial da Saúde (OMS)/2000. Resultados: Foram avaliados 50 pacientes com estado nutricional entre sobrepeso e obesidade grau III, conforme classificação da OMS/2000. Em relação à porcentagem de perda de peso, observou-se que 46% dos pacientes tiveram uma perda entre 10-15 kg, 24% perda menor que 10 kg, 22% perda entre 15-20 kg e 8% perda maior de 20 kg. Conclusão: Embora a perda média fique entre 15 a 20% do peso inicial, esta perda seja extremamente variável e dependa de vários fatores, como peso inicial, adaptação, volume de preenchimento, disposição emocional para mudanças, adesão ao controle clínico e nutricional, grau de atividade física, metabolismo basal, a motivação e a disciplina para implantar as mudanças são os grandes determinantes deste resultado. Contudo, podemos observar, no presente estudo, evidências sobre a eficácia do tratamento com balão intragástrico em pacientes obesos.(AU)

Objective: To study the relationship between weight loss and use intragastric balloon. Methods: A prospective cross-sectional study was carried out with 50 intragastric balloon users at a reference center in a gastrointestinal tract in RS. The body mass index (BMI) was calculated by dividing the weight (kilogram) by the height (meter) elevated squared and considered normal BMI <25; As overweight 25-29.9; BMI 30-34.9 as obesity grade I; BMI 35-39,9 as obesity grade II and BMI> 40 obesity grade III according to World Health Organization (WHO)/ 2000. Results: Fifty patients with nutritional status between overweight and grade III obesity were evaluated, according to WHO / 2000 classification. Regarding the percentage of weight loss, it was observed that 46% of the patients had a loss between 10-15 kg, 24% a loss less than 10 kg, 22% loss between 15-20 kg and 8% loss greater than 20 kg. Conclusion: Although the average loss is between 15 and 20% of the initial weight, this loss be extremely variable and depends on several factors such as initial weight, adaptation, filling volume, emotional disposition for changes, adherence to clinical and nutritional control, degree of physical activity, basal metabolism, motivation and discipline to implant the changes are the major determinants of this result. However, we can observe in the present study evidence on the efficacy of intragastric balloon treatment in obese patients.(AU)