Resultado do tratamento clínico intensivo da obesidade hospitalizado e sua avaliação após um ano
Outcome of hospitalized intensive clinical treatment of obesity and its evaluation after one year.
Introdução: A obesidade é uma doença crônica associada ao desenvolvimento de várias comorbidades. Seu tratamento é difícil e com grandes chances de insucesso e má adesão. O objetivo deste estudo é descrever o resultado do tratamento baseado em dieta de baixa e muito baixa caloria associada à atividade física em obesos.
Introduction: Obesity is a chronic disease associated with the development of several comorbidities. Their treatment is difficult and with high chances of failure and poor adherence. The objective of this study is to describe the treatment outcome based on a low and very low calorie diet associated with physical activity in obese individuals.
Métodos: Trata-se de uma coorte retrospectiva que acompanhou adultos obesos internados em uma clínica de tratamento de obesidade em Camaçari, Bahia, Brasil, no período entre maio de 2012 e outubro de 2015, e sua evolução por um período de um ano após a alta. O tratamento foi dividido em duas fases. A primeira fase foi intensiva, em regime de internação e os pacientes eram submetidos à dieta entre 500 e 1000 Kcal/dia, prática diária de atividade física e acompanhamento multidisciplinar. A segunda fase é chamada de manutenção, nesta o paciente deveria frequentar mensalmente a clínica com objetivo de manter o resultado obtido na fase inicial. Foi considerado sucesso de tratamento uma perda maior ou igual a 50% do peso em excesso e a adesão ao tratamento foi definida por frequência de pelo menos 50% nas manutenções.
Methods: This is a retrospective cohort that accompanies obese adults hospitalized at an obesity treatment clinic in Camaçari, Bahia, Brazil, between May 2012 and October 2015, and its evolution for a period of one year after ALTA MÉDICA. Treatment was divided into two phases. The first phase was intensive, hospitalized and the patients were submitted to a diet of between 500 and 1000 Kcal / day, practice of physical activities and multidisciplinary follow up. The second phase is called maintenance, in which the patient should attend the clinic monthly in order to maintain the result obtained in the initial phase. A treatment success was considered a weight loss greater than or equal to 50% of the excess weight and adherence to treatment was defined as a frequency of at least 50% in maintenance.
Resultados: Oitenta e seis obesos entre 20-59 anos, 60 (73%) mulheres, com média de peso de 121 (±23) kg e IMC de 43,6 (±6) kg/m2 foram admitidos para tratamento intensivo. O tempo de internamento teve duração de aproximadamente 179 (±70) dias. Ao final da fase inicial do tratamento, 21 (24%) alcançaram o sobrepeso e 80 (93%) da amostra tiveram sucesso no tratamento. Ao avaliar a fase de manutenção, a adesão ao tratamento foi de 44,2%ao final do primeiro semestre após alta e de 36,1% ao final de um ano. O sucesso de tratamento com perda ≥ 50% do peso em excesso foi mantido em 90,3% dos 31 pacientes aderentes ao final de um ano.
Results: Eighty six obese women aged 20-59 years, 60 (73%) women, with a mean weight of 121 (± 23) kg and a BMI of 43.6 (± 6) kg / m2 were hospitalized for intensive treatment. The length of hospital stay lasted approximately 179 (± 70) days. At the end of the initial phase of treatment, 21 (24%) ESTAVAM/ALCANÇARAM overweight and 80 (93%) of the sample was successful in the treatment. When evaluating the maintenance phase, adherence to treatment was 44.2% at the end of the first semester after ALTA HOSPITALAR and 36.1% at the end of one year. Successful treatment with weight loss ≥ 50% of excess weight was maintained in 90.3% of the 31 adherent patients at the end of one year.
Conclusão: O tratamento intensivo da obesidade baseado em atividade física e dieta de baixa e muito baixa caloria, além de acompanhamento multidisciplinar foi eficaz e obteve elevado sucesso entre os pacientes com adesão ao acompanhamento de um ano após a alta da fase intensiva. Esse dado nos alerta para a necessidade de buscar formas de aumentar a adesão ao tratamento da obesidade.
Conclusion: The intensive treatment of obesity based on physical activity and diet of low and very low calorie, in addition to multidisciplinary follow up was effective and obtained a high success among the patients with adherence to the follow up one year after the medical discharge ( ALTA MÉDICA) of the intensive phase. This fact alerts us to the need to seek ways to increase adherence to the treatment of obesity.
1. Conflito de Interesses:
Não há conflitos de interesse
2. Financiamento:
Nenhum financiamento
part of the stomach, thus creating a narrow sleeve. Aspects of interest in this context are de-novo re ux and its possible e ects, such as esophagitis and Barrett’s esophagus, as well as adequate weight loss in a long-term follow-up.
Method: is cross-sectional study of the rst 100 lsg patients was conducted in a multi-center setting (participating bariatric centers were Vienna Medical University, Klosterneuburg Hospital, Vienna Rudolfssti ung Hospital). e mean follow-up was between 10 and 14 years. Data on weight loss success, complications and reoperations was collected from all participating patients. Non-converted patients were also asked to complete questionnaires about their quality of life (baros, sf36, giqol, bql). Patients also received gastroscopies (including biopsies), manometry and 24h pH-metries.
Results: ese rst 100 patients, treated in one of the three bariatric centers mentioned above, had their Sleeve gastrectomy between 2003 and 2006. A third of them was converted to a Roux-en-Y gastric bypass within the follow-up period. Today, half of the patients who were not converted are from active gastritis and ulcers; Barrett’s metaplasia at the gastro esophageal junction was found in 15%. e 24-h pH-metry and manome try’s results were pathological for 50% of the non-converted patients. Primary Sleeve patients as well as those who were converted in the follow-up period managed an Excess Weight Loss (%ewl) of 50% at 10 years or more. Data on patients’ quality of life will be presented at the congress as well.
Conclusion: e results of this longterm study reveal that 10 years a year a number of patients has had to deal with conversions and/or postoperative re ux and weight regain. It suggests that a careful selection of patients is necessary when considering lsg.
T3P219
Weight regain after vertical gastric plication: Sleeve gastrectomy or Roux-en-Y gastric bypass as a salvage procedure? Analysis of the rst 100 consecutives.
Chahine, E.1; Hayek, M.1; Dirani, M.1; D´Alessandro, A.1; Chouillard, E.1 1POISSY-saint-germain-EN-LAYE medical center
Introduction: Bariatric surgery is the best available long-term treatment in patients with morbid obesity. Vertical Gastric Plication (gp) has been recently performed as a weight loss procedure in France. Despite its relative, short-term safety and e cacy, long-term results of gp are still controversial. The goal of this study was to assess the indications and outcome of revision for weight regain in patients with gp.
Methods: Patients were prospectively included in a database, with regular assessment of both results, and complications, respectively. Weight regain or insufficient weight loss were initially treated conservatively in all patients through clinical, biological, endoscopic and radiologic assessment. If conservative treatment was unsuccessful or in case of anatomical anomaly, surgical revision was indicated.
Results: Between February 2010 and September 2015, 100 patients had gp. Of these, 20 were lost to follow-up. The rate of patients with excess weight loss (ewl) > 50% was only 50%. The remaining 40 patients had either inadequate weight loss (22 patients) or weight regain (18 patients) and eventually required revisional surgery. Roux en Y Gastric Bypass (rygb) was performed in 24 patients (60%). Sleeve Gastrectomy (sg) was performed in 16 patients (40%). Median interval from gp to revision was 29 months (range, 18–41). Mean operative time was 168 min (range, 100– 228). Median length of stay was 3 days (range, 2–5). Major complications occurred in 2 patients (5%) including one stula and one intra-abdominal abscess, both a er sg.
Conclusions: Vertical Gastric Plication is associated to high rates of weight regain or inadequate weight loss. As compared to sg, rygb seems to be a safer revisional procedure a er gp.
None Disclosed/Payment received.
No Funding/Research relating to this abstract was funded.
T3P221
What do resident physicians know about nutrition?
Coelho, C.1; Souto, S.1
1Hospital de Braga
Introduction: Nutrition is one of the pillars of disease prevention. How ever, the curriculum of medical schools does not contemplate this eld in a satisfactory manner. e aim of this survey was to better understand clinical nutrition knowledge among resident physicians in a university hospital.
Methods: A questionnaire was sent to the institutional email address of 201 resident physicians working in Braga Hospital during 2015 and shared on a digital platform. the questionnaire was based on a non-val idated questionnaire used in a population of Canadian physicians(1). It included 12 multiple-choice questions and general queries about nutrition training in university.
Results: Completed questionnaires were received from 24,8% physicians (n = 50). the average of correct answers was 58%. there were no differences between gender or medical specialities. Training in nutrition during university was below 10 hours in the majority of the physicians, 82%. There were two questions with 100% correct answers: a common nutrient deficiency in alcoholics (correct answer – vitamin B1/thiamin) and the nutrient strongly associated with the prevention of neural tube defects (correct answer – folate). These two questions were also the highest scoring in the Canadian physicians survey. On the other hand, the question with the least correct answers, 14%, was: which substance raises the blood hdl-cholesterol level (correct answer – alcohol).
Conclusion: There is a substantial lack of training in nutrition in Portuguese physicians.
Reference:
1 Temple nj Journal of the American College of Nutrition Survey of Nutrition Knowledge of Canadian Physicians. 1999;(February 1999):37–41
Con ict of Interest: None disclosed
Funding: No Funding
T3P224
Will there be a di erence between weight loss among individuals with grade III obesity and superobesity undergoing the same intensive hospital treatment?
Braga, S.1; Leal, V.1; Reis, D.1; Sholl,J.1; Freitas, L.1
1Clínica da Obesidade
Introduction: Obesity is a chronic disease, with a multifactorial etiology, which causes important damages to the health of the individual. e se verity of obesity is characterized by the Body Mass Index (bmi), the higher the bmi, the greater the risk of morbidity and mortality
Methods: is a retrospective cohort that compared the weight evolution of two groups with different bmi. Group 1 was composed of obese individuals with grade 3 (bmi 40 – 49.9 kg / m²) and group 2 with super obese individuals (bmi ≥ 50 kg / m²). All patients were hospitalized at an obesity treatment clinic in Camaçari, Bahia, Brazil, between the years of 2012 to 2016 and their weight evolution six months after discharge was recorded. During the treatment, patients were submitted to the very low calorie diet (500 to 1000 Kcal / day), daily practice of physical activity and multidisciplinary follow-up. e success of the treatment was considered when there was weight loss over 50% of the excess weight
Results: 82 medical records were analyzed, of which 52 (62.6%) were women and the mean age was 39.9 (± 11) years. At admission, 67 (82%) were grade 3 obese (mean bmi of 43.4 (± 3) kg / m²) and 15 (18%) were diagnosed as having superobesity (mean bmi of 54.6 (± 5) kg / M²), mean length of hospital stay was 121 (± 17) days and 158 (± 20) days, respec
tively. At the end of treatment, there was a reduction of 64.3 (± 9)% of the excess body weight between the individuals in group 1 and 68.7 (± 10)% among the individuals in group 2, resulting in a nal bmi of 31.5 (± 3) kg / m² and 34.3 (± 3) kg / m² respectively. When weight loss is evaluated.
Obes Facts 2017;10(suppl 1):1–259 219.
Agendamento
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