研究发现:减重手术后的行为是关键


  【24drs.com】大部份减重手术研究都着重于术前的变项,现在,探讨术后因素的一篇研究显示,评估术后的体重管理实务与饮食行为、以及使用的有问题的物质,都会显著影响患者的体重减轻情况。
  
  Grand Forks北达柯他大学医学与健康科学院James E. Mitchell医师等人,在4月20日JAMA Surgery期刊在线发表「Longitudinal Assessment of Bariatric Surgery-2 (LABS-2)」这篇研究的结果。
  
  作者们写道,特别的是,资料显示,行为发生正向改变-包括停止负面行为或增加正面行为,可以影响减重量。
  
  为了使严重肥胖成年人的减重手术效果达到最好,必须厘清与术后成功减重有关的因素,因此,作者们进行了一篇研究,评估严重肥胖成年人减重手术之后,减重量的术后预测因子。
  
  LABS-2研究包括了减重术后的2,022名患者,其中1,513人是进行Roux-en-Y胃绕道手术(RYGB),509人进行腹腔镜可调整式胃束带手术(LAGB),所有研究对象都是在2006年3月至2009年4月间首次进行减重手术,追踪到2012年9月。
  
  在术前对这些患者进行调查,术后每年调查一次、进行3年;这些调查检视了25项被视为可调整的术后行为,包括饮食行为及问题、减重实务、使用有问题的物质等相关行为。
  
  研究对象的平均年龄为47岁,身体质量指数中位数为46,78%是女性;减重手术后3年,观察到的减重百分比中位数,RYGB组是开始时体重的31.5%、LAGB组是16.0%。
  
  进行RYGB的患者中,对于3年追踪期间的体重变化差异,有三项行为可以解释大部份(16%)的变异性。特别是,每周自己量体重一次者、感到饱足时停止进食者、不再整天吃不停者,减重量达开始时体重的平均38.8%,比没有这些行为的研究对象(平均:-24.6%;平均差异:-14.2%; 95%信赖区间[CI], -18.7% 至 -9.8%;P < .001) 多了约14%,比已经长期使用这些健康行为者(平均:-33.2%;平均差异:-5.7%;95% CI, -7.8%至-3.5%;P < .001)多6%。
  
  Mitchell医师等人指出,LAGB组也获得类似的结果。他们写道,这篇研究的结果认为,某些行为、其中多数是可调控的,对进行RYGB或LAGB患者的减重差异程度有显著影响,这个差异幅度大且具有临床意义。特别是,资料认为,行为发生正向改变,包括减少负面行为或增加正面行为,都可以影响减重量。
  
  作者们因此强调,对进行减重手术后的患者,医师们应着重在这些行为。他们结论指出,减重手术后,调整有问题的饮食行为与饮食模式的结构化问题,应进行评估,以改善进行减重手术者的减重结果。
  
  在编辑评论中,来自密西根州VA Ann Arbor Healthcare System的Amir A. Ghaferi医师、Marilyn Woodruff, MSN, ANP-BC与Jenna Arnould, MS, RD强调,减重手术提供者应寻求更佳的纵向管理办法。
  
  不过,他们也指出,当要区分患者的行为因素与荷尔蒙或遗传因素对于减重手术后减重情况的影响时,照护者也面临一些困难。
  
  他们结论表示,目前我们应该为我们的患者提供一个可以最大程度遵守最佳实务的基础架构,同时注意避免采用一体适用的方法。
  
  资料来源:http://www.24drs.com/
  
  Native link:Behavior After Bariatric Surgery Key, Study Finds

Behavior After Bariatric Surgery Key, Study Finds

By Nicola M. Parry, DVM
Medscape Medical News

Preoperative variables have been the focus of numerous bariatric surgery studies. Now a study looking at postoperative factors demonstrates that assessing weight management practices and eating behaviors after surgery, as well as problematic substance use, can significantly affect how much weight a patient loses.

James E. Mitchell, MD, from the University of North Dakota School of Medicine and Health Sciences, Grand Forks, and colleagues published the results of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study online April 20 in JAMA Surgery.

"In particular, the data suggest that developing positive changes in behavior, including ceasing negative behaviors or increasing positive behaviors, can affect the amount of weight loss," the authors write.

To maximize the favorable effects of bariatric surgery in severely obese adults, it is essential to identify factors that are associated with successful weight loss after surgery. Therefore, the authors conducted a study to evaluate postoperative predictors of the amount of weight loss after bariatric surgery in severely obese adults.

The LABS-2 study included 2022 post–bariatric surgery patients, of whom 1513 had undergone Roux-en-Y gastric bypass (RYGB) and 509 had undergone laparoscopic adjustable gastric banding (LAGB). All participants were undergoing first-time bariatric surgery between March 2006 and April 2009, and were followed up until September 2012.

Surveys were conducted on participants before surgery and then annually after surgery for 3 years. The surveys examined 25 postoperative behaviors that are considered modifiable, including those related to eating behaviors and problems, weight loss practices, and problematic substance use.

The median age of study participants was 47 years, and the median body mass index was 46; 78% were women. Three years after bariatric surgery, the observed median percentage weight loss was 31.5% of baseline body weight for RYGB and 16.0% for LAGB.

Among participants who underwent RYGB, three behaviors explained most of the variability (16%) in weight change at 3-year follow-up. In particular, participants who self-weighed weekly, stopped eating when feeling full, and stopped eating continuously throughout the day lost an average of 38.8% of their baseline weight. This was about 14% more than participants who did not use these behaviors (mean, ?24.6%; mean difference, ?14.2%; 95% confidence interval [CI], ?18.7% to ?9.8%; P < .001), and 6% more than those who had always used these healthy behaviors (mean, ?33.2%; mean difference, ?5.7%; 95% CI, ?7.8% to ?3.5%; P < .001).

Dr Mitchell and colleagues note that similar results were obtained for LAGB. "The results of this study suggest that certain behaviors, many of which are modifiable, are associated with weight loss differences of significant impact in patients undergoing RYGB or LAGB. The magnitude of this difference is large and clinically meaningful," they write. "In particular, the data suggest that developing positive changes in behavior, including ceasing negative behaviors or increasing positive behaviors, can affect the amount of weight loss."

The authors therefore highlight the need for clinicians to target these behaviors in patients after they have undergone bariatric surgery. "[S]tructured programs to modify problematic eating behaviors and eating patterns following bariatric surgery should be evaluated as a method to improve weight outcomes among patients undergoing bariatric surgery," they conclude.

In an accompanying editorial, Amir A. Ghaferi, MD, Marilyn Woodruff, MSN, ANP-BC, and Jenna Arnould, MS, RD, all from the VA Ann Arbor Healthcare System in Michigan, emphasize that "bariatric surgery providers should seek better methods for longitudinal management."

However, they also point out the difficulty faced by providers as they try to differentiate the effects of patient behavior from hormonal or genetic factors that may contribute to decreased weight loss after bariatric surgery.

"Currently, we owe it to our patients to provide an infrastructure to maximize adherence to best practices, while taking care to avoid applying a one-size-fits-all approach," they conclude.

This study was supported by a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases, with grants for the data coordinating center, Columbia University Medical Center (in collaboration with Cornell University Medical Center Clinical and Translational Research Center), University of Washington (in collaboration with the Diabetes Training Research Center), Neuropsychiatric Research Institute, East Carolina University, University of Pittsburgh Medical Center (in collaboration with Clinical Trials Research Services), and Oregon Health and Science University. The authors have disclosed no relevant financial relationships. Dr Ghaferi reported receiving research funding from the Agency for Healthcare Research and Quality, the National Institute of Aging, and the Patient Centered Outcomes Research Institute and receiving salary support from Blue Cross Blue Shield of Michigan as the director of the Michigan Bariatric Surgery Collaborative. The other editorialists have disclosed no relevant financial relationships.

JAMA Surg. Published online April 20, 2016.

    
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