研究發現:減重手術後的行為是關鍵


  【24drs.com】大部份減重手術研究都著重於術前的變項,現在,探討術後因素的一篇研究顯示,評估術後的體重管理實務與飲食行為、以及使用的有問題的物質,都會顯著影響患者的體重減輕情況。
  
  Grand Forks北達柯他大學醫學與健康科學院James E. Mitchell醫師等人,在4月20日JAMA Surgery期刊線上發表「Longitudinal Assessment of Bariatric Surgery-2 (LABS-2)」這篇研究的結果。
  
  作者們寫道,特別的是,資料顯示,行為發生正向改變-包括停止負面行為或增加正面行為,可以影響減重量。
  
  為了使嚴重肥胖成年人的減重手術效果達到最好,必須釐清與術後成功減重有關的因素,因此,作者們進行了一篇研究,評估嚴重肥胖成年人減重手術之後,減重量的術後預測因子。
  
  LABS-2研究包括了減重術後的2,022名患者,其中1,513人是進行Roux-en-Y胃繞道手術(RYGB),509人進行腹腔鏡可調整式胃束帶手術(LAGB),所有研究對象都是在2006年3月至2009年4月間首次進行減重手術,追蹤到2012年9月。
  
  在術前對這些患者進行調查,術後每年調查一次、進行3年;這些調查檢視了25項被視為可調整的術後行為,包括飲食行為及問題、減重實務、使用有問題的物質等相關行為。
  
  研究對象的平均年齡為47歲,身體質量指數中位數為46,78%是女性;減重手術後3年,觀察到的減重百分比中位數,RYGB組是開始時體重的31.5%、LAGB組是16.0%。
  
  進行RYGB的患者中,對於3年追蹤期間的體重變化差異,有三項行為可以解釋大部份(16%)的變異性。特別是,每週自己量體重一次者、感到飽足時停止進食者、不再整天吃不停者,減重量達開始時體重的平均38.8%,比沒有這些行為的研究對象(平均:-24.6%;平均差異:-14.2%; 95%信賴區間[CI], -18.7% 至 -9.8%;P < .001) 多了約14%,比已經長期使用這些健康行為者(平均:-33.2%;平均差異:-5.7%;95% CI, -7.8%至-3.5%;P < .001)多6%。
  
  Mitchell醫師等人指出,LAGB組也獲得類似的結果。他們寫道,這篇研究的結果認為,某些行為、其中多數是可調控的,對進行RYGB或LAGB患者的減重差異程度有顯著影響,這個差異幅度大且具有臨床意義。特別是,資料認為,行為發生正向改變,包括減少負面行為或增加正面行為,都可以影響減重量。
  
  作者們因此強調,對進行減重手術後的患者,醫師們應著重在這些行為。他們結論指出,減重手術後,調整有問題的飲食行為與飲食模式的結構化問題,應進行評估,以改善進行減重手術者的減重結果。
  
  在編輯評論中,來自密西根州VA Ann Arbor Healthcare System的Amir A. Ghaferi醫師、Marilyn Woodruff, MSN, ANP-BC與Jenna Arnould, MS, RD強調,減重手術提供者應尋求更佳的縱向管理辦法。
  
  不過,他們也指出,當要區分患者的行為因素與荷爾蒙或遺傳因素對於減重手術後減重情況的影響時,照護者也面臨一些困難。
  
  他們結論表示,目前我們應該為我們的患者提供一個可以最大程度遵守最佳實務的基礎架構,同時注意避免採用一體適用的方法。
  
  資料來源: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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