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Post-op lifestyle intervention may enhance surgical outcomes

Tue, 11/03/2020 - 13:06
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Timely post-operative lifestyle intervention could be useful for bariatric patients in helping them enhance and maintain better outcomes after bariatric surgery, according to researchers from the Evangelical Hospital ‘Villa Betania’ and the University of Naples ‘Parthenope’, in Naples, Italy. Specifically, they state that a multidisciplinary team of different professionals may be fundamental in order to guarantee the long-term effectiveness of the surgical intervention.

The authors noted that although bariatric surgery is the most successful treat for patients with obesity, post-surgical outcomes could be hindered by psychosocial aspects or persisting unhealthy behaviours (resulting in unsatisfactory weight loss/weight regain and possibly, revisional surgery). Subsequently, their study, ‘An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients’, published in PLUSOne, sought to evaluate the effects of an integrated post-operative exercise-based educational and motivational programme in improving behaviours, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention.

The researchers recruited 82 patient and 70 completed follow-up (28 in the intervention group (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) in the treatment as usual (TAU) group). The intervention included an exercise programme, a dietary educational programme and motivational support. All these activities were free of charge and were provided for twelve months by the same staff in a hospital gym facility. TAU protocol for control patients consisted of periodical routine medical examinations by the surgeon. TAU patients were contacted by phone to participate to follow-up after 12 months since their recruitment. All the following outcomes were measured at the start (T0) and at the end (T1) of the 12-month intervention and the measurements were performed by investigators who were blinded to the participants.

The Obesity-Related WELL-being questionnaire (ORWELL-97) was administered to all the participants in order to detect possible variations in obesity-related quality of life and analyse their attitude towards physical activity (PA). The questionnaire included 18 items and is aimed to measure the importance attributed by subjects to a series of determinants related to quality of life and the difficulties regarding these aspects that they actually perceived (occurrence) in relation to the overweight condition. A score in the ORWELL-97 questionnaire ≥70 was considered indicative of a clinically significant burden of obesity on quality of life.

At the start of the study, binge eating disorders were identified in 24 patients in the intervention group (four with moderate BED, 20 with severe BED) and in 40 of the control patients (ten moderate, 30 severe). At the end of the study, only one patient in the intervention group showed moderate BED, while 25 moderate and ten severe BEDs were found among TAU patients (p<0.01). Furthermore, the increase of habitual PA levels was reported by patients to the intervention group was significantly higher compared to the TAU group (p<0.01).

For quality of life, at the start of the study all the patients enrolled perceived a high burden related to their weight status (ORWELL-97 score >70). At the end of the study, three patients from TAU group reported a score lower than 70, while 27 of the patients in the intervention group showed a score under this threshold value.

There was also a general improvement in both groups, with the only exception of lower limbs strength in controls. However, the changes were more consistent and significant in the intervention group, especially for hip circumference and flexibility outcomes. The differences registered between groups were all significant (p<0.01).

“As the recourse to bariatric surgery is becoming very common, it is fundamental that it could be considered a starting point for the establishment of a healthy lifestyle rather than an ending goal in obesity treatment,” the authors concluded. “In this perspective, a multidisciplinary team composed by different professionals who sustain patients in adopting new behaviours may be fundamental in order to guarantee the long-term effectiveness of the surgical intervention. Adapting the post-operative support to the individual health and organisational needs of the patients may enhance their compliance. Due to the limitations related to the sample self-selection adopted in our investigation, further controlled randomised studies in this direction are needed.”

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