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Bariatric Patients and Weight Loss Surgery Maintenance

Bariatric Patients and Weight Loss Surgery Maintenance. A Brief Psychosocial Consideration Dr. Michael J. Alicea, Ed.D., MSW, MS South Miami Hospital February 27, 2014. Background. It is said that having weight loss surgery (WLS) is like being born into a newly created body.

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Bariatric Patients and Weight Loss Surgery Maintenance

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  1. Bariatric Patients and Weight Loss Surgery Maintenance • A Brief Psychosocial Consideration • Dr. Michael J. Alicea, Ed.D., MSW, MS • South Miami Hospital • February 27, 2014

  2. Background • It is said that having weight loss surgery (WLS) is like being born into a newly created body. Bocchieri, Meana & Fisher, 2007

  3. Background • Patients must learn to (all over again): • Eat • Drink • Walk • Sit • Stand • Dress Themselves Ogden & Clementi, 2010; Throsby, 2008

  4. Attitudes about Bariatrics • Patients must relearn key social skills and assert themselves into new roles by relating in new ways to:

  5. Attitudes about Bariatrics • Many celebrate the day of weight loss surgery as a new birthday. • Before they know it, they step into a new life with a new identity. Bocchieri, Meana & Fisher, 2007

  6. WLS Defined • As either not losing 50% excess body weight or regaining that same weight after having lost it. If weight loss is not permanent, the surgery has failed. • The primary reason cited for failure is non-compliance Elkins et al., 2005; Reedy, 2009

  7. Social Implications • Weight Loss Surgery (WLS) is not the panacea it was once thought to be. • Between 20% and 40% of WLS patients begin regaining weight by 24 months post surgery. Boeka, Prentice-Dunn & Lokken, 2010; Elkins, Whitfield, Marcus, Symmonds, Rodrigues & Cook, 2005

  8. Psychological Implications • The physical aspects of WLS are well understood, but the psychological aspects of WLS are not. • It is vital that the psychological processes beyond surgery are well understood. • It is important to note that the psychological processes involved in WLS involve not just the patient, but their entire social community, making this a psychosocial problem. Davin & Taylor, 2009; Maggard, Shugarman, Suttorp, Maglione, Sugerman, Surgerman, Livingston, 2005

  9. Psychological Implications • Success in WLS requires that patients make behavioral and psychosocial changes. • Those whose development closely aligns with psychosocial theory have a higher levels of psychosocial adaptation. • A higher level of psychosocial adaptation is correlated with higher levels of social connectedness and positive health outcomes. Erikson, 1963; Wilt, Cox & McAdams, 2010; Martikainen, Bartley & Lahelma, 2002; Wilt et al, 2010

  10. Literature Review • According to the National Health and Nutrition Examination Survey (NHANES) program conducted in 2007-2008. • 68% of adults in the United States are overweight or obese; defined as body mass index (BMI) ˃25. • 5% are morbidly obese with a BMI of over 40 (Typically qualify for obesity surgery). C.L., Ogden & Carroll, 2010; Shah, Simha & Garg, 2006; Echols, 2010; Stewart et al, 2010

  11. Literature Review • The World Health Organization coined a term “Globesity” with respect to this worldwide epidemic. World Health Organization, 2003, p.1

  12. Comorbidities • The prevalence of morbid obesity has increased twice as fast as the prevalence of obesity and is associated with a number of comorbidities. Echols, 2010; Mehler, Lasater & Padilla, 2003; Stewart et al, 2010

  13. Comorbidities Includes • Type 3 Diabetes • Coronary Heart Disease • Hypertension • Sleep Apnea • Gallbladder Disease • Certain Types of Cancer

  14. Morbid Obesity • Morbid obesity shortens life expectancy and is one of the biggest threats to health and well-being in the world today. • Diet, exercise, psychological and pharmacological therapies have not been effective in treating morbid obesity. World Health Organization, 2003

  15. Obesity Surgery Failure • Unfortunately, obesity surgery failure rates are rising with the increased numbers of surgeries performed. Elkins et al., 2005; Pontiroli et al., 2007; Sarwer et al., 2008; Stewart et al., 2010

  16. Literature Review Limitations • Success after bariatric surgery requires behavioral modification. • There is very little information on the psychological and social-relational changes and the resulting adjustments after WLS. • One misconception is that obesity is a “cheat” or is taking the “easy way out” of an obesity problem, rather than losing the weight without the aid of surgery. Boeka, 2009; Elkins et al., 2005; Zalesin, et al, 2010; Davis-Berman & Berman, 2009; Grimaldi & Van Etten, 2010

  17. Psychosocial Factors • A higher level of psychosocial adaptation is correlated with high levels of social connectedness and positive health outcomes. • Mediating the effects of social structural factors on individual health outcomes. • Conditioned and modified by social structures and contexts in which they exist. Martikainen et al., 2002; Wilt et al., 2010

  18. NOTE • “Psychosocial adjustment can influence health through psychobiological processes or through behavior modifications in lifestyles.” Martikainen et al., 2002

  19. Literature Review: Key Word Search • Psychosocial adjustments after WLP. • Identity transformations and weight loss. • Identity formation, and; • Physiological effects of WLS. International Journal of Epidemiology, 2012

  20. Search Engines Health and Psychosocial Instruments Academic Search Complete CINAHL Plus with Full Text Education Research Complete MEDLINE with Full Text Mental Measurements Yearbook PsycARTICLES PsycBOOKS PsycCRITIQUES PsycEXTRA PsycINFO SocINDEX

  21. Hypothesis • Since there is sufficient evidence in the literature review to predict that there are changes in identity that accompany large weight losses, it is (in theory) possible that these changes happen through a developmental process. • It is also possible that a failure to successfully pass through these developmental changes will correlate with weight regain. Finfgeld, 2004; Granberg, 2001; Schafer & Ferraro, 2011; Throsby, 2008

  22. Existing Theory • A growing number of researchers are working with the idea that identity change is necessary for permanent weight loss • Understanding the specific processes that promote identity change is another matter. • It is important to understand that changes in identity are part of lasting health behavior changes, but understanding how identity is changes is at the heart of the issue. Bocchieri et al., 2007; Epiphanious & Ogden, 2010b; Granberg, 2001; 2011; Johnson, 1990; Ogden & Hills, 2008; Throsby, 2008

  23. Phenomenon Identified • Researched the core phenomenon into what identity restructuring and its effect on weight loss maintenance. • Why WLS is failing for a significant number of patients. • Failure estimates from 20% to 40% of patients who have WLS. Elkins et al., 2005; Livhits et al., 2010; Pontiroli et al., 2007

  24. WLS Failure Consequences • Morbid obesity results in lower health related quality of life. • Severe social and economic consequences to those who are morbidly obese. • Higher rates of : • Depression • Anxiety • Personal Rejection • Discrimination • General Public Perceptions Greenberg, 2003; Hall, 2010; Herdon, 2005

  25. WLS Dilemma • Weight loss maintenance in general is a problem that has yet to be solved by either medicine or psychology. • That there is a “cure” for obesity, despite volumes of claims to the contrary, to this date, no surgery, no medicine, no psychological therapy, has been able to adequately and permanently address this global problem. • Many who lose weight regain it because they think that in the process of losing the weight, they have been cured of obesity and do not need to attend to it any longer. Kroger & Green, 1996; Pulkkinen & Kokko, 2000; Wilt et al., 2010

  26. Future Research Study on WLS • Issues related to patient behavioral compliance. • Addressing compliance and motivational issues to increase further understanding of WLS issues. • Researching long term psychosocial impacts of WLS (Longitudinal Study). • Researching practice implications for creating programs to assist with psychosocial adjustments after WLS.

  27. WLS: Final Word • Its important to understand that WLS does not happen in a social vacuum. • A patient’s life revolve around social systems that include family members, significant others, co-workers and friends who are equally affected by the WLS. • For some patient’s, no amount of weight loss will change how they see themselves. • If the public’s perception of obesity are ever going to change it will be at least in part be through increased understanding and facilitating a compassion for people who suffer with this disease.

  28. Thank You • Dr. Michael J. Alicea, Ed.D., MSW, MS • South Miami Hospital • February 27, 2014

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