Fatores preditivos para o reganho ponderal em pacientes submetidos à cirurgia bariátrica sem acompanhamento por equipe multiprofissional de saúde: seguimento

Abstract

Many patients undergoing bariatric surgery do not maintain their regular medical follow-up. We evaluated alcohol use, depressive symptoms, health-related quality of life (HRQoL), the prevalence of eating disorders and dumping syndrome in a cohort of post- bariatric patients without regular medical follow-up. These screened disorders were compared between those with low versus high weight regain index (RWR) and also correlated with surgical outcomes. The methodology used was ninety-four post-bariatric patients without medical follow-up (87.2% female, age 42±9 years, BMI=32.9±6.5kg/m 2), BMI=32.9±6.5 kg/m2, and operative time of 6.1±4.0 years undergoing Roux-en-Y gastric bypass (n=80) or sleeve gastrectomy (n=14) were divided into high RWR groups (≥ 20%) and Low RWR (<20%). At the first visit, they completed self-report measures, which assessed symptoms of eating disorder, grazing, and symptoms suggestive of dumping syndrome. The Eating Disorder Examination Questionnaire (EDE-Q), the Repetitive eating Questionnaire [Rep(eat)-Q], and a self-assessment questionnaire based on the reduced Sigstad scoring tool were used. We also used the Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short Form Health Survey. It was obtained as aresilt neck and waist circumferences; diastolic blood pressure and surgery time were higher in the high regain group vs. low (P≤0.05). No differences were detected between groups for alcohol use and depressive symptoms (P≥ 0.07), but those with high regain showed worse indicators of quality of life (functional capacity, limitation due to physical aspects, body pain and vitality) (P ≤ 0.05). In the low-regain group, TRP was inversely correlated with functional/social capacity and vitality. Positive associations were present between TRP vs. depressive symptoms, while negative ones were observed for functional capacity and general health perception in the high regain group. For eating disorders, high regain exhibited higher EDE_Q scores for total eating disorder score, food restriction, and weight concerns than low regain, even as for the repetitive eating and compulsive eating subscales. On the other hand, no difference between the groups was detected in the subscales of concern about food and body shape. A total of 82.9% of patients reported symptoms suggestive of dumping syndrome, with no difference between groups. It was concluded that is was found high values in the total EDE_Q score in both groups, but even higher in the high-regain group, as well as very high results in the Rep(eat)-Q and higher in the high-regain group for both the compulsive overeating subscale and the on repetitive eating. The prevalence of depressive symptoms after bariatric surgery is also high, but it did not differ between the high and low weight regain groups. Quality of life worsened in those who regained more weight, especially in the physical components of the scale. Alcohol use did not differ between the studied groups and dumping syndrome does not seem to be related to weight regain. Our results suggest the importance and need for regular monitoring of these patients by a multidisciplinary health team, with special attention to modifiable behavioral factors for planning strategies to prevent weight regain