scholarly journals Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

2021 ◽  
Author(s):  
John Brazil ◽  
Francis Finucane
Keyword(s):  
Bariatric Surgery ◽  
Lifestyle Modification ◽  
Evidence Base ◽  
Healthcare Systems ◽  
Good Evidence ◽  
Surgical Patients ◽  
Fixed Duration ◽  
Consensus Guidelines ◽  
Obesity Stigma ◽  
Improve Health

AbstractMany healthcare systems require patients to participate in a structured lifestyle modification programme prior to bariatric surgery, even though bariatric consensus guidelines do not recommend this. While there is good evidence that such programmes improve health in other conditions such as metabolic and cardiovascular diseases, there is no evidence that they improve outcomes after bariatric surgery. The distinction needs to be drawn between the well-established need for individualised multidisciplinary dietetic and physical activity care for bariatric surgical patients and the potential harms from mandating participation in compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery, reinforce obesity stigma, or both. Large clinical trials might help to address some of the uncertainty and provide an evidence base for clinicians and policymakers. Graphical abstract

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

Evidence-Based Treatment for the Eating Disorders

2010 ◽  
pp. 451-451
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Evidence-Based Treatment for the Eating Disorders

2012 ◽  
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Innovative Technology – Enhancing Healthcare for All (Vol. 25, No. 5, Full Issue)

2021 ◽  
Vol 25 (05) ◽  
Keyword(s):  
Heart Failure ◽  
Health Outcomes ◽  
Digital Technology ◽  
Research Study ◽  
Intravenous Iron ◽  
Healthcare Systems ◽  
Innovative Technology ◽  
Heart Failure Patients ◽  
New Methods ◽  
Improve Health

For the month of May 2021, APBN discovers how the used of digital technology and innovative new methods can help treatment, prevention and management of diseases. In the Columns section, we have a contribution by Son Pham, Country Manager for GE Healthcare Vietnam and the CEO for GE Vietnam on how technology has helped healthcare systems in Vietnam during the COVID-19 pandemic. In the Spotlights section, read about a research study by the National Heart Centre Singapore (NHCS) and its international partners affirm the use of intravenous iron to help heart failure patients improve health outcomes.

Evidence Base for Bariatric Surgery

2016 ◽  
pp. 65-75
Author(s):  
Luca Leuratti ◽  
Haris A. Khwaja ◽  
David D. Kerrigan
Keyword(s):  
Bariatric Surgery ◽  
Evidence Base

scholarly journals Obesity, stigma and reflexive embodiment: Feeling the ‘weight’ of expectation

2018 ◽  
Vol 24 (4) ◽  
pp. 421-441 ◽  
Author(s):  
Oli Williams ◽  
Ellen Annandale
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Subjective Experience ◽  
Lifestyle Modification ◽  
Participant Observation ◽  
Economic Status ◽  
Social Significance ◽  
Structured Interviews ◽  
Obesity Stigma ◽  
Group Members

The dominant obesity discourse which emphasises individual moral responsibility and lifestyle modification encourages weight-based stigma. Existing research overwhelmingly demonstrates that obesity stigma is an ineffective means by which to reduce the incidence of obesity and that it promotes weight-gain. However, the sensate experiences associated with the subjective experience of obesity stigma as a reflexively embodied phenomenon have been largely unexamined. This article addresses this knowledge gap by providing a phenomenological account. Data are derived from 11 months of ethnographic participant observation and semi-structured interviews with three single-sex weight-loss groups in England. Group members were predominantly overweight/obese and of low-socio-economic status. The analysis triangulates these two data sources to investigate what/how obesity stigma made group members feel. We find that obesity stigma confused participant’s objective and subjective experiences of their bodies. This was primarily evident on occasions when group members felt heavier after engaging in behaviours associated with weight-gain but this ‘weight’ did not register on the weighing scales. We conceptualise this as the weight of expectation which is taken as illustrative of the perpetual uncertainty and morality that characterises weight-management. In addition, we show that respondents ascribed their sensate experiences of physiological responses to exercise with moral and social significance. These carnal cues provided a sense of certainty and played an important role in attempts to negotiate obesity stigma. These findings deepen the understanding of how and why obesity stigma is an inappropriate and ineffective means of promoting weight-loss.

SWEETWISE: developing a multi-professional approach to diabetes mellitus

2015 ◽  
Vol 17 (02) ◽  
pp. 107-113
Author(s):  
Amrit Takhar ◽  
Jenny Herbert ◽  
Rosemary Plum ◽  
Mukesh Lad ◽  
Deborah Manger ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Lifestyle Modification ◽  
Continuing Professional Development ◽  
Health Checks ◽  
Professional Network ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Patient Advice ◽  
Audit Project ◽  
Improve Health

The formation of a local joint professional network (LJPN) in Northamptonshire has led to a joint Continuing professional development initiative and an audit project to determine the take up of annual health checks by patients with diabetes mellitus with dentists, optometrists, pharmacists as well as the usual check with the General Medical Practice team. The findings showed that a significant number of patients (29–50%) do not access available dental, optometry and pharmacy advice. Better collaboration between the professions has the potential to improve health outcomes in diabetes mellitus and other areas where lifestyle modification reduces adverse health risks. A patient advice card (SWEETWISE) was developed by the group and could be used to help educate patients and health professionals.

scholarly journals Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Maggie Lawrence ◽  
Eric Asaba ◽  
Elaine Duncan ◽  
Marie Elf ◽  
Gunilla Eriksson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Prevention ◽  
Delphi Study ◽  
Lifestyle Modification ◽  
Well Being ◽  
Evidence Base ◽  
Consensus Definition ◽  
Lifestyle Risk Factors ◽  
Lifestyle Risk ◽  
Definition Of

Abstract Objective Evidence supporting lifestyle modification in vascular risk reduction is limited, drawn largely from primary prevention studies. To advance the evidence base for non-pharmacological and non-surgical stroke secondary prevention (SSP), empirical research is needed, informed by a consensus-derived definition of SSP. To date, no such definition has been published. We used Delphi methods to generate an evidence-based definition of non-pharmacological and non-surgical SSP. Results The 16 participants were members of INSsPiRE (International Network of Stroke Secondary Prevention Researchers), a multidisciplinary group of trialists, academics and clinicians. The Elicitation stage identified 49 key elements, grouped into 3 overarching domains: Risk factors, Education, and Theory before being subjected to iterative stages of elicitation, ranking, discussion, and anonymous voting. In the Action stage, following an experience-based engagement with key stakeholders, a consensus-derived definition, complementing current pharmacological and surgical SSP pathways, was finalised: Non-pharmacological and non-surgical stroke secondary prevention supports and improves long-term health and well-being in everyday life and reduces the risk of another stroke, by drawing from a spectrum of theoretically informed interventions and educational strategies. Interventions to self-manage modifiable lifestyle risk factors are contextualized and individualized to the capacities, needs, and personally meaningful priorities of individuals with stroke and their families.

scholarly journals THE INTESTINAL MICROBIOTA AND THE ROLE OF PROBIOTICS IN IRRITABLE BOWEL SYNDROME: a review

2015 ◽  
Vol 52 (4) ◽  
pp. 331-338 ◽  
Author(s):  
Joaquim Prado MORAES-FILHO ◽  
Eamonn M M QUIGLEY
Keyword(s):  
Irritable Bowel Syndrome ◽  
Intestinal Microbiota ◽  
Health Benefit ◽  
Gastrointestinal Disorder ◽  
Evidence Base ◽  
Good Evidence ◽  
Specific Strain ◽  
Rome Iii ◽  
Irritable Bowel ◽  
Micro Organisms

Irritable bowel syndrome is a common, chronic relapsing gastrointestinal disorder that affects 7%-22% of the population worldwide. According to Rome III Criteria, the disorder is defined by the coexistence of abdominal discomfort or pain associated with an alteration in bowel habits. Its pathophysiology is not completely understood but, in addition to some important abnormalities, the disturbed intestinal microbiota has also been described supported by several strands of evidence. The treatment of irritable bowel syndrome is based upon several therapeutic approaches but few have been successful or without adverse events and more recently the gut microbiota and the use of probiotics have emerged as a factor to be considered. Probiotics are live micro-organisms which when consumed in adequate amounts confer a health benefit to the host, such as Lactic bacteria among others. An important scientific rationale has emerged for the use of probiotics in irritable bowel syndrome, although the data regarding different species are still limited. Not all probiotics are beneficial: it is important to select the specific strain which should be supported by good evidence base. The mechanisms of action of probiotics are described and the main strains are quoted.

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