Different subgroups were analysed regarding both the expectation of effectiveness of bariatric surgery and the consideration for referral for surgery.
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Regarding the expectation of effectiveness, no differences were found in the following subgroups: different hospital regions center A vs. The 76 respondents who would consider referral for bariatric surgery were asked additional questions regarding their attitudes towards specific aspects of bariatric surgery in children. Fifty-one GPs Five respondents 6. The presence of obesity-related comorbidity would influence the minimum BMI threshold for 66 respondents Dyslipidemia and non-alcoholic hepatic steatosis were relevant for 36 Presence of a depressive disorder was mentioned as relevant by 30 respondents The respondents who answered not to consider referral for bariatric surgery were asked if certain circumstances would alter their opinion.
Twenty-two respondents There were no differences regarding uncertainty about complications or efficacy among the respondents who would refer for surgery compared to those who would not. There were no differences in reasons for reluctance among the two hospital regions. Thirty-three respondents Bariatric surgery may be considered in children with therapy-resistant morbid obesity. Although the majority of respondents think that bariatric surgery may be an effective last-resort treatment option, only This discrepancy may be related to non-efficacy-related factors, such as matters of principle.
Remarkably, the average minimum age threshold of This might indicate that the GPs open to referral for bariatric surgery are becoming more progressive in their attitudes, while the majority of GPs remain reluctant to refer morbidly obese children or adolescents for bariatric surgery. Frequently mentioned reasons for reluctance were uncertainty regarding complications in the long term and uncertainty regarding long-term efficacy Although bariatric surgery is effective and safe both in the short and long term in an adult population [ 25 , 26 , 27 , 28 , 29 ], there indeed is a scarcity of long-term data in the paediatric population, which must be accommodated by future research [ 30 ].
On the other hand, a significant proportion of GPs reported reluctance due to the aforementioned personal notions, which should be addressed through educational means, to assure proper and uniform care for therapy-resistant morbid obese adolescents. One of the strengths of this study is that the population used for this survey is representative for the different Dutch GP practices, combining GPs affiliated with both secondary and tertiary medical centers.
Metabolic surgery: A powerful solution or a last resort?
Since there are no Dutch tertiary centers practicing bariatric surgery on a regular base, the subgroup GPs affiliated to the tertiary center in the present study is assumed to be less experienced in bariatric care but may be more updated on innovative treatments since they hold the GP training. Due to the design of this study, GPs affiliated to a secondary center without bariatic surgery have not been included, which may lead to a certain amount of bias. However, in a small country such as the Netherlands, most GPs are in close proximity to a bariatric center in daily practice. Another strength of this survey is that reasons for reluctance were reported by all respondents, offering more insight in reasons why GPs would not refer.
Self-selection bias is one of the limitations of this study, accompanied by the fact that potential differences between responders and non-responders could not be assessed. Another important limitation to this survey is that the self-reported answers regarding current practice might not reflect the actual practice. This survey is based on estimations of GPs themselves and no verification of data has been carried out.
In addition, the prevalence of childhood morbid obesity seems to be relatively low in most practices Furthermore, the sample size of respondents did not meet the desired minimum of the sample size calculation due to a lower than anticipated response rate. Although this must be kept in mind when interpreting the results, the current sample is the largest to date investigating this topic. The reported absence of CLI treatment in many cases and poor compliance to the national guidelines when defining treatment success implies that there is a relevant knowledge gap that may lead to inadequate treatment of paediatric morbid obesity in primary care.
This implication is further supported by several comparable studies in adults, where a majority of GPs reported feeling unconfident, insufficiently competent, and disempowered regarding treatment of obese patients [ 17 , 19 , 20 , 21 ]. One study surveying knowledge on procedural aspects, efficacy, and safety of adult bariatric surgical procedures in primary care practitioners found that non-referrers had significantly less knowledge compared to those who do refer [ 16 ]. Additionally, in a recent study Educational resources on the topic of bariatric surgery must be provided to GPs, to improve care for morbidly obese adolescents.
Only few surveys that have investigated attitudes of GPs towards bariatric surgery in youngsters have been published. Claridge et al.
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Woolford et al. Interestingly, the study of Penna et al. This discrepancy further supports the notion that education of GPs and communication between surgeons and GPs is necessary to offer a uniformly optimal quality of care for obese adolescents. There may be a group of morbidly obese adolescents who would benefit from referral to bariatric surgery, but are instead treated sub-optimally.
This could be the result of insufficient knowledge of clinical practice guidelines and bariatric surgery in general. Moreover, the fact that only half of the GPs would consider referral of selected adolescents, even though the majority considers bariatric surgery as an effective last-resort treatment option, may in part be based on opinions and matters of principle. These issues should be addressed by ameliorating communication and cooperation between surgeons and GPs as well as providing GPs with educational resources on bariatric surgery in adolescents and in general.
Skip to main content Skip to sections. Advertisement Hide. Download PDF. Bouvy L. Open Access. First Online: 26 November Background Bariatric surgery is regarded as the most effective treatment of morbid obesity in adults.
cogtiotempli.tk Objectives The aim of this study was to investigate the current practice of GPs regarding treatment of paediatric morbid obesity and their attitudes towards the emergent phenomenon of paediatric weight loss surgery. Methods All GPs enlisted in the local registries of two medical centres were invited for a question anonymous online survey. Results Among invited GPs, Conclusion There is a potential for undertreatment of morbidly obese adolescents, due to suboptimal knowledge regarding guidelines and bariatric surgery, as well as negative attitudes towards surgery.
Introduction The prevalence of morbid obesity in both adults and children has risen drastically worldwide over the past few decades, causing significant morbidity, mortality and financial costs for society [ 1 , 2 , 3 , 4 , 5 ]. In the Netherlands, paediatric bariatric surgery is exclusively performed in a clinical research setting. Questionnaire An anonymous questionnaire was designed in an online platform for questionnaires and surveys Survey Monkey Inc. Analysis All completed surveys were used for analysis. Of the invited GPs, respondents completed the online survey All respondents were licensed and practicing GPs.
The least frequent treatment modalities reported to be provided were cognitive behavioural therapy CBT and family treatment. Open image in new window. All respondents were asked about possible reasons for reluctance towards bariatric surgery in children and adolescents with morbid obesity. Main findings The present study aimed to investigate the practice and attitudes of GPs regarding paediatric morbid obesity using a digital survey.
In current treatment, lifestyle advices, dietary advices and sports or exercise programs all provided by experts are offered most often by the responding GPs. Compliance with ethical standards Conflict of interest All authors declare that they have no conflict of interests. Llewellyn A, Simmonds M, Owen CG et al Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis.
This finding underscores the importance of the dietitian on the bariatric surgery team. From through , the prevalence of obesity in the United States was The incidence of obesity has increased substantially among US veterans 5. Obesity is associated with diseases in all of the organ systems, and gastric bypass surgery can prevent secondary complications of obesity. Surgical treatment of obesity is more effective and produces longer lasting outcomes than medication therapy or counseling 6. More than , bariatric procedures were performed in the United States in 7 , and that number will continue to increase.
Roux-en-Y gastric bypass RYGB surgery has become the gold standard among bariatric surgeries, and it is the most commonly performed bariatric procedure in the United States and all over the world 7,8. Gallagher et al reported that the cost of RYGB surgery at the VHA is offset by reduction of health care costs within the first year after surgery 9. The procedure is also reported to increase life expectancy by an average of 7. Moreover, weight loss surgery has been reported to ameliorate chronic medical conditions such as diabetes and improve quality of life 11, In veterans, long-term follow-up has confirmed significant and durable weight loss with marked improvement in comorbidities 5.
Independent studies have reported significantly greater weight loss after RYGB than with vertical banded gastroplasty Studies have followed the RYGB outcomes up to 15 years after the surgery The role of the registered dietitian nutritionist is to perform dietary assessments, to evaluate for nutritional deficiencies, and to provide counseling to help patients meet postsurgery weight loss goals Dietitians are part of the multidisciplinary bariatric team.
Expert guidance and visits to dietitians are part of the surgical process. Veterans are an underprivileged and disenfranchised population, and they suffer from greater socioeconomic and health disparities than the general population 4. The aim of this study was to explore the relationship between the number of nutrition visits a patient made and change in body mass index BMI after gastric bypass surgery for the veteran population.
This project was reviewed and approved by the San Francisco Veterans Administration Medical Center Institutional Review Board and was performed in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Before analysis, patient records and information were de-identified to ensure anonymity.
Data from patients who underwent RYGB at our institution from June through July were collected from the computerized patient record system. A total of 79 patients who had RYGB during the study period constituted the study population. Date of surgery, age, sex, race, height, BMI, number of nutrition encounters during the 2 years after surgery, and weight before and 2 years after surgery were recorded.
BMI was calculated as weight in kg divided by height in m 2. SPSS version Multivariate linear regression was used to determine the effects of nutrition visits, sex, race, and age on BMI change. Characteristics of patients are shown in the Box. The mean number of nutrition encounters during the 2 years postsurgery was 6.
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The average BMI change was a decrease of In this study, patients attending more nutrition visits following surgery experienced greater declines in BMI. These nutrition visit-specific results are consistent with those of Compher et al, who examined the relationship between clinical visits and post—gastric bypass weight loss and found that the odds of weight loss increased 2.
Lier et al found that regular attendance to postoperative nutrition counseling visits was associated with weight loss 1 year after gastric bypass surgery Furthermore, Shen et al reported that patient follow-up played a significant role in the amount of weight lost after bariatric surgery Patients with no follow-up visits were 4. Nutrition care before surgery, during the hospital stay, and after surgery is important for the quality of life of the patient and the success of the surgery.
There are no set evidence-based guidelines on the postsurgery nutrition follow-up schedule, which differs from institution to institution Current VA guidelines recommend that patients have 2 to 4 nutrition visits presurgery and 2 to 3 visits during hospital stay.
Furthermore, nutrition appointments should be scheduled at 1 to 2 weeks, 4 to 6 weeks, 3 months, 6 months, and 12 months after surgery, and then annually afterwards. Patients require a lifetime of nutritional follow-up to have a good quality of life 20 , because bariatric surgery patients are at risk of malnutrition and micronutrient deficiencies following surgery. Nutrition visits are helpful for bariatric surgery patients. Dietary counseling improved nutrient intake of gastric bypass surgery patients Freire et al stated that lack of nutritional counseling follow-up was significantly associated with regaining weight Through frequent contact dietitians can detect challenging situations such as increased food urges, inactive lifestyle, and eating fast foods, all of which can contribute to regaining weight Regular nutrition visits can also aid detection and prevention of micronutrient deficiencies and severe malnutrition.
Nutritional deficiencies are very common after RYGB despite supplementation with standard doses of multivitamins. Thus, nutrition visits can prevent regaining weight, osteomalacia, protein—calorie malnutrition, and, most of all, micronutrient deficiencies Dietitians can also help prevent dumping syndrome in patients by giving appropriate dietary advice.
In addition, contact with medical professionals is a source of motivation for patients This study had limitations.
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