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Bariatric surgery or lifestyle intervention? An exploratory study of severely obese patients' motivation for two different treatments

机译:减肥手术还是生活方式干预?严重肥胖患者使用两种不同疗法的动机的探索性研究

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摘要

Background: In the complex field of treating severe obesity, motivation is receiving increased attention. This explorative study aims to highlight what influences the preferences of severely obese patients deciding for either gastric bypass surgery or lifestyle treatment.Methods: Patients awaiting laparoscopic gastric bypass were presented with an 18-week inpatient lifestyle programme alternative to gastric bypass. Questionnaires provided qualitative data (reasons for choosing one treatment over another) and quantitative data (mental health assessment using the Hospital Anxiety and Depression Scale). The material was analysed according to a sequential exploratory design involving thematic analysis of patients’ arguments, validation using HADS, and statistical computations (hypothesis testing) with one-way ANOVA followed by Dunnett's post hoc test.Results:159 participants (mean BMI 47.2 kg/m2) returned questionnaires of which 32% wanted the lifestyle treatment alternative to surgery. Reasons for choosing the two treatments varied widely as did also the corresponding data on mental health. Two subgroups stood out with particularly high mental symptom scores, namely patients choosing surgery due to reluctance to engage in social interaction in lifestyle treatment, and patients preferring lifestyle treatment due to the fear of dying during general anaesthesia. These two subgroups showed significantly higher symptom scores than other subgroups within their therapy-of-choice group. The number of comorbid diseases was also found to impact upon motivation.Conclusions: Patients carry different incentives for choosing the same type of treatment. On a subgroup level, psychopathological symptoms seem to follow motivational patterns. Analysing motivation and mental health may provide measures for identifying subgroups with various prospects for therapy outcome.
机译:背景:在治疗严重肥胖的复杂领域中,动机受到越来越多的关注。这项探索性研究旨在强调哪些因素会影响决定进行胃旁路手术或生活方式治疗的严重肥胖患者的喜好。方法:向等待腹腔镜胃旁路手术的患者提供了为期18周的替代胃旁路手术的住院患者生活方式计划。问卷提供了定性数据(选择一种治疗而非另一种治疗的原因)和定量数据(使用医院焦虑和抑郁量表进行的心理健康评估)。根据循序渐进的探索性设计对材料进行了分析,其中包括对患者论点进行主题分析,使用HADS进行验证以及采用单向ANOVA进行统计学计算(假设检验),然后进行Dunnett事后检验。结果:159名参与者(平均BMI为47.2千克) / m2)返回的问卷,其中32%的人希望生活方式替代手术。选择两种治疗的原因差异很大,相应的心理健康数据也是如此。有两个亚组的精神症状评分特别高,一个是由于不愿在生活方式治疗中进行社交互动而选择手术的患者,另一个是由于害怕在全身麻醉期间死亡而选择生活方式治疗的患者。这两个亚组的症状评分明显高于其选择治疗组中的其他亚组。结论:患者为选择相同类型的治疗方法会采取不同的诱因。在亚组水平上,心理病理症状似乎遵循动机模式。分析动机和心理健康状况可能会提供措施,以识别具有不同治疗前景的亚组。

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