Eficacia de la técnica de balón intragástrico junto con un programa en terapia y modificación de conducta en pacientes obesos con y sin trastorno por atracón.

Introducción: La obesidad debe de ser considerada como un trastorno crónico, epidémico y de abordaje terapéutico complejo. Ante el alto índice de fracasos hacia los métodos conservadores, defendemos la técnica de balón intragástrico junto con un programa en terapia y modificación de conducta que ayude al paciente a reducir su peso, a modificar hábitos y mejorar su calidad de vida con el objetivo final de mantenimiento de por vida. Objetivos: Evaluar la eficacia terapéutica en pérdida de peso de participantes obesos adultos con y sin trastorno por atracón utilizando la técnica de balón intra gástrico junto con un programa en terapia y modificación de conducta de 24 meses de duración. Evaluar la influencia del trastorno por atracón concurrente a la obesidad así como los cambios psicológicos que presentan los participantes antes y después del tratamiento sobre la insatisfacción con la imagen corporal, autoestima y sintomatología ansiosa depresiva. Hipótesis: Hemos planteado varias hipótesis de trabajo desde las que proponemos que los pacientes obesos sin trastorno por atracón conseguirían una mayor pérdida de peso y una mejora más notable en la modificación de hábitos y estilo de vida. Por otro lado también hemos planteado que la comorbilidad con el trastorno por atracón en obesidad condiciona a una mayor sintomatología ansioso - depresiva, mayor insatisfacción con la imagen corporal y menor grado de autoestima. También que el trastorno por atracón junto síndrome de ingesta nocturno genera en los pacientes los máximos niveles de ansiedad. Método: Diseño cuasi experimental, mixto longitudinal con medidas repetidas, datos independientes y comparando resultados intra y entre grupos. Los participantes fueron 133 adultos y todos ellos pacientes diagnosticados en una unidad clínica de obesidad con un IMC mayor o igual a 30. Todos ellos clasificados en tres grupos en función siguiendo criterios diagnósticos DSM IV sobre el trastorno por atracón (sin trastorno por atracón, trastorno por atracón completo, trastorno por atracón parcial). Variables registradas (clínicas, antropométricas y psicométricas) se registraron antes de iniciar el tratamiento, a los 6m 12 y 24 meses. Análisis estadístico SPPSS.18 Conclusiones: 1. - Los pacientes obesos con y sin trastorno por atracón consiguen un promedio significativo de pérdida de peso de 20 Kg durante los primeros seis meses con un mantenimiento de resultados durante los 18 meses de tratamiento y seguimiento. 2. -Existen diferencias significativas en la modificación de los hábitos y estilo de vida ante la presencia o no del trastorno por atracón en obesidad. 3. -Mayor insatisfacción con la imagen corporal entre los pacientes obesos con trastorno por atracón que entre aquellos que no presentan el trastorno. 4. - Mayor sintomatología ansioso depresiva y menor grado de autoestima en obesidad cuando está presente el trastorno por atracón. 5. - La comorbilidad conjunta del trastorno por atracón y síndrome de ingesta nocturno (night eating disorder) determina la mayor sintomatología ansiosa en obesidad. 6. - Notable mejora terapéutica cognitiva conductual con mejor curso entre los pacientes obesos sin trastorno por atracón.Directors: Dra. Rosa Mª Raich Escursell & Dra. Marisol Mora Giral. Objectives To evaluate the therapeutic efficacy of a 24 month behavioral modification therapy program in obese adult patients with and without binge eating disorder who are using the intragastric balloon for weight loss. To evaluate the influence of binge eating disorder occurring with obesity as well as the psychological changes that the participants demonstrate before and after the treatment in respect to poor body image, self esteem, and symptoms of anxiety and depression. Hypothesis We have developed several working hypotheses proposing that obese patients without binge eating disorders achieve greater weight loss and more notable improvement in habit and lifestyle modification. In addition we propose that the co-morbidity of binge eating disorder with obesity creates more symptoms of anxiety and depression, greater dissatisfaction with body image and a lower self esteem. We also propose that night eating disorder creates the highest levels of anxiety in patients. Methodology Quasi experimental mixed longitudinal design, with repeated measurements, independent data, and results compared within and between groups. The participants were 133 adults with a BMI greater or equal to 30. All of them were patients who had been diagnosed in a health and nutrition unit. They were classified in three functional groups according to the diagnostic criteria of the DSM IV for binge eating disorder, (no binge eating disorder, full binge eating disorder, and partial binge eating disorder.) The variables documented (clinical, anthropometric and psychometric) were documented before the beginning of treatment and at 6 ,12, and 24 months. Conclusions 1. Obese patients with and without binge eating disorder can achieve a significant weight loss of an average of 20 kilos during the first six months and maintain this weight loss.for the following 18 months. 2. There are significant differences in habit and lifestyle modification between obese patients with and obese patients without binge eating disorder. 3. There is more dissatisfaction with body image in obese patients with binge eating disorder than in patients who do not have this disorder. 4. More symptoms of anxiety and depression and lower self esteem are present in obese patients with binge eating disorder. 5. Co morbidity of binge eating disorder and night eating disorder result in the highest level of anxiety symptoms in obese patients. 6. The efficacy of cognitive behavioral therapy is greater in patients without binge eating disorder

Adherence to healthy lifestyle habits is a determinant of the effectiveness of weight loss among patients undergoing endoscopic bariatric therapies

Endoscopic bariatric therapies (EBTs) are promising strategies for the treatment of obesity. However, there is still great variability in its effectiveness in weight loss. Thus, we investigated whether adherence to healthy lifestyle habits is a significant determinant of weight loss effectiveness among patients undergoing EBTs. Additionally, the role of eating behaviors and psychological traits in the effectiveness of weight loss was studied. A cohort of 361 participants (81.4% women; age 41.8 ± 9.5 years; BMI 37.8 ± 4.3 kg/m2) was followed for 1 year after EBT. Anthropometric parameters, adherence to healthy lifestyle habits, emotional eating, and psychological traits (anxiety and depression) were evaluated. General linear models were used to compare outcome variables according to weight loss effectiveness groups (poor vs. good weight-loss-responders). Additionally, a hierarchical linear regression model was used to determine whether adherence to healthy lifestyle habits, emotional eating, or psychological traits were significant predictors of excess weight loss (%EWL). One year after EBT, weight loss differed significantly between good and poor weight-loss-responders (67.5% EWL [95% CI: 64.2, 70.8] vs. 28.2% EWL [95% CI: 25.5, 30.9], p 2 times/week were the two lifestyle habits that most significantly determined weight loss response. Furthermore, our results revealed that while adherence to healthy lifestyle habits was a significant determinant of %EWL 3, 6, and 12 months after EBT (p < 0.001), emotional eating was a significant determinant of %EWL only 3 and 6 months after the intervention (p < 0.01 and p < 0.05, respectively). Regarding psychological traits, we observed that neither anxiety nor depression were significant determinants of %EWL. Our results revealed that adherence to healthy lifestyle habits is a significant determinant for weight loss effectiveness among patients with obesity undergoing EBT. These findings highlight the importance of implementing an adequate nutritional intervention program, especially since patients who adhere to good lifestyle habits are able to achieve a weight loss that would be comparable with bariatric surgery

Development and Validation of a Short Questionnaire on Dietary and Physical Activity Habits for Patients Submitted to Bariatric Endoscopic herapies

Purpose: Individuals with obesity frequently regain weigh after endoscopic bariatric therapies (EBT) unless they adhere to healthy habits. The objective was to create and validate a short, self-administered questionnaire (EMOVE) to assess healthy dietary and physical activity (PA) habits' adherence to be used in clinical practice. Materials and Methods: In this prospective, unicentric study, 463 patients completed the short, Spanish EMOVE questionnaire, to be validated following the Medical Outcome Trust Criteria. Conceptual and measurement model, reliability (internal consistency and test-retest [subgroup of 93 patients]), construct validity, responsiveness, interpretability, and burden were evaluated. Patients enrolled from January 2017 through August 2018 and auto-filled the EMOVE at baseline and at 3, 6, and 12 months. Results: Patients submitted to intragastric ballon for 6 and 12 months or POSE were 82.7% women with a mean age of 42.7 years, and a mean BMI of 37.1 kg/m2. Four factors were extracted with exploratory factor analysis related to intake frequency, portions and proportions, time and place of eating, and physical activity. EMOVE showed adequate internal consistency (α = 0.73), very good test-retest (r = 0.91, CI: 0.86-0.94; p < 0.001), moderate construct validity of dietary (r = 0.24, CI: 0.11-0.37, p < 0.001), and PA habits (r = 0.44, CI 0.30-0.58; p < 0.001). Stable responsiveness, with correlations from 0.29 to 0.39 (p < 0.001) between the EMOVE scores and the % of total weight loss at 3, 6, and 12 months. Participants categorized as having good or excellent habits (score ≥ 30 points) lost significantly more weight (p < 0.05). Finally, the administration burden was 2.96 min. Conclusion: The EMOVE is a useful tool in Spanish language to easily assess the level of adherence to healthy dietary and PA habits to be used routinely in clinical practice