Patients with Obesity Problems - Research Proposal Example

Research proposal: Long Term Effects of Bariatric Surgery s 14th February Long term effects of bariatric surgery Identification of the Problem Obesity is viewed as a chronic disease and any proposed treatment is expected to show long-term durability to be considered effective. Bariatric surgery is very effective, although it poses a risk to the patient. Patients who undergo weight loss surgery are obliged to commit a program of changes in lifestyle, vitamin supplementation, diet, and follow-up to maintain weight loss after surgery in the short run. However, in the long run, by committing to lifetime’s healthy eating and regular exercise, some patients find this rigorous exercise hard to adhere to slip back to unhealthy habits. As noted by Walsh (2013) bariatric surgery results in significant weight loss than nonsurgical treatment among patients with diabetes and who are mildly obese. However, evidence for long-term efficacy and safety still remains limited. Purpose of the Study Although patients with obesity problems loose more weight with bariatric surgery as compared to medical weight-loss treatment, the study is going to examine the long term effects of bariatric surgery since there are many risks and benefits associated with the surgery. There are different types of weight loss surgeries each with its characteristic risks and benefits. Some of the factors that impact on the bariatric surgery in the long term include: eating habits, the body mass index of the patients, previous stomach surgeries, and health conditions linked to obesity. With regard to the effect of bariatric surgery to diabetes, Rao and Subhash (2012) argued that weight loss surgery is currently the most effective diabetes treatment with regard to morbid obesity and want to obtain amelioration of the medical co-morbidities of obesity and sustaining significant weight loss. Research Questions i. What are the long term effects of bariatric surgery? ii. What are the psychological effects of bariatric surgery? iii. What is the correlation between bariatric surgery and obesity in the long term? iv. How does bariatric surgery affect absorption of nutrients in the long run? Literature Review Severe obesity is chronic condition which is difficult treat with exercise and diet alone. This is where bariatric surgery comes in handy. It involves an operation on the stomach or the intestines that assists patients who extreme obesity for them to loose weight. There are risks and rewards associated with bariatric surgery (Pories, 2008). The surgery works in manner that restricts the intake of food (Jaunoo and Southall, 2010), thus promoting weight loss and reducing the risk of disease such type 2 diabetes and cardiovascular ailments. Other surgeries have been performed in order to interrupt how food is digested, thus preventing some nutrients and calories, such as vitamins from being absorbed. Obesity is a source of distress, which is linked to a negative body image, more intimate and interpersonal problems, and more hardships in professional issues. The distress that is connected to the contemporary culture stigmatizes obese people. As a result, it increases the probability of internalizing negative information about them, and this causes obese persons to feel psychologically discomfited about their physical appearance (Maia, 2012). Bariatric surgery usually restricts food intake, thus leading to weight loss. According to Sundbom and Gustavsson (2009), there are different types of bariatric surgery including vertical sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric band, and biliopancreatic diversion with a duodenal switch (Madura and DiBaise, 2012). The major benefit of bariatric surgery is weight loss. Patients who undergo weight loss surgery usually loose more than 50 percent of their excess weight. Furthermore, ailments that are related to obesity markedly improve after the bariatric surgery, enhance life expectancy, and reduce cardiovascular risk in the long run (Fontaine, et al., 2011). Recent studies have indicated that weight loss surgery may even lower the rates of death for patients who have been diagnosed with severe obesity. The best results are manifested when patients follow surgery with regular exercise and healthy eating patterns (U.S Department of Health and Human Services, 2012). Bariatric surgery can significantly change both the weight and health of youth with extreme obesity. Gastric bypass surgery has been the major operation utilized to treat youths with extreme obesity (Wilson, Thomas and Randall, 2007). The other benefit of bariatric surgery is the resolution of comorbidities. There is no other medical intervention that simultaneously treats numerous diseases as weight loss surgery does. Tucker et al. (2007) outlined that as people loose weight more rapidly; in the long run the weight loss goals are attained. However, it is the maintenance mode that is considered to be the risky stage for most people. Most of them find it hard to dieting and exercising regularly. As a result, one starts gaining weight back. This is because there is lack of good support system which will drive someone to stick to good habits. Jaunoo and Southall (2010) noted that weight loss surgery usually poses risks to the patients in the long term. First, nutrients might be poorly absorbed, particularly in patients who do not take their prescribed minerals and vitamins. In some instances, if the patients do not handle this problem quickly, diseases may start occurring along with permanent damages to the nervous system. These diseases include pellagra, beri beri and kwashiorkor. Other problems that occur in the later stages of bariatric surgery include strictures and hernias. Strictures occur when the sites where the intestine is joined narrows. On the contrary, hernias occur when part of the body budges through a weak area of muscle. Biliopancreatic diversion with a duodenal switch in the long term leads to the decrease in the amount of food, minerals, and vitamins absorbed thus creating chances for nutritional deficiencies (OBrien et al., 2013). Lastly, the long term complications of gastric bypass surgery include gallstones, marginal ulcers, and bowel obstruction as well as nutritional deficiencies (Buchwald et al., 2009). Candidates of weight loss surgery need to have a body mass index of 40kg/m2 with significant obesity related co-morbidities, an acceptable operative risk, supportive social or family environment. Besides, they need to have documented failure of nonsurgical weight-loss programs. They also need to be living an alcohol and substance free life. Next, they must be devoid of uncontrolled depressive or psychotic disorder. They need also to be aware of the benefits and risks related weight loss surgery. Lastly, one needs to be aware in the way in which life might change after the surgery (Brethauer et al., 2013). Theoretical Framework Many studies have been done with regard to the long-term effects of bariatric surgery but most of them have been focusing on the probable solutions to weight loss surgery. OBrien at al. (2013) noted that 80 % or more of patients do well after weight loss surgery. Their quality of life is also improved after the surgery. Using the symptom substitution theory multiple studies have demonstrated that the patients become healthier since they have less obesity-connected conditions including diabetes, hypertension, metabolic syndrome, sleep apnea, and other related medical problems. Currently, bariatric surgery is an option for adults with severe obesity. Using the social cognitive models, like the theory of reasoned action, after bariatric surgery, diseases like ulcers are usually more difficult to diagnose and treat. Therefore, one needs to check with his/her primary care doctor or pharmacist, when commencing new medication. The theory of planned behavior will be used to predict exercise. Variables i. Bariatric surgery Bariatric surgery is viewed by many as the most effective treatment for obesity in relation to maintenance of long-term weight loss and enhancement in obesity-correlated comorbid conditions. For obesity treatment, weight loss surgery has become one of the therapeutic choices for most patients who have clinically significant obesity. ii. Vitamin absorption In the long run the absorption of nutrients and calories, such as vitamins is reduced due to bariatric surgery. The surgery is performed in order to interrupt how food is digested. iii. Obesity Obesity is no longer a disease that is associated with the adults, as an increasing number of adolescents are becoming overweight (Stefater, Jenkins and Inge, 2013). Bariatric surgery can significantly change both the weight and health of youth with extreme obesity. Gastric bypass surgery has been the major operation utilized to treat youths with extreme obesity. Morbid obesity is usually associated with decreased life span. After bariatric surgery, life expectancy increases in the long run. Serious health problems linked to obesity such as type 2 diabetes, severe sleep apnea, or heart disease are also reduced as a result. iv. Diabetes Gastrointestinal procedures for non obese and non morbidity patients have exhibited great promise as the most appropriate surgical option for treating diabetes. Diabetes is directly related to obesity. v. Psychological effects Most obese patients have exhibited increased psychological effects due to their conditions. This later leads to stress, hypertesnsion, and negative body image. On the other hand, bariatric surgeons exhibit emotional exhaustion and burn-out due to clinical case loads of obesity. vi. Long term effects of bariatric surgery The benefits include: weight loss goals are attained; there is also increased life expectancy; low death rate for patients diagnosed with severe obesity; lastly, bariatric surgery is the resolution of comorbidities. Other problems which occur in the later stages of bariatric surgery include strictures, gallstones, hernias, marginal ulcers, bowel obstruction, and nutritional deficiencies especially vitamins and minerals. vii. Laparoscopic Roux-en-Y surgery and laparoscopic adjustable gastric banding The laparoscopic Roux-en-Y gastric bypass procedure results in more short-term weight loss than laparoscopic adjustable gastric banding, although the latter is characterized by a lower mortality rate and fewer postoperative complications in the long run. Research Methodology The study will utilize a qualitative research methodology. It will be used due to the fact the research was aimed at answering the question like ‘what is,” ‘how’ and ‘what was’ (Nenty, 2009). Data collection The methods that will be used to collect qualitative data included open-ended questions, observation, key informant interviews, collection tools, personal interviews, surveys with close end-questions, filling of questionnaires, and focus groups. Surveys will be done through telephone and internet. The questionnaires will be self explanatory and they will be asked to fill it on their own volition. They included demographics, obesity related problems, list of potential obesity- and work-related stressors, and type of bariatric surgery underwent, as well as long term effect thereafter. The people to be interviewed include 3 senior surgeons at Johns Hopkins Hospital and Calvary Hospital, patients who will have undergone adjustable gastric band and vertical sleeve gastrectomy. Other interviewees will include who had undergone laparoscopic Roux-en-Y surgery, laparoscopic adjustable gastric banding, and biliopancreatic diversion with a duodenal switch. The primary data collected will complement the existing secondary data on bariatric surgery. The secondary data will be collected from health reports on bariatric surgery from the government and other medical care documents. A document will be given to each of the participants, which will include the following: covering letter, consent form, demographic questionnaire, and supplementary questionnaire, and General Health Questionnaire– 12 (GHQ-12). Subject Selection Qualitative data will be collected from a sample population of 57 patients of which 23 of them were females, 25 males and 12 children. These are patients who have undergone gastric banding, gastric bypass surgery, surgeons at John Hopkins and Calvary Hospitals, mildly obese patients, and morbidly obese patients who have undergone bariatric surgery. Data analysis Descriptive analysis would be done on the socio-demographic indicators and how bariatric surgery impacts on the patients in the long term. The interview data would be analyzed using the initial steps of grounded analysis method of qualitative research (Glaser and Strauss, 2012). The interviews will be transcribed verbatim and consecutively analyzed with NVivo 8.0 software with regard to the constant comparative method. Statistical analysis will be performed on all the completed questionnaires. Pairwise correlations and descriptive statistics will be calculated. The simple correlation coefficient will be utilized to test the significance and estimate the strength of the bivariate relationships. The Pearson and nonparametric Spearman correlations will also be calculated. Besides, Fisher exact test or X 2 will test for comparison of dichotomous or categorical end points. Statistical tests would be done to find out if there is any correlation between the bariatric surgery and independent variables such as obesity, psychological effects on patients, absorption of minerals and vitamins, clinical case load, and psychological ill-health in surgeons and patients. The statistical tests would be carried out by the biostatistician. Data communication The data will be communicated through a nursing symposium. To ensure the validity of the communicated data and the coding process, a second researcher will be consulted as auditor throughout the entire process of data analysis to assist the primary author by challenging ideas and helping in the construction of the categories. The survey used GHQ-12 as a validating instrument. Ethical Considerations The participants will sign that they will provide informed consent to be included in the study and for audio-taping the interviews, which will be approved by the Clinical Research Ethics Committees of the respective hospitals. Ethical approval will be sought from the Ministry of Health Research Committee. The exploratory research method to be used in this research may raise various moral issues including invasion of privacy, the researcher’s subjective interpretation of data and confidentiality of information. Since questionnaires and interviews will be among the instruments of data collection in this study, it will be necessary to consider issues of confidentiality, privacy and security of the collected data. To maintain privacy and confidentiality of the respondents, identification information of participants was not made available to people who were not directly involved in the research. References Brethauer, S., Chand, B., & Schauer, P. (2013). Risks and benefits of bariatric surgery: Current evidence. Cleveland Clinic Journal of Medicine , 74 (2), 30-45. Buchwald H, Avidor Y, Braunwald E, et al. 2009. Bariatric surgery: a systematic review and meta-analysis. JAMA, 292:1724–1737. Fontaine K., R, Redden D., T, Wang C, Westfall A., O, and Allison D., B. 2011. Years of life lost due to obesity. JAMA, 289:187–193. Glaser B, Strauss A. 2012. The discovery of grounded theory: strategies for qualitative research. Chicago, IL: Aldine Transaction. Jaunoo, S., & Southall, P. J. (2010). Bariatric Surgery. International Journal of Surgery , 8 (2), 45-65. Madura, J. A., & DiBaise, J. K. (2012). Quick fix or long-term cure? Pros and cons of bariatric surgery. Ann Surg. , 4 (19), 56-68. Maia, S. S. (2012). Obesity and Treatment Meanings in Bariatric Surgery Candidates: A Q ualitative Study. Obes Surg , 22, 1714-1722. OBrien, P., MacDonald, L., Anderson, M., Brennan, L., & Brown, W. (2013). Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Journal of Ann. Surgery , 257 (1), 87-94. Pories, W. (2008). Bariatric surgery: risks and rewards. The Journal of clinical endocrinology and metabolism, , 11 (1), 89-96. Rao, R., & Subhash, K. (2012). Diabetic and bariatric surgery: a review of the recent trends. Surgical Endoscopy , 26 (4), 134-155. Stefater, M. A., Jenkins, T., & Inge, T. H. (2013). Bariatric surgery for adolescents. Journal of Pediatric diabetes , 14 (1), 1-12. Sundbom, M., & Gustavsson, S. (2009). Bariatric Surgery. Clinics in dermatology , 22 (4), 212- 225. Tucker O. N, Szomstein S, and Rosenthal R. 2007. "Nutritional consequences of weight-loss surgery". Med. Clin. North Am. 91 (3): 499–514. U.S Department of Health and Human Services. (2012). Bariatric Surgery for Severe obesity. New York: U.S Department of Health and Human Services. Ogden C., L., Yanovski S., Z., Darroll M. D, and Flegal K. M. 2007. The epidemiology of obesity. Gastroenterology, 132:2087–2102. Walsh, N. (2013, June 5). Retrieved February 13, 2014, from Long-Term Benefit of Bariatric Surgery Questioned: http://www.medpagetoday.com/Surgery/GeneralSurgery/39629 Wilson S., T, Thomas H., I, and Randall S., B. 2007. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Archives of Pediatrics & Adolescent Medicine. 161(3):217-221. Zeller, M., H., Roehrig H., R., Modi A., C., Daniels S., R., and Inge T. H. 2006. "Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery". Pediatrics 14 (4): 1155–1161. Read More