Oct 8, 2020 in Medicine

Gastric Bypass Surgery with Diet and Exercise

The clinical problem is the need to develop the appropriate intervention mechanisms so that patients after postoperative gastric bypass surgery experience long-term weight loss. According to the preliminary research, long-term weight loss is contingent on lifestyle changes, including nutrition and exercise. Postoperative gastric bypass patients often have limited knowledge regarding the ways of maximizing weight loss. Moreover, they risk their lives when they undergo gastric bypass surgery, which makes it imperative to keep their ideal body weight and sustain a healthy lifestyle. Thus, there is a need to provide insight into the best intervention strategy that will enable patients to experience and maintain long-term weight loss. Two critical concepts to achieve optimal weight loss results are body mass index (BMI) and calculation of daily caloric intake. In adult women who are status post gastric bypass surgery (P), does ongoing nutrition and lifestyle training (I) compared to standard postoperative guidance (C) result in greater weight loss and decreased BMI (O) over the period of one year (T)? Expected outcomes of this proposed EBP change include an increase in patient knowledge of healthy nutrition and lifestyle choices designed to maximize weight loss and BMI reduction.

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Literature Search

To determine whether ongoing lifestyle and nutrition training over time have a significant effect on BMI after a successful gastric bypass surgery, it is imperative to analyze the results of randomized controlled trials. To accomplish this goal, search engines like PubMed and Google Scholar were utilized to find studies that satisfy the aforementioned requirements. The keywords used were gastric bypass surgery, BMI, and weight loss.

Literature Review

The purpose of the study entitled High-volume exercise program in obese bariatric surgery patients: A randomized, controlled trial was to determine the impact of high-volume exercise in helping the patient achieve the ideal BMI (Adams-Huet et al., 2011). The sample included a 12-week randomized control group which enrolled 33 participants who recently underwent Roux-en-Y gastric bypass (RYGB) and gastric bypass surgery and had class two (BMI 35.5-39.9) or class three (BMI ? 40) obesity (Adams-Huet et al., 2011). Study participants were placed in a supervised exercise routine to burn 500 kcal/week initially, increasing to a maximum of >2000 kcal/week. The participants also had to adhere to the dietary guidelines developed for post bariatric surgery. They were asked to limit intake to 1,200-1,500 kcal/day and spend a minimum of 20 minutes eating their meal. Diet was assessed three days a week. At the end of the study, 82% were expending >2,000 kcal/week with a decrease in body weight from 110.3 to 106.1 pounds. The strength of this study is that it could show the value of lifestyle changes as described in PICOT and that it is found on the random assignment of the participants. The weakness of the study is that the role of education was not emphasized and that the researchers were not blind to the study group.

The study by Baum et al. (2012) aimed at tracking down the effect of comprehensive lifestyle and nutrition. It assisted in weight loss initiatives and, at the same time, enhanced physical activity among Hispanic Americans following post-operative procedures in gastric bypass surgery (Baum et al., 2012). This randomized controlled trial enrolled 114 RYGB patients and separated them into two groups. The intervention group received comprehensive diet and exercise classes with support from a dietician. The control group received a printed healthy lifestyles guideline. Participants started the trial six months after the surgery and were reevaluated 12 months after the surgery. All participants were given the option to receive counseling from various health care professionals. Forty-five (31.3%) participants selected a health professional for counseling, 15 (10.4%) selected a dietician, and 88 (61.1%) selected some other professional (Baum et al., 2012). The results showed that both groups lost weight; however, the intervention group lost more weight (80%) preoperatively compared to the control group (64%). The BMI reduction in the intervention group and control groups was 48.98 to 28.88 and 49.54 to 32.89, respectively. The strength of the study can be found in the achievement of a balance between the education component and the lifestyle change that has to be implemented. Just like in the previous study, the proponents succeeded in randomly assigning the control or intervention group. However, both studies share the same problem, which is the fact that the researchers were not blind to the study group. Moreover, it is difficult to replicate the education or training component because the participants sought help or acquired knowledge from different sources.

In a relatively new study by Barnes, Grilo, Martino, and White (2014), the proponents aimed at simply tracking down the weight loss of the respondents who underwent gastric bypass surgery. The parameters used were triglyceride level measurement and the depression scores of the participants. This randomized controlled trial enrolled 89 participants and separated them into three groups for primary care. The groups included web-based motivational interviewing (MIC), nutrition psychoeducation (NPC), and a usual care (UC) group (Barnes et al., 2014). The duration of the study was three months. MIC and NPC groups met for five sessions while the control group, UC, met for a single appointment. MIC and NPC groups focused on motivation and psychoeducation, respectively, and had an access to a weight loss website so that the subjects could track their exercise and daily diets. UC group had a single appointment with a primary care which provided no information and asked the participants not to start any structured weight loss programs till the three-month follow-up appointment. The outcome of the study was that 94% of NPC experienced weight loss, decreased depression, and the reduction in triglyceride levels (Barnes et al., 2014). The strength of the study is random sampling and the use of education and other learning strategies to educate the patients regarding the importance of lifestyle changes to experience long-term weight loss. The weakness of the study is the lack of emphasis on exercise and the fact that the proponents of the study were not blind to the study group.

The last study by Coen, Tanner, and Helbling (2014) documented the attempt to establish whether moderate exercise following an RYGB surgery succeeded in helping the participants to experience improvements when it comes to insulin sensitivity and cardiorespiratory fitness compared to those who opted for a sedentary lifestyle. It was a randomized controlled trial with 128 men and women who had undergone an RYGB surgery. They were randomized to join a 6-month semi-supervised moderate exercise scheme or an intervention program that enabled the participants to learn more about weight loss in a post-operative surgery context. The proponents of the study wanted to measure a decrease in body weight and sensitivity to insulin. According to Coen et al.,

SI improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min1/?U/ml, P = 0.18 for ?, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive SI improvement (PP: CON vs. EX; +1.57 vs. +2.69 min1/?U/ml, P = 0.019) above that of surgery. Exercise also improved SG (ITT: CON vs. EX; +0.0023 vs. +0.0063 min1, P= 0.009) compared with the CON group. Exercise improved cardiorespiratory fitness (VO2 peak) compared with the CON group. (2014)

The strength of the study is seen in the emphasis placed on the effect of education and moderate exercise. The weakness of the experiment is that the participants did not experience the combined effect of education and exercise as some only received the education portion while others could experience the moderate exercise protocol.

Synthesis

These four studies shared a common purpose of determining the efficacy of certain intervention strategies when it comes to enhancing the positive impact of gastric bypass surgery. They also shared common ground in the methodology because they used either an exercise protocol, an intervention method, or a combination of both. The four RCT-based studies explicitly discussed the impact of the intervention strategies implemented. In all four, there was a reduction in weight and the achievement of a healthier lifestyle, in general.

In the first study, the participants had to undergo a process supervised by the researchers (Adams-Huet et al., 2011). However, there was no education mechanism to teach them to alter their lifestyle. In the second study, there was an education component but there was no exercise component (Baum et al.2012). In the third study, there was a combination of both but there was no protocol followed (Barnes et al., 2014). In the fourth study, there was a combination of both, which was applied haphazardly, as some had exercise while others had only the education component (Coen et al., 2014). Furthermore, the fourth study included another element, which was to study the impact of exercise and education insulin sensitivity, which was not tackled in the previous three studies.

However, there was no way to determine the combined effect of exercise and education when done at the same time to the same group of respondents. Furthermore, the results do not provide clear findings whether lifestyle intervention through education is an effective tool. It was not made clear whether the respondents went through an exercise program as a direct effect of the seminar or lectures, or whether it was the result of the existence of a regimented exercise program. Thus, it also leads to a secondary question whether the weight loss program can be sustainable if there is no one controlling respondents. If left on their own, it is not clear whether they will be able to create a sustainable program that will ensure the gradual reduction in weight or, at least, maintain an ideal weight for each individual.

Nevertheless, studies made it clear that there can be the greater effectiveness of the weight loss program if it is enhanced by an education, learning, or training component. It is not enough to tell patients what to do, they should have a change of mindset, which is possible there is education or learning.

Clinical Recommendations

Future research studies should look into the possibility of combining both the exercise and education component of the study. They should track down the impact of exercise, diet, and education intervention. There must be a clear protocol that the respondents should follow to determine clearly that there was indeed a significant effect when combining both protocols. It is also imperative to design a research initiative that looks into the long-term sustainability of the weight loss and fitness enhancement program if the researchers lose contact with the respondents or patients.
 
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