Halit Eren TAŞKIN, Gözde İN, Muzaffer AL, Abdullah Kağan ZENGİN

Covid–19 Pandemisi Sırasında Uygulanan Sosyal İzolasyon Protokolünün Postoperatif Dönemdeki Bariatrik Cerrahi Hastalarının Egzersiz Düzeyi, Beslenme Alışkanlıkları, Metabolik Parametreleri ve Emosyonel Durumları Üzerine Etkileri

GİRİŞ ve AMAÇ: 2020 yılının ilk aylarından itibaren etkinliği her geçen gün daha da artan covid-19 pandemisi dünya genelinde kronik hastalıklarda dahil olmak üzere bütün diğer hastalıklara yönelik yapılan sağlık hizmetlerinin kısıtlanmasına ve sağlık kaynaklarının pandemiye yöneltilmesine sebebiyet vermiştir. Bu nedenle obezite ve yandaş hastalıkların tedavisi ve hasta takibinde ciddi problemler yaşanmaktadır. Bu dönem ve hemen sonrasındaki normalleşme döneminde hastaların tekrar kilo almamaları, egzersiz ve diyet protokollerinin takibi ve emosyonel durumlarının belirlenmesi ve sorunlarının çözümü son derece önemlidir. Bu çalışmada pandeminin neden olduğu stresin ve hareket kısıtlamasının bariatrik cerrahi geçiren 1 yıllık takip hastalarının, yaşadıkları sosyal, davranışsal ve emosyonel durumların ortaya konulması ve bu dönemde uyguladıkları egzersiz protokollerinin ve beslenme alışkanlıklarının metabolik durumları üzerine etkilerinin belirlenmesi hedeflenmiştir. YÖNTEM ve GEREÇLER: İ.Ü.C. Cerrahpaşa Tıp Fakültesi Genel Cerrahi Anabilim Dalında Roux-en-Y gastrik bypass (n = 15) ve Sleeve gastrektomi (n = 20) geçiren, iki farklı egzersiz programı uygulanan (Kombine egzersiz (Aerobik+progresif dirençli egzersiz) ve Aerobik egzersiz) 35 takip hastanın pandemi öncesi ve başlangıcından itibaren 8 hafta sonrasında ki takip verileri online tıp uygulamaları ve e-posta ile gönderilen anketlersonucunda incelendi ve istatistiksel olarak farklılıklar ortaya konuldu. BULGULAR: Erken dönem sonuçlarımız değerlendirildiğinde, covid-19 pandemisi sırasında yaşanan sosyal izolasyon önlemleri hem bariatrik cerrahi geçiren hastaların fazla kalori almalarına neden olmuş hem de beslenme alışklanlıklarında ve emosyonel durumlarında köklü değişimlere neden olmuştur. TARTIŞMA ve SONUÇ: İleride gerçekleşmesi muhtemel yeme bozukluklarının ve bunun neticesinde kilo alımının önlenmesi için online tıp uygulamalarının etkin şekilde kullanımı umut vericidir. Çalışmamız pandemi döneminde bu uygulamanın hasta takibi ve egzersiz protokollerinin uygulanması açısından yararlı olduğunu göstermiştir.

The Effects of Social Isolation Measures Due to Covid-19 Pandemia On The Exercise Status, Eating Behaviours, Metabolic Parameters And Emotional Status of Postoperative Bariatric Surgery Patients

NTRODUCTION: Starting from the first months of 2020, Covid19 pandemia caused devastating burden on health systems through out the World casuing restrictions on treatment of chronic disesases and redirection of resources to the treatment of pandemia. For this reason the treatment of obesity and comorbidities has been hindered and follow-up of patients were not bein managed optimally. Duringand after the pandemia to prevent the weight recevidism and to manage the optimal follow-up patients the current situation should be determined. METHODS: Here in this study we aimed to determine the pycho-social status, eaiting patterns and exercise protocols of post-bariatric surgery patients in social isolation who has been at least followed-up for 1 years. RESULTS: We have studied the parameters from the two group of bariatric patients who underwent Roux-en-y gastric bypass (n=15) and sleeve gastrectomy(n=20) in Istanbul University Cerrahpasa-Cerrahpasa Medical Faculty where two different types of execise protocols (aerobic exercise versus aerobic combined with progressive resistance training) has been applied. Thirty-five patients has been followed up for 8 weeks after the start of pandemia by telemedicine modallities and statistical calculations were made. DISCUSSION AND CONCLUSION: Our preliminary resluts suggest that social isolation measures resulted in excess calorie intake and changed the eating behaviours of the post-bariatric patients mainly due to emotional stress. The use of telemedicine to determine the current situation is curicial to determine current situation and to prevent eaiting disorders and weight recevidism in post-bariatric patients.

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1. Rolling updates on coronavirus disease (COVID-19). (Updated 29 June 2020). https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen (Accessed 11 July 2020.)
2. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet. 2020; 395(10223):470–473.
3. Mahase E. China coronavirus: WHO declares international emerge
4. Bhasker A. & Greve J. Are Patients Suffering from Severe Obesity Getting a Raw Deal During COVID-19 Pandemic? Obesity Surgery.2020 ; 1-2
5. Yeo D, Yeo C, Low TY, et al. Outcomes after metabolic surgery in Asians-a meta-analysis. Obes Surg. 2019. 29(1):114-126.
6. Yeo C, Kaushal S, Lim B, et al. Impact of bariatric surgery on serum uric acid levels and the incidence of gout-a meta-analysis. Obes Rev. 2019;20:1759–70.
7. Weng TC, Chang CH, Dong YH, et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5(7):e006964.
8. Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev. 2018;19(8):1141–63.
9. Washburn, R., & Montoye, H. The Assessment Of Physical Activity By Questionnaires. American Journal Of Epidemiology. 1986;123(4), pp. 563-576.
10. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561–571.
11. Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897.
12. Beck, A.T., Lester, D. & Trexler, M. The Measurement of Pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 1974 : (42), 861-874.
13. Turkish Health Ministry TH. Statistics of COVID-19 pandemic. Accesssed 11 July 2020.
14. Mitchell NS, Catenacci VA, Wyatt HR, et al. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–32. 15. Maggisano M. Maeda A., Okrainec A. et al. Physical Activity and Its Association With Psychosocial Health Following Bariatric Surgery. Appl Physiol Nutr Metab.2019 Dec;44(12):1379-1382.
16. Coleman, K. J., Caparosa, S. L., Nichols, J. F. et al. Understanding the Capacity for Exercise in Post-Bariatric Patients. Obes. Surg., 2017 : 27(1), 51-58.
17. Sockalingam S, Leung SE, Cassin SE. The impact of COVID-19 on bariatric surgery: re-defining psychosocial care. Obesity (Silver Spring, Md). 2020.
18. Yeo D, Toh A, Yeo C, et al. The impact of impulsivity on weight loss after bariatric surgery: a systematic review. Eating and weight disorders : EWD. 2020.
19. Burgess E, Turan B, Lokken K, et al. Profiling motives behind hedonic eating. Preliminary validation of the Palatable Eating Motives Scale. Appetite. 2014;72:66–72.
20. Boggiano M, Wenger L, Turan B, et al. Eating tasty food to cope. Longitudinal association with BMI. Appetite. 2015;87:365–70.
21. Reaves D.L. Dickson JM, Halford J. Et all. A Qualitative Analysis of Problematic and Non-problematic Alcohol Use After Bariatric Surgery. Obes Surg. 2019 Jul;29(7):2200-2209.
22. Coulman K, MacKichan F, Blazeby J, et al. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev. 2017;18(5):547–59.
23. Magro, D. O., Ueno, M., Coelho-Neto, J. S., Callejas-Neto, F., Pareja, J. C., Cazzo, E. 2018. Longterm weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10-year follow-up study. Surg. Obes. Relat. Dis., 14(7), 910-917.
24. Cassin, S. E., Sockalingam, S., Du, C., et al. A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients. Behaviour research and therapy, 2016: 80, 17-22.
25. Loddo C, Poullenot F, Rivière P, et al. Malnutrition after bariatric surgery requiring artificial nutrition supplies. Obes Surg. 2018;28(6):1803–5.
26. Frame-Peterson LA, Megill RD, Carobrese S, et al. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.
27. Flegal KM, Kit BK, Orpana H, et al.. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013;309(1):71–82.
28. Inadomi, M. Iyengar R., Fischer I. et al. Effect of patient-reported smoking status on short-term bariatric surgery outcomes. Surg. Endosc. (2017). doi:10.1007/s00464-017-5728-1
29. Kowalewski P.K. Olszewski R, Walędziak M.S. et. al. Cigarette Smoking and Its Impact on Weight Loss After Bariatric Surgery: A Single Center, Retrospective Study. Surg Obes Relat Dis.2018 Aug;14(8):1163-1166.
30. Moser, F. Signorini FJ, Maldonado PS et al. Relationship Between Tobacco Use and Weight Loss After Bariatric Surgery. Obes. Surg. 26, 1777–1781 (2016).