Because of the high prevalence of obesity, this illness is considered a public health problem. Studies worldwide show that bariatric and metabolic surgery is the most effective weight loss treatment. It has been recommended for the treatment of severe obesity while also obtaining the remission of more than 80% of associated medical diseases [1], [2].
To be as effective as possible it requires good patient involvement during the whole process. The perioperative preparation, beginning in the preoperative phase, is fundamental and should include the needed support from the health professionals working in the process for a successful postoperative period, assuming changes in behavior and patient capacitation. A good patient's self-management helps to achive behavioral changes to be achieved before and after surgery [3], [4].
Understanding how behavioral interventions, before and after surgery, can impact bariatric surgery results is crucial. The guidelines of the American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, the Obesity Medicine Association, and American Society of Anesthesiologists [5] recommend that a multidisciplinary team with expertise in various areas of behavioral intervention should be involved in the follow-up of these patients [6], [7].
There are few meta-analyses on these assessments and those that exist consider and recommend a multidisciplinary intervention led by one of the team professionals, with screening and referral required, with interventions for no less than six months of follow-up [4], [8].
The available after-surgery evidence show varying results in the postoperative evolution of patients and, occasionally, the need of reoperations and secondary surgeries [9]. These results sometimes show insufficient weight loss or even weight regain, while, some other studies, mention that the weight regain may even occur before six months [10], [11]. Also, 20 to 30% of patients don’t achieve the desired weight loss before five years [12], [13], and about 87% of patients present weight regain at ten years [14], [15], [16]. In this sense, and because we have evidence that behavioral interventions are effective to achive 5–10% weight loss in non-surgical treatments [17], it is relevant to understand their influence and role in bariatric surgery patients.
The figure of a nurse case manager has proven its benefit in managing several health/disease conditions, especially chronic diseases and self-management of treatment, reducing the number of related hospitalizations, complications, and emergent admissions while promoting quality of life. Chronic diseases such as diabetes and hypertension are conditions that may include more benefits with follow-up by a case manager [18], namely in reducing risk behaviors related to these diseases, such as lifestyle change, smoking cessation, better dietary choices, and physical exercise [19]. The joint teamwork between nurses and patients may achieve better results. The care is focused on what the patient needs and wants, regardless of the type of communication. A holistic and multidimensional approach shows potential for positive clinical results in managing chronic conditions [4].
Bariatric surgery is a significant medical intervention requiring comprehensive patient education and support. A nurse-led case manager can provide personalized education regarding the surgery, potential risks and benefits, dietary and lifestyle changes needed before and after surgery, and what to expect during recovery. This support is essential for ensuring that patients are well-informed and prepared for the journey ahead.
Objectives
Primary objectives
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- To analyze the effects of a specialized intervention, managed by nurses in the perioperative period, on the self-management outcomes after bariatric surgery.
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- To analyze the impact of specialized intervention on weight evolution in the pre-operative and post-operative periods.
Secondary objectives
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- To characterize how a specialized intervention can contribute to changes in lifestyles, increased well-being and self-care, and the functional adaptation of patients in the perioperative period.
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- To promote self-care (maintenance, monitoring and management).
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- To promote adapting health behaviors to meet favorable conditions for bariatric surgery and maintain a healthy lifestyle post-surgery.
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- To increase the practice of physical activity.
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- To improve follow-up with the patient to ensure therapeutic adherence and monitor and evaluate symptoms effectively.