Fischer Lars, Wekerle Anna-Laura, Sander Johannes, Nickel Felix, Billeter Adrian T, Zech Ulrike, Bruckner Thomas, Müller-Stich Beat P
Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Obesity Clinic, Schön Klinik Hamburg Eilbek, 22081, Hamburg, Germany.
Obes Surg. 2017 Jul;27(7):1684-1690. doi: 10.1007/s11695-016-2534-0.
The effects of bariatric surgery on excess weight loss (EWL) and comorbidities are proven. Still, a significant number of patients prefer conservative therapy (ConsP).
The goal of this study was to examine why ConsP and patients awaiting bariatric surgery (SurgP) choose which therapy, and to define the differences in their expectations.
Prospective study, 1 university hospital, 1 general hospital, Germany.
ConsP and SurgP were asked to complete a questionnaire. Statistical analysis including all patients and a BMI-matched cohort was performed using the chi-square and Wilcoxon rank-sum test.
Overall, 151 patients participated in this study (50 ConsP, 101 SurgP, 69.4% females). The mean age was 41.1 years (SD ± 12.2 years). ConsP had a significant lower body mass index (BMI, 44.7 kg/m vs. 49.3 kg/m, p < 0.01). The educational level was significantly higher in ConsP. SurgP suffered significantly more often from depression (21.6% vs. 36.6%, p = 0.02) and joint pain (45.1% vs. 68.7%, p = 0.02). ConsP completed significantly more diets that were supervised by physicians or considered well-structured (56.3% vs. 31.0%, p = 0.04). SurgP considered their chosen therapy a last resort significantly more often (p < 0.01). A BMI-matched analysis between ConsP and SurgP revealed no significant differences in the prevalence of comorbidities but showed that fear of surgery plays a major role in the decision-making processes of obese patients.
A higher BMI and a greater prevalence of comorbidities had driven patients to seek a more radical solution for their obesity, i.e., surgery. The BMI-matched analysis suggests that fear of surgery is a relevant factor in why obese patients do not decide to undergo bariatric surgery lightly.
减肥手术对减轻超重及合并症的效果已得到证实。然而，仍有相当数量的患者倾向于保守治疗（ConsP）。
本研究的目的是探讨为什么选择保守治疗和等待减肥手术的患者（SurgP）会选择某种治疗方法，并明确他们期望上的差异。
前瞻性研究，德国1所大学医院、1所综合医院。
要求ConsP和SurgP完成一份问卷。使用卡方检验和Wilcoxon秩和检验对所有患者以及体重指数匹配队列进行统计分析。
总体而言，151名患者参与了本研究（50名ConsP，101名SurgP，女性占69.4%）。平均年龄为41.1岁（标准差±12.2岁）。ConsP的体重指数显著更低（体重指数，44.7kg/m²对49.3kg/m²，p<0.01）。ConsP的教育水平显著更高。SurgP患抑郁症（21.6%对36.6%，p=0.02）和关节疼痛（45.1%对68.7%，p=0.02）的情况明显更常见。ConsP完成由医生监督或认为结构良好的饮食的比例显著更高（56.3%对31.0%，p=0.04）。SurgP更常将他们选择的治疗视为最后手段（p<0.01）。ConsP和SurgP之间的体重指数匹配分析显示合并症患病率无显著差异，但表明对手术的恐惧在肥胖患者的决策过程中起主要作用。
更高的体重指数和更高的合并症患病率促使患者为其肥胖寻求更激进的解决方案，即手术。体重指数匹配分析表明，对手术的恐惧是肥胖患者不会轻易决定接受减肥手术的一个相关因素。
