School of Nursing and Department of Psychology, Duquesne University, Pittsburgh, Pennsylvania.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Surg Obes Relat Dis. 2018 Jan;14(1):112-116. doi: 10.1016/j.soard.2017.07.023. Epub 2017 Jul 20.
Among carefully screened patients, bariatric surgery has proven safe and efficacious in the management of clinically severe obesity and poorly controlled type 2 diabetes. Nonetheless, individual outcomes vary, suggesting the need for interventions to maximize and sustain the health benefits of surgery. In this short review, we synthesize findings from the extant research literature to suggest the potential utility of a stepped care approach to optimize the postsurgery weight trajectory, which requires further research using adaptive designs. Starting with low-intensity, cost-effective interventions, such as self-weighing and self-monitoring, interventions that increase in intensity, such as counseling, meal replacements, or weight loss medications, could be added strategically according to predetermined decision rules based on patient weight change. Interventions could subsequently be withdrawn if no longer indicated, or reinstituted when appropriate, allowing for efficient allocation of resources in a personalized approach to postsurgery weight management over time.
在经过精心筛选的患者中，减重手术已被证明在治疗临床重度肥胖和控制不佳的 2 型糖尿病方面是安全有效的。尽管如此，个体的治疗效果仍存在差异，这表明需要采取干预措施来最大化和维持手术带来的健康益处。在这篇简短的综述中，我们综合了现有研究文献的结果，提出了一种分级护理方法的潜在效用，以优化手术后的体重轨迹，这需要使用适应性设计进一步研究。从低强度、具有成本效益的干预措施开始，如自我称重和自我监测，然后根据基于患者体重变化的预定决策规则，有策略地增加干预措施的强度，如咨询、代餐或减肥药物。如果不再需要，干预措施可以随后被撤回，或者在适当的时候重新开始，从而在个性化的术后体重管理方法中实现资源的有效分配。
