终生逆境与病态肥胖患者肥胖治疗的关联。
Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity.
机构信息
Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway.
Department of Psychiatry, Unit for Consultation-Liason Psychiatry, Akershus University Hospital, Lørenskog, Norway.
出版信息
Obes Facts. 2019;12(1):1-13. doi: 10.1159/000494333. Epub 2019 Jan 17.
BACKGROUND
Bariatric surgery is associated with greater and more sustainable weight loss compared with lifestyle intervention programs. On the other hand, bariatric surgery may also be associated with physical and psychosocial complications. The influence of psychological evaluation on treatment choice, however, is not known. We aimed to examine variables associated with treatment choice and, specifically, if self-reported lifetime adversity influenced obesity treatment, i.e. bariatric surgery, high-intensive lifestyle treatment or low-intensive lifestyle treatment in primary care.
METHODS
We consecutively included 924 patients from the registry study of patients with morbid obesity at Akershus University Hospital, Lørenskog, Norway. Treatment selection was made through a shared decision-making process. Self-reported lifetime adversity was registered by trained personnel. Logistic regression models were used to assess the associations between obesity treatment and possible predictors.
RESULTS
Patients who chose bariatric surgery were more likely to have type 2 diabetes (DM2) compared with patients who chose lifestyle treatment (bariatric surgery: 35%, high-intensive lifestyle treatment: 26%, and low-intensive lifestyle treatment: 26%; p = 0.035). Patients who chose bariatric surgery were less likely than patients who chose lifestyle intervention to report lifetime adversity (bariatric surgery: 39%, high-intensive lifestyle treatment: 47%, and low-intensive lifestyle treatment: 51%; p = 0.004). After multivariable adjustments, increasing BMI, having DM2, and joint pain were associated with choosing bariatric surgery over non-surgical obesity treatment (odds ratio [95% CI]: BMI 1.03 [1.01-1.06], DM2 1.47 [1.09-1.99], and joint pain 1.46 [1.08-1.96]). Self-reported lifetime adversity was furthermore associated with lower odds of choosing bariatric surgery in patients with morbid obesity (0.67 [0.51-0.89]).
CONCLUSION
This study shows that increasing BMI, DM2, and joint pain were all associated with treatment choice for obesity. In addition, self-reported lifetime adversity was associated with the patients' treatment choice for morbid obesity. Consequently, we suggest that decisions concerning obesity treatment should include dialogue-based assessments of the patients' lifetime adversity.
背景
与生活方式干预相比，减重手术可带来更大且更持久的减重效果。然而，减重手术也可能与身体和心理社会并发症相关。但目前尚不清楚心理评估对治疗选择的影响。本研究旨在探讨与治疗选择相关的变量，具体而言，即自我报告的终生逆境是否会影响肥胖治疗，例如在初级保健中选择减重手术、高强度生活方式治疗或低强度生活方式治疗。
方法
我们连续纳入了挪威阿克什胡斯大学医院洛伦斯克肥胖患者注册研究中的 924 名患者。治疗选择是通过共同决策过程做出的。由经过培训的人员记录自我报告的终生逆境。使用逻辑回归模型评估肥胖治疗与可能的预测因子之间的关联。
结果
选择减重手术的患者更有可能患有 2 型糖尿病（DM2），而选择生活方式治疗的患者则较少患有 2 型糖尿病（减重手术：35%，高强度生活方式治疗：26%，低强度生活方式治疗：26%；p=0.035）。与选择生活方式干预的患者相比，选择减重手术的患者报告的终生逆境较少（减重手术：39%，高强度生活方式治疗：47%，低强度生活方式治疗：51%；p=0.004）。经多变量调整后，BMI 增加、患有 DM2 和关节疼痛与选择减重手术而非非手术肥胖治疗相关（比值比[95%CI]：BMI 1.03[1.01-1.06]、DM2 1.47[1.09-1.99]和关节疼痛 1.46[1.08-1.96]）。此外，自我报告的终生逆境与肥胖患者选择减重手术的可能性降低相关（0.67[0.51-0.89]）。
结论
本研究表明，BMI 增加、DM2 和关节疼痛均与肥胖的治疗选择相关。此外，自我报告的终生逆境与患者对肥胖的治疗选择相关。因此，我们建议肥胖治疗决策应包括基于对话的患者终生逆境评估。
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