Treino de habilidades sociais e comportamento alimentar após cirurgia bariátrica

Abstract

Bariatric surgery has been the primary clinical indication for morbid obesity cases after the observation of medical intractability. However, there are records of much varied results: weight regain; anorexia and bulimia; regular weight maintenance. Among the factors studied in the literature is the relation between obesity and a general social skills deficit or one that is specifically related to feeding situations. This study assessed the effects of Social Skills Training (SST) in eating behavior in individuals undergoing bariatric surgery. The participants were ten adult women indicated for bariatric surgery, distributed in two conditions: Condition 1 – Routine treatment + Social Skills Training, composed of two participants (P1 and P2); and, Condition 2 - Routine treatment, composed of eight participants (from P3 to P10). The inclusion criteria of participants in Condition 1 were: (a) be in the preoperative examinations bariatric surgery; (b) having membership index Diet (IAD) below 50; (c) no history of any other surgical procedures for obesity (gastric balloon, for example); and (d) low scores on at least one of the five factors evaluated in the Social Skills Inventory (IHS). The inclusion criteria of participants in Condition 2 were: (a) have performed Bariatric Surgery in a period of more than three but less than a year and (b) no history of any other surgical procedures for obesity (gastric balloon, for example). The participants in Condition 1 were exposed to six data collection phase: Initial Assessment; Evaluation of eating behavior before THS; THS; Reassessment of eating behavior after the THS; Reassessment of social behavior after the THS and; Follow-up. The THS was based in self-monitoring, analysis of contingencies and behavioral testing. All phases were carried out in the late post surgical period, except the Initial Assessment that occurred in the preoperative period. The participants of the condition 2 held only an initial assessment, applied in the late post-surgical period. The data about the eating behavior were obtained through the analysis of the interview script on eating behavior and 24-hour dietary recall adapted (R24h), allowing the identification of the food ingested, fractionation, the IAD per meal, absolute medium by R24h and the overall average of the IAD's per phase of the study. The data on social behavior were obtained through the analysis of the IHS and the self-monitoring form of issue of THS, allowing the identification of values obtained in each issue and in factorials scores of IHS and the frequency and consequence of each issue of THS. Were drawn comparisons between the IAD and the factorial scores and values per item of the IHS: 1) per participant in different phases of the study; 2) for participants exposed to the same condition of the study; 3) for participants exposed to different conditions of the study. As to social behavior, it was found that the participants of both conditions showed deficits in five factors and components items in the items grouped into factors of IHS. With the exception of P2 of condition 1, the other participants showed greater deficits in F5 factor issue (Self-control of aggressiveness in aversive situations). As for eating behavior, it was found that no participant obtained average in R24h, or IAD on general average of IADs three of each phase of the procedure, equivalent to or greater than 50, having occurred few IADs absolutes per meal with these values. The early withdrawal of multidisciplinary follow-up by 9/10 attendees may have contributed to this result. The analysis of the R24h of the participants of both conditions also indicated that the choice of food and meal frequency in the late post-surgical period varied little, since despite the inclusion of foods with lower caloric value, identified the maintenance of food calorie diet and the elimination of meals in most participants. The comparison of the data of the eating behavior and repertoire of social skills of the two participants in the Condition 1 indicated that the THS conducted in late post-surgical period had no significant effects for the increase of the IAD. This result was confirmed with the comparison of values obtained in the same variables for Condition 2 participants, in spite of the effects in terms of increasing repertoire of self-observation and self-knowledge in the participants of the condition 1.