VISOKA ŠOLA ZA ZDRAVSTVENE VEDE SLOVENJ GRADEC Diplomsko delo visokošolskega strokovnega študijskega programa prve stopnje ZDRAVSTVENA NEGA PREHRAMBNI REŽIM LJUDI PO BARIATRIČNI OPERACIJI Z GASTRIČNIM TRAKOM Mentor: pred. Igor Robert Roj Somentorica: doc. dr. Danica Železnik Slovenj Gradec, marec 2013 Kandidatka: Anica Brezovnik POVZETEK Teoretična izhodišča: Debelost je eno največjih tveganj za naše zdravje. Nekaterim se zdi, da nikakor ne morejo shujšati, vendar to ni res. Pomembni so zmerni obroki in telesna aktivnost, ki so pogoj za uspeh (Gordon, Gower in Harrar, 2011). Metoda: Uporabili smo kvantitativno metodo raziskovanja. Izbrali smo neslučajnostni vzorec. Podatke smo zbirali s pomočjo anketnega vprašalnika, ki smo ga izvedli med ljudmi, ki so bili operirani zaradi prekomerne debelosti po kirurški metodi z gastričnim trakom. Pridobljene podatke smo obdelali z računalniškim Excel programom. Od 40 anketnih vprašalnikov smo dobili vrnjenih 36, kar predstavlja 90 % realizacijo vzorca. Rezultati: Ljudje so po bariatrični operaciji s svojim življenjem bolj zadovoljni, saj so v večini primerov (57,8%) izgubili od 10 do 30 kilogramov telesne teže, 22,4% anketiranih pa celo preko 30 kilogramov telesne teže. Zaradi tega je tudi njihova samopodoba boljša, saj to trdi kar 81,2% anketiranih. Tega stanja pa ne bi dosegli brez zdravega načina prehranjevanja po bariatrični operaciji in brez povečane telesne aktivnosti, saj polovica anketiranih v svoj jedilnik vključuje tudi sadje in zelenjavo, 95,2% anketiranih uživa manjše obroke hrane in 72,8% anketiranih uživa manj kalorično hrano, kar 84% anketiranih pa je telesno bolj dejavnih kot pred bariatričnim posegom. Razprava: Ljudje po operaciji z gastričnim trakom so telesno bolj aktivni in se prehranjujejo bolj zdravo in zmerno. Njihova samopodoba je po bariatričnem posegu boljša. Ključne besede: bariatrična kirurgija, debelost, prehrana, samopodoba, telesna aktivnost. SUMMARY Theoretical background: Obesity is one of the biggest risks to our health. Some people feel that they can not lose weight, but this is not true. Moderate meals and physical activity, which are prerequisites for success, are important (Gordon, Gower and Harrar, 2011). Method: We used quantitative research method. We chose occasional pattern. Data were collected through a survey questionnaire, which was conducted among people who have had surgery for obesity with gastric band surgical method. Acquired data were processed with a computer program Excel. We got 36 questionnaires returned from 40 delivered,which represents 90% of the sample realization. Results: People are happier with their life after bariatric surgery, because they have in most cases (57, 8%) lost 10 to 30 pounds of body weight, 22.4% of people even over 30 kilograms of body weight. That their self-esteem is better, claims 81, 2% of respondents. This situation would not be achieved without a healthy diet after the bariatric surgery and increased physically activity<. Half of the respondents now also include fruit and vegetables to their menu, 95.2% of respondents enjoy smaller meals and 72.8% of the respondentsconsum fewer calories. 84% of the surveyed people are now more physically active than before bariatric surgery. Discussion: People with gastric band surgery are physically more active, eat healthier then before and in moderation. Their self-esteem after bariatric surgery is much better. Keywords: bariatric surgery, obesity, nutrition, self-esteem, physical activity. KAZALO 1 UVOD ............................................................................................................................... 1 2 OPREDELITEV DEBELOSTI ........................................................................................... 2 2.1 Vzroki debelosti.......................................................................................................... 3 2.2 Debelost in bolezni ..................................................................................................... 4 2.2.1 Sladkorna bolezen tip 2 .................................................................................... 5 2.2.2 Krvni tlak in debelost ........................................................................................ 6 2.3 Debelost in zmanjšanje telesne teže .......................................................................... 6 2.3.1 Neinvazivni načini zmanjšanja telesne teže ...................................................... 6 3 KIRURŠKE METODE ....................................................................................................... 7 3.1 Prilagodljiv gastrični trak ............................................................................................ 7 3.2 Vzdolžna resekcija želodca ........................................................................................ 8 3.3 Želodčni obvod........................................................................................................... 8 4 PREHRANJEVANJE PO OPERACIJI Z GASTRIČNIM TRAKOM ................................... 9 4.1 Zdrava prehrana ........................................................................................................ 9 4.1.1 Vitamini ...........................................................................................................10 4.1.2 Beljakovine ......................................................................................................11 4.1.3 Ogljikovi hidrati ................................................................................................11 4.1.4 Železo .............................................................................................................11 4.1.5 Folna kislina ....................................................................................................12 4.1.6 Kalcij ...............................................................................................................12 4.1.7 Cink .................................................................................................................13 4.2 Način prehranjevanja po operaciji z gastričnim trakom ..............................................13 4.3 Zapleti pri hranjenju po operaciji z gastričnim trakom ................................................14 5 RAZISKOVALNI DEL ......................................................................................................15 5.1 Namen in cilji raziskovanja ........................................................................................15 5.2 Raziskovalna vprašanja ............................................................................................15 5.3 Raziskovalna metodologija........................................................................................16 5.3.1 Metode in tehnike zbiranja podatkov ...............................................................16 5.3.2 Opis instrumentarija ........................................................................................16 5.3.3 Opis vzorca .....................................................................................................16 5.3.4 Postopek zbiranja in obdelave podatkov .........................................................16 5.4 Rezultati ....................................................................................................................16 5.5 Razprava ..................................................................................................................28 6 ZAKLJUČEK ...................................................................................................................33 7 LITERATURA IN VIRI .....................................................................................................35 PRILOGA KAZALO GRAFOV Graf 1: Spol in število anketirancev ...................................................................................17 Graf 2: Izguba kilogramov v prvem letu po kirurškem posegu ...........................................17 Graf 3: Način prehranjevanja pred operacijo z gastričnim trakom ......................................18 Graf 4: Način prehranjevanja po operaciji z gastričnim trakom ..........................................19 Graf 5: Zapleti po kirurškem posegu..................................................................................20 Graf 6: Telesna aktivnost pred operacijo z gastričnim trakom............................................21 Graf 7: Telesna aktivnost po operaciji z gastričnim trakom ................................................22 Graf 8: Samopodoba pred kirurškim posegom z gastričnim trakom ...................................23 Graf 9: Želja po dodatni izgubi kilogramov.........................................................................24 Graf 10: Samopodoba po kirurškem posegu z gastričnim trakom ........................................25 Graf 11: Odločitev za operativno izgubo prevelike telesne teže...........................................26 Graf 12: Obolevnost pred kirurškim posegom .....................................................................27 Graf 13: Izginulost/izzvenelost ali ublažitev bolezni po kirurškem posegu ...........................28