Free Dissertation Proposal On BMI=m:h2

Is there a need for PCA therapy?

Abstract
Obesity is an increasing concern; the World Health Organization has even declared obesity a global epidemic. The effects of obesity exceeded the obvious health complications to include psychological issues. Morbid obesity, on the other hand, is obesity exceeding a BMI of 40. This paper will examine the Bariatric surgery as a treatment of morbid obesity and its effects on the patients after the surgery. Special regard shall be paid to the improvements or deterioration in the Quality of Life to the patients after the surgery. In addition, a study will be formulate a study seeking to explore the neglected area of psychological characteristics of bariatric surgery candidates from a Greek sample. The examination of the sample will be in terms of Quality of Life before and after the surgery as well as exploring the need for a Person-Centered Counselling Support.
Quality of Life as a function of self-image and social support in morbidly obese patients before and after bariatric surgery: Is there a need for PCA therapy?
Obesity in the present age of modernism is becoming a scourge that seems to afflict the developed nations to the extent that the World Health Organization has termed it a global epidemic. Obesity and overweight are closely interlinked, in fact, more than half of the European population is overweight. The obesity rates in United States and Canada are 34.1 percent and 24.1 percent respectively. Obesity for the purposes of this paper is the accumulation of excess body fat to the extent at which it affects the life of the individual both psychologically and physically. The Body Mass Index (BMI) defines obesity.
BMI is closely related and tied to both the percentage of the body fat and the total body fat. BMI is calculated by determining the subject’s weight and dividing it by the square of their height. It is, therefore, calculated with the following formula;

where m is the subject’s weight, and h is correspondingly the subject’s height.
A BMI that is greater than or equal to 40 is considered morbid obesity; this reduces the life expectancy of an individual by eight to ten years. The negative impact of obesity extends further that the morbidity and mortality of the patient but alto to their quality of life. The World Health Organization defines the quality of life as a broad concept that incorporates the person’s psychological state, physical health, social relationships, level of independence, and the relationship with salient features of the individual’s environment. The quality of life is even further affected by the harmful and the steady discrimination that obese people are subjected to in their interpersonal exchanges, educational and even medical settings. The weight-based discrimination triggers poor body image, depression, and even suicidal ideation.

Background of the Study

The effectiveness of bariatric surgery in dealing with weight and improving most of the obesity related issues often overshadows the fact that it does not target the underlying factors. The factors include the psychological factors such as anxiety, depression, and negative affect that played a significant role in the development and maintenance the obesity. Other underlying factors are genetics and biological factors, emotional dysregulation. The factors are especially important as most people overeat to regulate their emotions.
Nevertheless, research has demonstrated that the eating pathology commonly present in the patients before surgery may persist after the surgery. After the surgery, a percentage of the patients fail to their dietetic habits and associated psychopathology. The main reason for this appears to be related in part to the patient’s inadequate emotional and behavioral changes.
The obese individuals are more likely to be diagnosed with a malady of disorders including mood, anxiety, alcohol use and personality disorders than their normal weight counterparts are. In a meta-analysis conducted to investigate a link between depression and obesity the obese people has a 55 percent increased risk of developing depression over a duration of time. Interestingly, the study also uncovered that the depressed people has a 58 percent risk of ending up obese. The analysis was a result of 15 combined studies. N = 58 745.
Bariatric surgery has numerous factors that determine the psychological functioning post-surgery; as mentioned earlier the reasons that might affect the patient’s performance after the surgery are emotional and behavioral inadequacies. As such, the factors associated with psychological functioning post-surgery include self-esteem of the individual, the social support available to them, their coping, and their body image. It is paramount to note that candidates for Bariatric surgery report a higher than the normal average suicidal behavior and ideation prior to the surgery. A review of 28 studies that had a total of 40,947 patients that examined the suicide in the post-surgery bariatric patients in Europe and North America discovered that the suicide rate after Bariatric surgery was 4.1 out of 10,000 this is in contrast the World Health Organization data that has 1.0 out of 10,000.
There are numerous reasons that could account for the increased suicide rate in the patients after Bariatric Surgery. The reasons can be grouped into two categories; psychological and behavioral reasons and the physiological reasons.
The psychological and behavioral reasons include dissatisfaction with the results. The patients may regard bariatric surgery with too high expectations of a sudden transformation. When the results fail to meet the idealized and unrealistic expectations, the patients end up depressed and even suicidal. Loose skin is another reason. After the surgery, most of the patients have the problem of excessive skin that has been demonstrated to affect depression in the patient and even their sexual functioning. The excessive skin in patients who had undergone bariatric surgery led to concerns over body image and depressive symptomology that result in greater weight gain which in turn can herald suicide. The patient may even feel hopeless either due to an onset of depression or because of the aforementioned failure of the result of the surgery to meet their expectations. Other factors that may lead to suicide include a poor body image, increased alcohol, and substance use. Finally, interpersonal stressors such as family conflicts and relationships issues may also contribute to the higher rate of suicides.
The physiological reasons that may play a role in the higher rate of suicides among the bariatric surgery patients than the average people may include, the antidepressants not sufficiently absorbed, gastrointestinal peptide changes, especially ghrelin and the dissection of vagus nerve.
The improved understanding of psychopathology and its prevalence among the morbidly obese patients before and after the Bariatric surgery is a critical area of study. High rates of the psychiatric disorders in the bariatric surgery has been suggested by evidence, but there has been a general neglect of serious studies in examining the prevalence in a Greek sample.
Therefore, the purpose of this paper shall be to investigate the psychological characteristics of bariatric surgery candidates from a Greek sample, in terms of Quality of Life before and after the surgery as well as exploring the need for a Person-Centered Counselling Support.

Research Questions and Objectives

The research questions set out here will also serve as the objectives of this study. The questions guiding this study are;
Are the self-image and the social support availed important factors in the Quality of Life of the morbidly obese people? Does the bariatric surgery help to resolve the patient’s psychosocial issues? Research has shown the bariatric candidates often fail to overcome their psychological issues after the surgery; can Personal-Centered Counselling contribute to reducing the patient’s issues?

Methods

Sample
Greek adults, who are Bariatric surgery candidates, will be the target population for this study; before and after they undergo the surgery. The participants of the study will be individuals selected with the following criteria; Candidates before surgery will form Group A and they must be over 18 years and have a BMI greater than or equal to 40. Group B will be the candidates after the surgery; they should be at least have been three months since their surgery and over 18 years.
The participants will be obtained through two means; first, the Bariatric surgeons who will invite their patients to participate and then through internet forums and closed Facebook groups that are created to support the patients before and after the bariatric surgery.

Instruments

The admiration of this survey will be electronic through a survey website, http://surveymonk ey.com. For the participants to join they will have to sign an informed consent form electronically; this will be done through an “I Agree” clickable link or checkable box. Once the participants consent, they will then view the survey. The survey will be voluntary.
The length of time taken will be observed and must not take more than 20 minutes to be completed. In order to speed up the process the survey shall have four questions per web page. Individuals shall be sent invitations through their Facebook inbox or emails to complete the survey. The message contained in the email will include the address of the survey site that has the electronic informed consent form. Once the survey is complete, the information about the individuals participating in the study shall be downloaded and deleted from the server.

Questionnaires

WHOQOL-BREF (World Health Organization Quality of life)
It comprises of 26 items that measure broad domains regarding the patients or the participants. The domains are the environment, psychological and physical heath, and social relationships. The WHOQOL-BREF is simply a shorter version of the original instruments that may be more convenient if used in clinical trials or larger research studies.

B-WISE

It is a 12 itemized self-report questionnaire and evaluates the body weight, self-esteem, and self-image.
DASS-42
The acronyms stand for Depression Anxiety Stress Scales; it is made up of 42 self-report items that are completed in five to ten minutes. The items each reflect a negative emotional symptom. The scales have subscales and analyze different aspects. The Depression scale has subscales that assess hopelessness, self-deprecation, anhedonia, inertia, lack of interest or involvement, and dysphoria. The Anxiety scale assesses skeletal muscle effects, autonomic arousal, subjective experience of anxious effect and situational anxiety. Finally, the stress subscales examine the levels of non-chronic arousal trough the difficulty in relaxing, being easily upset or agitated, nervous arousal and being irritable, impatient and over-reactive.

Statistical Methods

The analysis of the data collected will be done using SPSS (StaGsGcal Package for Social Sciences) for MacOs, StaGsGcs Standard 22.

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