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Cirurgia bariátrica em adolescentes : o meio socioeconómico como fator determinante da evolução clínica
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Introdução: A obesidade pediátrica é um importante problema de saúde pública, pelas comorbilidades associadas e pelas suas potenciais consequências na vida adulta. Na adolescência os seus efeitos são especialmente importantes, devido ao impacto na autoimagem corporal e qualidade de vida, com repercussão deletéria sobre a formação da identidade e aquisição de autonomia. O tratamento da obesidade no adolescente envolve principalmente a modificação do estilo de vida, com o apoio de uma equipa interdisciplinar. A cirurgia bariátrica surge como terapêutica de última linha. No adolescente, a opção pelo tratamento cirúrgico suscita considerações adicionais a nível ético e sociofamiliar.
Caso clínico: Adolescente de 18 anos integrada num estrato socioeconómico baixo e com vários fatores de mau prognóstico. Iniciou acompanhamento em Consulta de Obesidade Pediátrica aos 15 anos. Por aumento progressivo do índice de massa corporal (IMC), atingindo um valor máximo de 55,90 Kg/m2, foi operada para colocação de banda gástrica aos 16 anos. A evolução pós-operatória, sem a perda ponderal esperada, foi um desafio para a equipa que a acompanhou. Apesar de não terem sido alcançados os objetivos terapêuticos planeados relativamente ao IMC, a abordagem interdisciplinar envolvendo entidades de saúde, educação, cultura e desporto, permitiu colmatar as lacunas de suporte familiar manifestadas pela doente.
Discussão: Este caso é um exemplo da importância do contexto socioeconómico na evolução clínica de adolescentes obesos em tratamento, especialmente nos que são submetidos a cirurgia bariátrica. É realçada a importância do acompanhamento interdisciplinar e do envolvimento de várias estruturas sociais como elos terapêuticos na melhoria do prognóstico.
Conclusão: O meio socioeconómico deverá ser um dos fatores determinantes na seleção de potenciais candidatos à cirurgia bariátrica, especialmente no adolescente, por determinar o sucesso terapêutico.
Introduction: Pediatric obesity is a very important public health problem due to the associated comorbidities and its effects in adult life. During adolescence, the consequences of obesity are specially important because of the impact on body self-image and quality of life, leading to adverse repercussions on the formation of identity and acquisition of autonomy. The treatment of obesity in adolescence requires mainly a a change in lifestyle, with the support of an interdisciplinary team. Bariatric surgery is the last therapeutic choice. The option for a surgical treatment during adolescence raises additional ethical and sociofamiliar considerations. Clinical Case: Female adolescent, eighteen years old, belonging to a low socioeconomic status and with several risk factors for a poor prognosis. She was followed in Pediatric Obesity Clinic since she was fifteen years old. Due to a progressive increase in her body mass index (BMI), she was submitted to a gastric band placement when she was sixteen years old. The post-surgical evolution of BMI was not the one expected, which was a challenge to the team responsible for the care of the patient. Although the planned therapeutic BMI goals were not reached, the interdisciplinary approach, including entities related to health, education, culture and sport, made it possible to fill the gaps in family support. Discussion: The present clinical case is an example of the importance of socioeconomic context in the clinical evolution of obese adolescents experiencing treatment, specially in those who undergo bariatric surgery. It is highlighted the role of interdisciplinary follow-up and the involvement of several social infrastructures to improve the prognosis. Conclusion: One of the most important factors in the choice of bariatric surgery candidates is the socioeconomic status. In adolescents this factor is specially important because it determines the therapeutic success.
Introduction: Pediatric obesity is a very important public health problem due to the associated comorbidities and its effects in adult life. During adolescence, the consequences of obesity are specially important because of the impact on body self-image and quality of life, leading to adverse repercussions on the formation of identity and acquisition of autonomy. The treatment of obesity in adolescence requires mainly a a change in lifestyle, with the support of an interdisciplinary team. Bariatric surgery is the last therapeutic choice. The option for a surgical treatment during adolescence raises additional ethical and sociofamiliar considerations. Clinical Case: Female adolescent, eighteen years old, belonging to a low socioeconomic status and with several risk factors for a poor prognosis. She was followed in Pediatric Obesity Clinic since she was fifteen years old. Due to a progressive increase in her body mass index (BMI), she was submitted to a gastric band placement when she was sixteen years old. The post-surgical evolution of BMI was not the one expected, which was a challenge to the team responsible for the care of the patient. Although the planned therapeutic BMI goals were not reached, the interdisciplinary approach, including entities related to health, education, culture and sport, made it possible to fill the gaps in family support. Discussion: The present clinical case is an example of the importance of socioeconomic context in the clinical evolution of obese adolescents experiencing treatment, specially in those who undergo bariatric surgery. It is highlighted the role of interdisciplinary follow-up and the involvement of several social infrastructures to improve the prognosis. Conclusion: One of the most important factors in the choice of bariatric surgery candidates is the socioeconomic status. In adolescents this factor is specially important because it determines the therapeutic success.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Obesidade pediátrica Cirurgia bariátrica Adolescentes Contexto socioeconómico Pediatria