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Nurse-researcher evaluates how abuse victims respond to bariatric surgery

woman weighing herself
Patients who reported abuse as children and/or adults lost weight after bariatric surgery, but may benefit from the support of nutrition and mental health experts to prevent malnutrition during recovery, according to a study led by Polly Hulme, a professor in SDState's College of Nursing.

A unique opportunity to study patients undergoing bariatric surgery is helping health-care professionals understand the challenges that those who have experienced physical or sexual abuse face during recovery.

Victims of abuse are more likely to suffer from depression, eating disorders and obesity, according to South Dakota State University Nursing Professor Polly Hulme, whose research focuses on how childhood sexual abuse affects victims as adults. She led a team of researchers who examined the recovery of patients following a special type of bariatric surgery known as biliopancreatic diversion with duodenal switch. The study was conducted using data on all patients who had the procedure during 2009 and 2010 at a health-care facility in Omaha, Nebraska.

Of the 78 million Americans who are obese or morbidly obese, more than six million have likely suffered from physical, sexual or verbal abuse as children, according to the Kaiser Permanente Adverse Childhood Experiences study. This Centers for Disease Control and Prevention study is one of the largest focusing on how childhood abuse and neglect affects the victims’ adult lives.

Polly Hulme
Polly Hulme

“The same mechanisms that link physical and sexual abuse to increased risk for obesity may also negatively affect bariatric surgery outcomes,” Hulme explained.

As part of the screening process, bariatric surgery candidates are asked whether they have experienced abuse, Hulme explained. Of the 189 patients in the study, 42 reported a history of physical or sexual abuse. Nearly 73 percent of those who were abused experienced it as children, and more than 6 percent both as children and as adults.

Furthermore, the surgeon who performed the 189 procedures inserted a feeding tube in the small intestine to prevent malnutrition during recovery. This also allowed the researchers to compare the length of time the feeding tube was needed for patients to maintain nutritional levels. The study results are published in the August edition of Obesity Surgery.

“Those patients who reported abuse had good outcomes in terms of weight loss, but their feeding tubes, on average, were in place 17 days longer than other patients,” Hulme said. “This finding increases our understanding of the role abuse plays in malnutrition risk, and suggests these patients would benefit from the support of mental health and nutritional experts.”

Furthermore, the researchers used longitudinal mixed models to look at the weight loss trajectory. “We looked at patterns rather than at discrete points in time,” said Hulme, who examined three years of patient weight-loss data from electronic health records. “Our findings on weight loss were consistent with prior studies.”

The next step will be to determine whether gastric bypass patients who do not receive feeding tubes face similar nutritional challenges during recovery if they have a history of sexual or physical abuse.

“Many bariatric surgeons have noticed that patients with a history of childhood sexual or physical abuse often seem like a different population,” Hulme explained.  “Now we know that their weight loss outcomes are similar to those who do not report sexual or physical abuse, but we can better help these patients deal with the nutritional and psychological aspects associated with the changes they experience after bariatric surgery.”