Obesity and social representations among patients subjected to argon plasma coagulation ( APC )

Recebido em: 4 mar. 2020. Aprovado em: 11 jul. 2021. Publicado em: 7 mar. 2022. Abstract: This study sought to identify the Social Representations of Obesity among 15 individuals who underwent bariatric surgery through the Roux-en-Y Gastric Bypass (RYGB) method and were subjected to Argon Plasma Coagulation (APC) due to weight relapse. Data were collected through interviews and analyzed via Descending Hierarchical Classification. Obesity was associated with physical limitations and difficulties in social relationships. Prejudice and difficulty in changing habits are associated with the choice to undergo surgical treatment and to weight relapse. The suffering that goes along with obesity and the difficulty in changing habits seem to be associated with the search for surgical help.


Obesity and social representations among patients subjected to argon plasma coagulation (APC)
Obesidade e representações sociais entre pacientes submetidos à coagulação de plasma de argônio (APC) Obesidad y representaciones sociales entre pacientes sujetos a coagulación de plasma de argón (APC) The World Health Organization (WHO, 2019) indicates that obesity is a condition characterized by a body mass index (BMI) greater than or equal to 30.00 kg/m². In addition to increased risk of death, it is associated or acts as a predisposing factor for non-fatal conditions that compromise quality of life (Lima & Oliveira, 2016;Williams et al., 2015). Worldwide, the number of obese individuals has doubled between 1980 and 2014, when prevalence reached 11% among men and 15% among women (WHO, 2017). In Brazil, the percentage of women with obesity was 19.6%, while among men it was 18.1% in 2016 (HF, 2017).
Although weight gain is considered the result of an imbalance in the energy balance, the solution to this equation seems to be more complex than a simple caloric balance. Different health professionals have dedicated themselves to helping people with weight loss and maintenance, but the results have not always been effective or lasting. Conventional (non-surgical) treatment for weight reduction involves the need to change habits that are often rooted in life history and that are reinforced in social relationships (Barros, 2015;Christensen et al., 2018).
When conventional treatments do not provide the desired results, bariatric surgery emerges as an effective method for weight loss among obese individuals (Magouliotis et al., 2019;Vuuren et al., 2016). The most commonly used surgery method, Roux-en-Y Gastric Bypass (RYGB), results in a 35.8% body weight loss in the first year and 27.7% in 10 years (Brunaldi et al., 2018). However, a major change in lifestyle of the operated patient is required for weight loss to be sustained (Moura et al., 2019). Nearly 35% of RYGB-operated patients experience weight relapse (Moon et al., 2018). Relapse is caused by several factors and is related to gastrojejunal anastomosis (GJA) dilatation, in addition to genetic, psychological, environmental and behavioral factors (Brunaldi et al., 2018). an electrocoagulation method that uses an injection of ionized gas into the tissue. In patients with RYGB, this injection has proved to reduce gastrojejunal anastomosis diameter and contribute to a 6 to 10% body weight loss in one year (Moon et al., 2018). Patients who underwent RYGB and APC suffer from a history of obesity and difficulty in controlling weight through non-surgical life-long techniques, and the expected weight loss after APC is less significant compared to RYGB results, in addition revisional procedures are significantly more challenging than the initial surgery (Brunaldi et al., 2018;Vuuren et al., 2016). Representations (SRs) serve to justify practices, they make up a knowledge that can guide behaviors and form identities (Polli et al., 2018). SRs are forms of knowledge originated in communication processes which enable people to create 3/9 and share the same social reality, guiding their behavior (Jodelet, 2001).
Obesity and the difficulties and health problems related to it, can be better understood by considering the implications that socially shared beliefs have on eating and health practices adopted by different social groups. This view also allows to expand the individual's vision for the group or community, understanding that the physical aspect of obesity can imply a feeling of belonging and identity sharing with other people in the same situation. The SRs approach makes it possible to know the beliefs socially shared by these people, allowing the relationships between the beliefs and the practices adopted to be clarified (Fonte et al., 2017).
It is possible to suppose that people who live with subsequent failures in the attempt to lose weight seek alternatives to the models already tried. Vuuren et al. (2016) identified that the search for surgical procedures after the first surgical intervention is associated, by people who performed such procedures, with the unrealistic expectation of weight loss when performing the first surgery.
Even so, patients believe that they are unable to reach their desired weight without external, in this case, surgical, help. These patients believe that surgery can provide control overeating behaviors.
Bariatric surgery emerges as an alternative to conventional models of weight loss, which promises to be definitive. However, in some cases where there has been no success, new possibilities are necessary (Vuuren et al., 2016

Results
All participants indicated that they had done RYGB aiming to reach normal BMI and expected to be able to stay in this weight range. At the time of the interview, two participants presented normal BMI. Ten participants were overweight, and three participants were obese, this may be indicative of the difficulty in maintaining low weight despite performing the procedures (RYGB and APC). The number of APCs ranged from one to seven, indicating that even after the procedure most participants were unable to maintain their normal BMI. Weight loss outcomes after RYGB is expressed in Table 2 and after APC in Table 3.

Discussion
This study sought to identify the socially shared knowledge about obesity among people who have undergone bariatric surgery (RYGB) and at 7/9 least a second endoscopic intervention to reduce gastrojejunal anastomosis (APC). The socio-representational perspective allowed identifying ways of thinking about obesity that are shared in society and that are related to the search for weight loss with surgical intervention. By understanding the meanings attributed to obesity by people who experienced weight relapse, even after surgical procedures, one can think of alternative and more effective ways of helping people to be successful, through psychological, nutritional and educational support, such as for example, through therapeutic education, whose success has already been verified in relation to other chronic diseases (Apostolidis et al., 2020;Fonte et al., 2017).
The data showed the difficulty in maintaining weight after undergoing bariatric surgery, which is why participants sought APC once or more. It should be highlighted that overweight and body changes interfere with self-esteem, mood, health, social acceptance and rejection. The first two classes In addition, they suffer daily social rejection and prejudice. He feels judged, because obesity is as-sociated with a lack of self-control and willpower by non-obese people. Obesity is a complex condition, with repercussions in psychosocial spheres, especially in terms of the prejudice suffered (Araújo et al. 2018;Koelzer et al., 2016). Although body fat acts as a stigma (Goffman, 1988), it is considered a reversible attribute by the medical community, patients and society (Carof, 2017). As a result, the disapproval of obesity shown in social relationships and in the prejudice experienced by participants also involves psychological aspects.