A TELEHEALTH INNOVATION TO SUPPORT WEIGHT LOSS SURGERY

描述（由申请人提供）：由于减肥手术对肥胖的影响改变了生活，这种流行的手术因术后随访率和结局跟踪较差而闻名。腹腔镜胃旁路术（LGB）已成为美国最受欢迎的外科手术之一，也是病态肥胖（MO）的有效治疗方法。在美国，每年进行近25万例手术。手术后的患者可以看到由于通过绕过小肠限制食物摄入的部分而导致食物吸收不良而导致的体重急剧下降。然而，吸收不良也会导致营养素的损失，这种损失似乎会随着时间的推移而持续或恶化，通常会导致危险的营养缺乏症。确保这些营养素以适当的补充剂的形式添加到饮食中至关重要。然而，目前还没有系统的和可扩展的计划存在减肥手术诊所提供持续的营养教育和管理。此外，身体活动是保持智能减肥和身体成分的基础。然而，外科诊所很少提供具体的运动处方和活动计划的专业支持。减肥手术不是一种“灵丹妙药”，应该被视为一种帮助患者开始和维持新的饮食和身体活动行为的预防工具，这将支持减肥。不幸的是，在帮助患者启动和维持这些行为的工具方面存在巨大差距。很少有个性化的，可扩展的计划，以避免患者的行为陷阱，伴随着快速减肥后，这种革命性的手术。由于目前的术后模式通常是自我管理，提供者的支持不够理想，因此迫切需要一个指导性的自我护理计划，以确保智能体重管理，并辅以远程提供的专业支持。为了促进系统性随访并提高对术后方案的遵守，我们提出了一项基于证据的、结构化的远程医疗指导计划，用于自我管理行为，以维持健康的体重减轻。这个多学科的包提供了一个以患者为中心的，可扩展的，健身促进和监测系统，以改善：1）坚持营养补充剂，2）持续的身体活动在目标水平，和3）频繁称重。由于这些活动是电子监控的，因此该程序可以准确地记录患者的行为特征，以便专业人员更好地定制患者的计划。此外，将填补外科医生的空白，因为减肥诊所的认证正趋向于更高的结果报告要求-当诊所保持很少的术后随访数据时，这是一个困难的生产。 公共卫生相关性：肥胖是美国最大的公共卫生危机。胃旁路手术已经成为一种非常有效的治疗病态肥胖和治愈肥胖相关疾病，如糖尿病，曾经被认为是不治之症。然而，术后自我护理不足会造成严重的并发症。两个主要的行为陷阱是营养管理不善和身体活动不足。与NIH的使命一致，以促进创新的方法来对抗肥胖，我们提出了一个可扩展的远程医疗计划，以提高依从性，促进智能行为，并确保健康的减肥管理。

DESCRIPTION (provided by applicant): For such life-changing impact that bariatric surgery represents for obesity, this popular procedure is noted for its poor post- operative follow-up rates and outcomes tracking. Laparoscopic Gastric Bypass (LGB) has emerged as one of the most popular surgical procedures in the U.S. and an effective treatment for morbid obesity (MO). Close to a quarter-million surgeries are performed annually in the U.S. Post-surgical patients can see dramatic weight loss due to mal-absorption of food through bypassing sections of the small intestine limits food intake. However, mal-absorption also results in loss of nutrients, which appears to persist or worsen over time, often resulting in dangerous nutritional deficiencies. Assuring that these nutrients are added to the diet in the form of appropriate supplements is critical. Yet, no systematic and scalable program exists currently for weight loss surgery clinics to provide ongoing nutritional education and management. Further, physical activity is fundamental to maintaining smart weight loss and body composition. However, specific exercise prescriptions and professional support for activity plans are rarely offered by surgery clinics. Bariatric surgery is not a "magic bullet" and should be regarded as an adjunctive tool that helps the patient initiate and sustain new dietary and physical activity behaviors that will support weight loss. Unfortunately, a huge gap exists in tools to aid patients in initiating and sustaining these behaviors. There have emerged few individualized, scalable programs for patients to avoid behavioral pitfalls that accompany rapid weight loss following such revolutionary surgery. Because the current postoperative pattern is all-too-often self-managed with less-than-optimal provider support, a guided self-care program is much-needed to assure smart weight management, supplemented by remotely-delivered professional support. In order to facilitate systematic follow-up and to improve adherence to post-operative protocols, we propose an evidence-based, structured, tele-health guided program for self-managing behaviors that will sustain healthy weight loss. This multi-disciplinary package provides a patient-centered, scalable, fitness promotion and monitoring system to improve: 1) adherence to nutritional supplements, 2) sustained physical activity at goal levels, and 3) frequent weighing. Because these activities are electronically monitored, the program furnishes accurate patient behavior profiles to allow professionals to better tailor the patient's plan. In addition, gaps will be filled for surgeons, as certification of weight loss clinics is trending toward greater outcomes reporting requirements - a difficult production when clinics maintain little post-surgical follow-up data. PUBLIC HEALTH RELEVANCE: Obesity represents the largest public health crisis in the US. Gastric Bypass Surgery has emerged as a highly effective treatment for morbid obesity and cure for obesity-related diseases, such as diabetes, that once were considered incurable. Inadequate postoperative self-care, however, creates serious complications. Two primary behavioral pitfalls are nutritional mismanagement and insufficient physical activity. Consistent with NIH's mission to promote innovative approaches to combat obesity, we propose a scalable tele-health program to improve adherence, promote smart behavior, and assure healthy weight loss management.