目的：探討施行減重手術對肥胖患者身體心像之變化

方法：本研究為類實驗性設計，以單組前測、後測試驗，比較減重手術介入對肥胖患者身體心像的影響。受試者為北部及南部兩家教學醫院減重中心門診之肥胖患者，採立意取樣方式，共收案60位個案，但有四位患者未完成後測，故有效個案56名，完成率達93.3%。每位受試者皆有接受介入措施；胃縮小減重手術或胃繞道減重手術之治療。研究測量工具為尤(2002)所發展具有信效度的身體心像問卷，於病患接受減重手術前及手術後三個月回門診時進行測量。研究結果以SPSS 20.0 for Windows套裝軟體進行次數分配、百分比、平均數、標準差、卡方檢定(Chi-square Test)、成對t檢定(Paired t test)、獨立樣本t檢定(Independent t test)、單因子變異數分析(ONEWAY ANOVA)、皮爾森相關分析(Pearson’s Correlation)等統計分析。

結果：本研究發現接受減重治療的患者以男性、青壯年人、單身/未婚、大專/大學以上教育程度、月收入20000元至39999元者、BMI大於35kg/㎡、有受過取笑經驗、自覺健康狀況不好、肥胖對婚姻及個人形象有影響者居多。減重手術前，肥胖患者呈現負面身體心像，且身體質量指數(BMI)與外表評價呈負相關(r=-.36，p<.01)，表示身體質量指數越高者，其自我外表評價越差。經由減重手術治療後，肥胖患者的身體心像包括外表評價、外表取向、身體部位滿意度皆有顯著改善，且個人屬性之性別、年齡、BMI、婚姻狀態、教育程度、經濟收入、體型受取笑經驗、自覺健康狀況、自覺嚴重性(婚姻關係、人際關係、個人形象)與身體心像變化有顯著關係(p<.05)。然而，肥胖患者術後身體質量指數(BMI)及多餘流失體重百分比(EWL)與術後身體心像無相關性，表示減重成效與術後身體心像無顯著關係。並且，減重手術後三個月，體重迅速下降，導致皮膚鬆垮，以致有超過半數的肥胖患者對減重手術後肌肉張力(指彈性、結實程度)感到不滿意。


結論/實務應用：減重手術介入能改善肥胖患者之術後身體心像，而減重成效卻不是影響肥胖患者身體心像改變的主要因素，身體心像改變可能與患者生活環境、文化及價值觀差異有關係。然而，減重手術後，肥胖患者脂肪及肌肉快速減少，導致皮膚彈性及結實程度鬆垮，影響後續身體心像的變化。本研究發現減重手術後三個月能顯著改善肥胖患者負面身體心像，且為台灣第一篇探討減重手術與肥胖患者身體心像之研究，研究成果提供臨床實證依據，亦可做為未來減重手術與身體心像縱貫性研究之參考。

Objective: The purpose of this research is to investigate the effects of bariatric surgery in changing body image of the obese patients.

Method: This study is a quasi-experiment design, using pre-test and post-test to investigate effects of bariatric surgery in influencing body image of the obese patients. Purposive Sampling was used in this study. Sixty patients underwent gastric bypass or sleeve gastrectomies from two teaching hospitals, one is located in the north and the other is in south of Taiwan, were collected. However, four patients did not finish post-test surveies, in total, 56 patients became the effective cases with the complete rate of 93.3%. A reliable questionnaire of Body Image designed by Yu (2002) was utilized as the research tool to measure the effects of bariatric surgery before and after surgery three months later. The SPSS 20.0 software for windows was used for data analysis in frequency distribution, percentage, mean, standard deviation, Chi-square Test, Paired t test, Independent t test, One way ANOVA, Pearson’s Correlation.

Result：This study revealed that the patients who were male, young adults, single or higher education, income more than 20000-39999 NT dollars per month, body mass index higher than 35kg/m2, had teasing experience, self-awareness of poor health, strong impact from obesity on marriage or body image, tended to receive bariatric surgeries. Before the bariatric surgeries, the obese patients of this study had negative body image. There was a negative correlation between body mass index and the value of appearance(r=-.36 , p<.01). This meant that higher the body mass index was, the lower value of appearance. After the bariatric surgeries, the body image of the patients was improved in appearance value, appearance orientation, and body satisfaction. Demographic characteristics of these patients were found significantly related to the changes of body image(p<.05). However, the intensity of body mass index reduction and excess weight loss were not correlated to the improvement of postoperative body image. The result showed that the effects of weight loss were not related to the body image. Moreover, more than half of the obese patients felt dissatisfied with muscle tension (elasticity, strong degree) 3 months later after bariatric surgeries, due to the rapid weight loss of body weight causing of sagging excess skin.

Conclusion: Bariatric surgery could improve the negative body image of the obese patients. However, the effectiveness of weight loss by bariatric surgery is not the main factor to improve the body image of the obese patients. The changes of body image might be influenced by the difference of environment, culture, or social values. Besides, after bariatric surgery, obese patients’ fat and muscles were reduced quickly, leading to the loose of skin elasticity and firmness, and these influenced the subsequent changes in body image. Our research shows that significant improvement of negative body image can be achieved three months after the bariatric surgery. This paper is the first study in Taiwan to investigate the relation between bariatric surgery and body image. Our study results provide evidences for future research and design of longitudinal study in this field.

目錄
誌 謝 I
中文摘要 II
英文摘要 IV
目 錄 VI
表 目 錄 VIII
圖 目 錄 X
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究目的 3
第三節 研究問題 3
第四節 名詞解釋 4
第二章 文獻探討 5
第一節 肥胖 5
第二節 身體心像 9
第三節 減重手術 12
第三章 研究方法 17
第一節 研究設計 17
第二節 研究對象 18
第三節 研究工具及信效度分析 19
第四節 研究架構 21
第五節 研究假設 22
第六節 研究流程 23
第七節 研究倫理考量 24
第八節 資料處理及分析方法 25
第四章 研究結果 29
第一節 減重手術肥胖患者個人屬性 29
第二節 減重手術介入對肥胖患者身體心像之改變 37
第三節 肥胖患者個人屬性與減重手術身體心像變化之關係 49
第五章 討論 69
第一節 探討接受減重手術的肥胖患者個人屬性 69
第二節 分析減重手術介入前後對肥胖患者身體心像的影響 73
第三節 探討肥胖患者個人屬性與減重手術身體心像變化之關係 77
第六章 結論與建議 82
第一節 研究結論 82
第二節 醫護實務應用與建議 84
第三節 研究限制 87
參考資料 88
中文部分 88
英文部分 91
附錄一 人體試驗計劃同意書 101
附錄二 研究問卷使用同意書 103
附錄三 受試者同意書 104
附錄四 研究問卷 108

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