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Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study

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Abstract

Background

Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities. However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have characterized research to date.

Methods

We conducted a comprehensive assessment of n=100 LGB patients surveyed 2–3 years following surgery using standardized measures.

Results

Mean %EWL at follow-up was 59.1±17.2%. This high level of weight loss was associated with a low rate of metabolic syndrome (10.6%), although medications were commonly used to achieve control. Mean adherence to daily vitamin and mineral supplements important to the management of LGB was only 57.6%, and suboptimal blood chemistry levels were found for ferritin (32% of patients), hematocrit (27%), thiamine (25%), and vitamin D (19%). Aerobic exercise level (R 2=0.08) and pre-surgical weight (R 2=0.04) were significantly associated with %EWL, but recommended eating style, fluid intake, clinic follow-up, and support group attendance were not. Psychosocial adjustment results showed an absence of symptomatic depression (0%), common use of antidepressant medications (32.0%), low emotional distress related to the post-surgical lifestyle (19.8±14.0; scale range 0–100), a high level of perceived benefit from weight loss in terms of functioning and emotional well-being (82.7±17.9; scale range 0–100), and a change in marital status for 26% of patients.

Conclusions

At 2–3 years following LGB surgery aerobic exercise, but not diet, fluid intake, or attendance at clinic visits or support groups, is associated with %EWL. Depression is symptomatically controlled by medications, lifestyle related distress is low, and marital status is significantly impacted.

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Author information

Authors and Affiliations

  1. Behavioral Medicine Research, Baystate Medical Center, 140 High Street, Room 2104, Springfield, MA, 01199, USA

    Garry Welch & Sofija Zagarins

  2. Weight Loss Surgery Program, Baystate Medical Center, 140 High Street, Room 2104, Springfield, MA, 01199, USA

    Cheryl Wesolowski, Jay Kuhn & John Romanelli

  3. Department of Academic Affairs, Baystate Medical Center, 140 High Street, Room 2104, Springfield, MA, 01199, USA

    Jane Garb

  4. Department of Endocrinology and Diabetes, Baystate Medical Center, 140 High Street, Room 2104, Springfield, MA, 01199, USA

    Nancy Allen

Authors
  1. Garry Welch
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  2. Cheryl Wesolowski
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  3. Sofija Zagarins
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  4. Jay Kuhn
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  5. John Romanelli
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  6. Jane Garb
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  7. Nancy Allen
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Corresponding author

Correspondence to Garry Welch.

Appendix: Bariatric Surgery Self-management Questionnaire (BSSQ) Subscales and Item Content

Appendix: Bariatric Surgery Self-management Questionnaire (BSSQ) Subscales and Item Content

Eating behaviors (EB):

  1. 1.

    I ate a minimum of 5 mini meals or snacks during the day

  2. 2.

    I ate slowly, putting my utensils or food down between bites

  3. 3.

    It took about 20-30 minutes for me to eat my meals

  4. 4.

    I chewed my food until it was a pureed consistency like baby food

  5. 5.

    I used a bread and butter plate or dessert plate instead of a regular- sized plate for my meals

  6. 6.

    I checked for feeling of a feeling of fullness after every bite

  7. 7.

    I stopped eating immediately if I had any feelings of fullness or discomfort

  8. 8.

    I used a baby spoon, fork, and knife instead of regular sized ones

Fluid intake (FI):

  1. 9.

    I drank 48 ounces (six 8 oz glasses) or more of fluids during the day

  2. 10.

    I only drank water, sugar-free beverages, skim milk, or 1% milk

  3. 11.

    I sipped drinks slowly putting my drink down between sips

  4. 12.

    I avoided using a straw to drink

  5. 13.

    I carried a suitable drink with me at all times

  6. 14.

    I did not rely on feeling thirsty as a signal to drink

  7. 15.

    I checked my urine through the day to make sure it was pale yellow-to-clear in color showing good fluid intake

  8. 16.

    I drank 30 minutes before my meal and waited until 30 minutes after my meal so that I separated my fluids from my solid foods

Physical activity (PA):

  1. 17.

    I got 30-60 minutes of exercise 5 days or more in the past week (e.g., walking, exercise equipment at home, health club, class, etc)

  2. 18.

    I built some exercise into my daily routines (I took the stairs, walked around the supermarket or mall before shopping, etc.)

  3. 19.

    I built some weight training into my exercise program (hand weights, climbing stairs, weight machines, etc)

Dumping syndrome management (DSM):

  1. 20.

    I read nutrition fact panels on food labels to look for high levels of sugar

  2. 21.

    I avoided foods and beverages with 15 grams (3 tsp) of sugar or more a serving

  3. 22.

    I avoided foods and beverages with sugar listed as one of the first three ingredients (glucose, maltose, dextrose, fructose, honey, molasses, corn syrup, brown sugar, cane sugar, confectionary sugar)

  4. 23.

    I avoided sugar alcohols (mannitol, sorbitol, xylitol, lactitol) by looking at food labels as these cause cramping and diarrhea

Supplement Intake (SI):

  1. 24.

    I took a multi-vitamin with minerals tablet every day

  2. 25.

    I took 1000 to 1500 mg of calcium citrate or calcium carbonate with vitamin D every day

  3. 26.

    I took a B-complex vitamin supplement every day

  4. 27.

    I took my vitamin/calcium pills 4 hours or more apart to maximize absorption

Fruits, vegetables, and whole grain intake (FVW):

  1. 28.

    I ate at least 5 fruits and vegetables every day

  2. 29.

    I mostly chose whole grain breads, cereals, and crackers

  3. 30.

    I mostly chose brightly colored fruits and vegetables (yellow, green, red, orange, blue, purple)

Protein Intake (PI):

  1. 31.

    I ate 60-80 grams (2-3 oz) of protein every day (fish, eggs, chicken, turkey, beef, pork, ham, milk, peanut butter, beans, soy, tofu, lentils, cheese, nuts, yogurt, skim or 1% milk, or low sugar protein bars and shakes)

  2. 32.

    I ate the protein on my plate first during meals and snacks

  3. 33.

    I read food labels and chose the foods highest in protein and lowest in sugar

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Welch, G., Wesolowski, C., Zagarins, S. et al. Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study. OBES SURG 21, 18–28 (2011). https://doi.org/10.1007/s11695-009-0069-3

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