Physical Activity Predicts Weight Loss Following Gastric Bypass Surgery: Findings from a Support Group Survey

Abstract

Background

Patient adherence to recommended eating and physical activity behaviors is considered important to weight loss outcomes following gastric bypass surgery, but there has been little systematic research in this area to investigate behavioral predictors of weight loss.

Method

We developed a measure of postsurgical behaviors, the bariatric surgery self-management questionnaire (BSSQ). A survey was conducted of 200 patients attending postsurgical support groups (mean time since surgery 14 months, mean age 40 years, 85% female, presurgical weight 150 kg). Patients completed the BSSQ and measures of treatment regimen distress, perceived benefits of weight loss, and weight-related physical symptoms.

Results

Mean BSSQ adherence was in the 70% range, with subscale scores varying considerably. Distress levels associated with the new lifestyle were consistently low (≈20%) and perceived benefits of weight loss were high early on and maintained consistently (70–90%). A final predictive model showed premorbid weight, time since surgery, and BSSQ physical activity subscale were significant predictors of weight loss, accounting for 73% of variance.

Conclusions

Physical activity adherence was the sole significant behavioral predictor of weight loss, although maladaptive dietary habits and patient selection issues were identified for future research. It will be important to replicate the current study in prospective, longitudinal studies with representative patient cohorts. A challenge for researchers will be to develop novel, intensive recruiting and retention strategies to allow closer examination of these issues.

Appendix: Bariatric Surgery Self-management Behaviors Questionnaire Items

Eating Behaviors Subscale

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

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

• 3. It took about 20–30 minutes for me to eat my meals

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

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

• 6. I checked for feeling of fullness after every bite

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

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

Fluid Intake Subscale

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

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

• 11. I sipped drinks slowly putting my drink down between sips

• 12. I avoided using a straw to drink

• 13. I carried a suitable drink with me at all times

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

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

• 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 Subscale

• 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.)

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

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

Dumping Syndrome Management Subscale

• 20. I read nutrition fact panels on food labels to look for high levels of sugar in foods

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

• 22. I avoided foods and beverages with sugar listed as 1 of the first 3 ingredients (glucose, maltose, dextrose, fructose, honey, molasses, corn syrup, brown sugar, cane sugar, confectionary sugar)

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

Supplement Intake Subscale

• 24. I took a multi-vitamin with minerals tablet every day

• 25. I took 1,000 to 1,500 mg of calcium citrate or calcium carbonate with vitamin D every day

• 26. I took a B-complex vitamin supplement every day

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

Fruits, Vegetables, and Whole Grains Subscale

• 28. I ate at least 5 fruits and vegetables every day

• 29. I mostly chose whole grain breads, cereals, and crackers

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

Protein Intake Subscale

• 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)

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

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