Skip to main content
SpringerLink
Log in

Keeping the Weight Off: Physical Activity, Sitting Time, and Weight Loss Maintenance in Bariatric Surgery Patients 2 to 16 Years Postsurgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery patients often exhibit low levels of physical activity (PA), despite the presumed importance of PA as an adjunct to surgery for successful weight loss. Little is known regarding the associations of PA and sedentary behaviors to weight loss outcomes in the long term following surgery. The objective of the study was to assess the associations of PA and sitting time with weight status, weight loss, and weight maintenance outcomes in bariatric patients 2–16 years postsurgery.

Methods

A total of 303 Roux-en-Y Gastric Bypass patients (73 % female; mean age 47 ± 10 years, mean 7 ± 4 years since surgery) completed a telephone questionnaire. Patients reported moderate-to-vigorous PA (MVPA: # sessions/week ≥30 min) and average daily sitting time (h/day). Associations with various weight outcomes were assessed.

Results

Only 48 % of patients reported ≥1 session/week MVPA, and mean reported sitting time was 7 ± 4 h/day. Neither MVPA nor sitting time was associated with weight loss outcomes at patients’ lowest weight postsurgery. However, both MVPA and sitting time were independently positively and inversely, respectively, associated with total (kg) weight loss, % weight loss, and % excess weight loss at current weight, as well as weight loss maintained vs. regained, controlling for age, sex, surgery type, presurgery BMI, total initial weight loss, and time since surgery.

Conclusions

Results demonstrate associations between MVPA and high sitting time and weight loss outcomes among bariatric patients in the long term. The implications for long-term weight management and concomitant health outcomes highlight the need for appropriate follow-up and interventions in this unique high-risk patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

EWL:

Excess weight loss

RYGB:

Roux-en-Y gastric bypass

PA:

Physical activity

MVPA:

Moderate-to-vigorous physical activity

SB:

Sedentary behavior

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

References

  1. Katzmarzyk PT, Mason C. Prevalence of class I, II and III obesity in Canada. CMAJ. 2006;174(2):156–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Shields M, Carroll MD, Ogden CL. Adult obesity prevalence in Canada and the United States. NCHS Data Brief. 2011;56:1–8.

    PubMed  Google Scholar 

  3. Andreyeva T, Sturm R, Ringel JS. Moderate and severe obesity have large differences in health care costs. Obes Res. 2004;12(12):1936–43.

    Article  PubMed  Google Scholar 

  4. Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1–S13.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17 Suppl 1:S1–70, v.

    PubMed  Google Scholar 

  6. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–24.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  8. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  9. Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14(7):939–47.

    Article  PubMed  Google Scholar 

  10. Arkinson J, Ji H, Fallah S, et al. CIHI survey: bariatric surgery in Canada. Healthc Q. 2010;13(2):14–7.

    Article  PubMed  Google Scholar 

  11. Ross R, Lam M, Blair SN, et al. Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial. Arch Intern Med. 2012;172(5):414–24.

    Article  PubMed  Google Scholar 

  12. Shaw K, Gennat H, O'Rourke P, et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4, CD003817.

    PubMed  Google Scholar 

  13. Goodpaster BH, Delany JP, Otto AD, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA. 2010;304(16):1795–802.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Tremblay MS, Warburton DE, Janssen I, et al. New Canadian physical activity guidelines. Appl Physiol Nutr Metab. 2011;36(1):36-46; 47-58.

    Google Scholar 

  15. Bond DS, Jakicic JM, Vithiananthan S, et al. Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls. Surg Obes Relat Dis. 2010;6(1):72–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hatoum IJ, Stein HK, Merrifield BF, et al. Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity. 2009;17(1):92–9.

    Article  PubMed  Google Scholar 

  17. Livhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20(5):657–65.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Jacobi D, Ciangura C, Couet C, et al. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–77.

    Article  CAS  PubMed  Google Scholar 

  19. Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A systematic review. Obes Surg. 2012;22(2):335–41.

    Article  PubMed  Google Scholar 

  20. Klem ML, Wing RR, McGuire MT, et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66(2):239–46.

    CAS  PubMed  Google Scholar 

  21. McGuire MT, Wing RR, Klem ML, et al. Behavioral strategies of individuals who have maintained long-term weight losses. Obes Res. 1999;7(4):334–41.

    Article  CAS  PubMed  Google Scholar 

  22. Livhits M, Mercado C, Yermilov I, et al. Behavioral factors associated with successful weight loss after gastric bypass. Am Surg. 2010;76(10):1139–42.

    PubMed  Google Scholar 

  23. Klem ML, Wing RR, Chang CC, et al. A case-control study of successful maintenance of a substantial weight loss: individuals who lost weight through surgery versus those who lost weight through non-surgical means. Int J Obes Relat Metab Disord. 2000;24(5):573–9.

    Article  CAS  PubMed  Google Scholar 

  24. Tremblay MS, Colley RC, Saunders TJ, et al. Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab. 2010;35(6):725–40.

    Article  PubMed  Google Scholar 

  25. Sedentary Behaviour Research Network. Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012;37:540–2.

    Article  CAS  PubMed  Google Scholar 

  26. Healy GN, Wijndaele K, Dunstan DW, et al. Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care. 2008;31(2):369–71.

    Article  PubMed  Google Scholar 

  27. Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3):105–13.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Bond DS, Unick JL, Jakicic JM, et al. Objective assessment of time spent being sedentary in bariatric surgery candidates. Obes Surg. 2011;21(6):811–4.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Unick JL, Bond DS, Jakicic JM, et al. Comparison of two objective monitors for assessing physical activity and sedentary behaviors in bariatric surgery patients. Obes Surg. 2012;22(3):347–52.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Bond DS, Graham Thomas J, Unick JL, et al. Self-reported and objectively measured sedentary behavior in bariatric surgery candidates. Surg Obes Relat Dis. 2013; 9(1):123–8.

    Google Scholar 

  31. Shields M, Tremblay MS. Sedentary behaviour and obesity. Health Rep. 2008;19(2):19–30.

    PubMed  Google Scholar 

  32. Vatier C, Henegar C, Ciangura C, et al. Dynamic relations between sedentary behavior, physical activity, and body composition after bariatric surgery. Obes Surg. 2012;22(8):1251–6.

    Article  PubMed  Google Scholar 

  33. Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.

    Article  PubMed  Google Scholar 

  34. Bray GA, Bouchard C, Church TS, et al. Is it time to change the way we report and discuss weight loss? Obesity. 2009;17(4):619–21.

    Article  PubMed  Google Scholar 

  35. Evans RK, Bond DS, Wolfe LG, et al. Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2007;3(5):526–30.

    Article  PubMed  Google Scholar 

  36. Colles SL, Dixon JB, O'Brien PE. Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding. Obes Surg. 2008;18(7):833–40.

    Article  PubMed  Google Scholar 

  37. Bond DS, Phelan S, Wolfe LG, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009;17(1):78–83.

    Article  PubMed  Google Scholar 

  38. King WC, Bond DS. The importance of preoperative and postoperative physical activity counseling in bariatric surgery. Exerc Sport Sci Rev. 2013;41(1):26–35.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Papalazarou A, Yannakoulia M, Kavouras SA, et al. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18(7):1348–53.

    Article  CAS  PubMed  Google Scholar 

  40. Chaston TB, Dixon JB, O'Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes. 2007;31(5):743–50.

    CAS  Google Scholar 

  41. Brzozowska MM, Sainsbury A, Eisman JA, et al. Bariatric surgery, bone loss, obesity and possible mechanisms. Obes Rev. 2013;14(1):52–67.

    Article  CAS  PubMed  Google Scholar 

  42. Franckowiak SC, Andersen RE. Metabolic assessment of overweight patients. In: Berdanier CD, Feldman EB, Dwyer J, editors. Handbook of Nutrition and Food. 2nd ed. Boca Raton (FL): CRC Press; 2008. p. 847–867.

  43. Murphy JC, McDaniel JL, Mora K, et al. Preferential reductions in intermuscular and visceral adipose tissue with exercise-induced weight loss compared with calorie restriction. J Appl Physiol (1985). 2012;112(1):79–85.

    Article  Google Scholar 

  44. Hunter GR, Brock DW, Byrne NM, et al. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity. 2010;18(4):690–5.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Pontiroli AE, Frige F, Paganelli M, et al. In morbid obesity, metabolic abnormalities and adhesion molecules correlate with visceral fat, not with subcutaneous fat: effect of weight loss through surgery. Obes Surg. 2009;19(6):745–50.

    Article  PubMed  Google Scholar 

  46. Johnson MF, Nichols JF, Sallis JF, et al. Interrelationships between physical activity and other health behaviors among university women and men. Prev Med. 1998;27(4):536–44.

    Article  CAS  PubMed  Google Scholar 

  47. Hildebrandt SE. Effects of participation in bariatric support group after Roux-en-Y gastric bypass. Obes Surg. 1998;8(5):535–42.

    Article  CAS  PubMed  Google Scholar 

  48. Andersen RE, Jakicic JM. Interpreting the physical activity guidelines for health and weight management. J Phys Act Health. 2009;6(5):651–6.

    PubMed  Google Scholar 

  49. Dunstan DW, Howard B, Healy GN, et al. Too much sitting—a health hazard. Diabetes Res Clin Pract. 2012;97(3):368–76.

    Article  PubMed  Google Scholar 

  50. Chau JY, van der Ploeg HP, Merom D, et al. Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults. Prev Med. 2012;54(3–4):195–200.

    Article  PubMed  Google Scholar 

  51. van Uffelen JG, Watson MJ, Dobson AJ, et al. Sitting time is associated with weight, but not with weight gain in mid-aged Australian women. Obesity. 2010;18(9):1788–94.

    Article  PubMed  Google Scholar 

  52. Bond DS, Thomas JG, Unick JL, et al. Self-reported and objectively measured sedentary behavior in bariatric surgery candidates. Surg Obes Relat Dis. 2013;9(1):123–8.

    Article  PubMed Central  PubMed  Google Scholar 

  53. McGuire MT, Wing RR, Klem ML, et al. What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol. 1999;67(2):177–85.

    Article  CAS  PubMed  Google Scholar 

  54. Klem ML, Wing RR, Lang W, et al. Does weight loss maintenance become easier over time? Obes Res. 2000;8(6):438–44.

    Article  CAS  PubMed  Google Scholar 

  55. Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Grundy SM, Blackburn G, Higgins M, et al. Physical activity in the prevention and treatment of obesity and its comorbidities. Med Sci Sports Exerc. 1999;31(11 Suppl):S502–8.

    Article  CAS  PubMed  Google Scholar 

  57. Ekelund U, Brage S, Besson H, et al. Time spent being sedentary and weight gain in healthy adults: reverse or bidirectional causality? Am J Clin Nutr. 2008;88(3):612–7.

    CAS  PubMed  Google Scholar 

  58. Shields M, Connor Gorber S, Tremblay MS. Estimates of obesity based on self-report versus direct measures. Health Rep. 2008;19(2):61–76.

    PubMed  Google Scholar 

  59. Bond DS, Jakicic JM, Unick JL, et al. Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity. 2010;18(12):2395–7.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Clemes SA, David BM, Zhao Y, et al. Validity of two self-report measures of sitting time. J Phys Act Health. 2012;9(4):533–9.

    PubMed  Google Scholar 

Download references

Acknowledgments

K.M. Herman was supported by a Heart and Stroke Foundation of Canada postdoctoral research fellowship. R.E. Andersen holds a Canada Research Chair in Physical Activity and Health. We thank Ms. Kathleen M. Andersen for her assistance with data entry and overall database management.

Conflict of Interest

KMH, TEC, NVC, and REA declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave W, Montreal, QC, H2W 1S4, Canada

    Katya M. Herman, Tamara E. Carver & Ross E. Andersen

  2. Department of Surgery, McGill University, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada

    Nicolas V. Christou

  3. Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada

    Katya M. Herman

Authors
  1. Katya M. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamara E. Carver
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas V. Christou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ross E. Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katya M. Herman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Herman, K.M., Carver, T.E., Christou, N.V. et al. Keeping the Weight Off: Physical Activity, Sitting Time, and Weight Loss Maintenance in Bariatric Surgery Patients 2 to 16 Years Postsurgery. OBES SURG 24, 1064–1072 (2014). https://doi.org/10.1007/s11695-014-1212-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1212-3

Keywords

Search

Navigation