Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass

doi:10.1016/j.jada.2009.12.028

Journal of the American Dietetic Association

Volume 110, Issue 4, April 2010, Pages 527-534

https://doi.org/10.1016/j.jada.2009.12.028 Get rights and content

Abstract

Background and objective

Long-term data on patients with obesity outcome after bariatric surgery are lacking. The goal was to document dietary and anthropometric changes more than 5 years after surgery, as well as patients' eating behavior, psychological state, and quality of life.

Methods

A cohort of 80 women (mean age 40±10 years) who underwent a Roux-en-Y gastric bypass between 1997 and 2002 were followed in a Swiss University Hospital for an average of 8±1.2 years. The primary outcome was successful weight loss defined as excess weight loss ≥50%. Body composition was measured by bioelectrical analysis, and diet was assessed via a food diary. Eating disorders, psychological factors, and quality of life were evaluated by questionnaires. Patients' perceptions of difficulties and benefits were explored using semistructured interviewing. Results at baseline and last visit were compared using paired t test. Cofactors' means were compared between successful and unsuccessful patients with Student t tests and logistic regression.

Results

Average weight loss 8 years after surgery was 30.7±13.8 kg. Excess weight loss ≥50% was observed for 47 patients (59%). Between baseline and last visit, relative proportions of fat mass/total body weight decreased, and fat-free mass/total body weight increased. Mean energy intake was 2,355±775 kcal at baseline and 1,680±506 kcal at last visit, with 42% of energy from carbohydrates, 39% of energy from fats, and 19% of energy from protein (0.8 g/kg). At last visit, 41 patients (51%) described episodes of binge eating or night eating syndrome. Factors associated with excess weight loss ≥50% were: younger age at operation, greater number of psychological consultations before the operation, and higher scores on ineffectiveness and social insecurity scales at baseline.

Conclusions

More than half of the patients achieved successful weight loss, but disordered eating behavior was frequent. Periodic follow-up screenings and interdisciplinary care are advised. The definition of successful outcome should take into account problematic eating behaviors.

Section snippets

Methods and Procedures

In Switzerland, bypass operation and follow-up are normally paid for by mandatory basic health insurance for patients with BMI >40, or BMI >35 with at least one associated comorbidity, when conservative approaches failed previously. Indication for surgery is set by each patient's physician. Severe personality disorders and suicidal ideation are contraindications to this operation.

Statistical Analysis

Descriptive data are presented as mean±standard deviation for continuous data and frequencies for categorical variables. Patients were classified as successful (excess weight loss ≥50%) or unsuccessful (excess weight loss <50%) at last visit. Measures performed at baseline and last visit were compared with paired t test. Means of cofactors in each outcome group were compared by using Student t test for continuous variables and frequencies of dichotomous variables with Pearson χ² (all tests

Baseline Characteristics

Mean weight of the 141 patients (131 women and 10 men) before surgery was 122.8±20.5 kg, for a mean BMI of 46.0±7.0. Patients' mean age was 40±10 years, most were Swiss (60%), married (62%), and professionally active (63%).

Follow-Up Data

Among 141 patients who received the operation, 135 (96%) were contacted for follow-up at 1 year, among which 80 (59%) patients, all female, accepted to come for a last visit, which occurred at a mean of 8±1.2 years since the operation (range 6 to 11 years). Weight change 1

Discussion

Similar to findings from other studies, most weight loss occurred in the short term after surgery (19, 34). However successful this result may appear, more than half of patients regained at least 5 kg between the first year and last visit, and they expressed feelings of guilt and shame. This should be addressed early by the team, because the risk of disordered eating patterns could increase in this situation (35, 36, 37, 38). As expected, successful and unsuccessful patients differed in their

Conclusions

More than half of patients achieved successful weight loss 8 years after surgery. Factors associated with this outcome were younger age at baseline, a leaner body composition 1 year after surgery, and lower energy intake at last visit. Ineffectiveness and social insecurity scores at baseline were associated with successful outcome, but the latter was not when adjusted for the number of psychological consultations before surgery. The findings of this study reinforce the importance of

M. Kruseman is a professor, Nutrition and Dietetics Department, School of Health Professions, Geneva, University of Applied Sciences Western Switzerland, Carouge, Switzerland, and with the Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland.

References (58)

L.E. Bocchieri et al.
A review of psychosocial outcomes of surgery for morbid obesity
J Psychosom Res.
(2002)
U.G. Kyle et al.
Bioelectrical impedance analysis-part II: Utilization in clinical practice
Clin Nutr.
(2004)
U.G. Kyle et al.
Single prediction equation for bioelectrical impedance analysis in adults aged 20-94 years
Nutrition
(2001)
U.G. Kyle et al.
Fat-free and fat mass percentiles in 5,225 healthy subjects aged 15 to 98 years
Nutrition
(2001)
D. Bucquet et al.
The French version of the Nottingham Health ProfileA comparison of items weights with those of the source version
Soc Sci Med.
(1990)
J.T. Markowitz et al.
Perceived deprivation, restrained eating and susceptibility to weight gain
Appetite
(2008)
P. Burton et al.
The influence of restrained and external eating patterns on overeating
Appetite
(2007)
Obesity: Preventing and Managing the Global Epidemic
(2000)
A. Schmid et al.
Economic burden of obesity and its comorbidities in Switzerland
Soz Praventivmed.
(2005)
A. Neilson et al.
Obesity and its comorbidities: Present and future importance on health status in Switzerland
Soz Praventivmed.
(2005)

M. Deitel et al.

Recommendations for reporting weight loss

Obes Surg.

(2003)

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There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery.
Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data.
Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: −9.41 to −0.49) and FM loss by 7.64 kg (95 % CI: −14.01 to −1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: −7.80 kg; 95 % CI: −14.50 to −1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02).
The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG.
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Preservation of fat-free mass in the first year after bariatric surgery: a systematic review and meta-analysis of 122 studies and 10,758 participants
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Moreover, subgroup analysis based on method of body composition assessment showed a significant reduction in FFM in BIA (WMD: –8.45 kg [95% CI: –9.33, –7.57], P < .001, I2 = 78%, P heterogeneity < .001), DEXA (WMD: –7.80 kg [95% CI: –9.04, –6.56], P < .001, I2 = 80.4%, P heterogeneity < .001), and TBW (WMD: –12.35 kg [95% CI: –18.38, –6.32], P < .001, I2 = 62.5%, P heterogeneity = .069) (Supplementary Table 1). A total of 9 investigations assessed FFM%: after 3 months [40,42,44,51,54,57,58,127,128] (SG [3], BS [2], GBP [2], adjusted gastric banding [AGB, 1], and GB [1]); after 6 months 14 investigations [40,42,51,57,58,66,67,79,82,84,127,129–131] (SG [5], BS [3], GBP [6], and AGB [1]), and after 12 months 10 investigations [40,58,84,109,114,122,125,127,132,133] (SG [5], GBP [6], and AGB [1]). Three months.
The main goal of bariatric surgery (BS) in patients with morbid obesity is reducing body mass and fat mass (FM). However, body mass loss is systematically accompanied by a decline in fat-free mass (FFM). We aimed to examine the time-course effect of BS on FFM and body FFM percentage (FFM%) in individuals with morbid obesity by conducting a systematic review and meta-analysis of controlled adult human trials. We searched PubMed, Scopus, Embase, Institute for Scientific Information Web of Science, and Cochrane databases within the period from October 2002 to May 2021, with no restriction in the English language, to find studies assessing the effect of BS on FFM and FFM% in patients with morbid obesity. A meta-analysis of 122 studies carried out on data of 10,758 patients with morbid obesity after BS showed that BS was associated with a substantial decrease in FFM at 1 (–3.47 kg [95% confidence interval [CI]: –3.88, –3.07]), 3 (–5.59 kg [95% CI: –6.01, –5.17], 6 (–6.61 kg [95% CI: –7.25, –5.98]), and 12 (–8.34 kg [95% CI: –9.04, –7.63]) months after the surgery; however, the FFM% increased at 3 (6.51% [95% CI: 5.00, 8.02]), 6 (8.56% [95% CI: 6.81, 10.31], and 12 (11.29% [95% CI: 8.94, 13.64]) months after the surgery. BS was associated with sustained declines in FFM and increases in FFM% from 1–12 months with no indication of plateau phase postoperatively. These findings emphasize that postbariatric care should focus more on FFM loss during the first year after surgery.
Diet and physical activity are associated with suboptimal weight loss and weight regain 10–15 years after Roux-en-Y gastric bypass: A cross-sectional study
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In the present study, poor WL outcomes (SWL and WR) 10 years after RYGB were associated with a higher intake of energy and energy-dense foods and less PA, compared with the OWL, NWR and/or the control group. The absence of differences in EI between the SWL and OWL groups is in line with the majority of the previous research [9,27–30], even though some have reported a higher EI in those with poor WL after bariatric surgery [14,31,32]. Contradicting results may be due to differences in follow-up time, sample sizes, method of estimating food intake, and degree of underreporting.
Suboptimal weight loss (SWL) after bariatric surgery affects approximately 30% of the patients in the long-term. Diet and physical activity (PA) are likely to modulate long term weight loss outcomes after Roux-en-Y gastric bypass (RYGB).
To compare food habits and PA levels between those experiencing SWL and optimal weight loss (OWL), and between those experiencing weight regain (WR) and no weight regain (NWR), 10–15 years after RYGB, in addition to a pre-operative control group.
Participants were recruited from the Bariatric Surgery Observation Study (BAROBS), ≥ 10 y after RYGB. Food intake was assessed by a Food Frequency Questionnaire (FFQ) and PA levels with Sensewear armbands.
75 participants (79% females) were recruited. Excess weight loss (EWL) was 17 ± 19% and 87 ± 22% in the SWL and OWL groups, respectively and WR was 31 ± 15% and 1 ± 11% in the WR and NWR groups, respectively (P < 0.001 for both). The OWL group reported a lower energy intake (P = 0.012) than the control group. The control group reported a higher intake of milk, cream and cheese than both SWL group (P = 0.008) and OWL group (P < 0.001). The SWL group reported a higher intake of processed meat products than the OWL group, while the OWL group reported a lower intake of sauces than both the SWL and the control groups (P < 0.001 and P = 0.005, respectively). The OWL group reported a lower intake of cakes, sugar and sweets than both SWL group (P = 0.035) and control group (P = 0.021). The WR group reported a lower PA duration (P = 0.046) compared with the NWR group. EWL was positively, and WR negatively, correlated with average PA duration.
A high intake of energy-dense foods and low PA is associated with poor weight loss outcomes, namely SWL and WR, 10–15 years after RYGB.
Evaluation of the impact of gastric bypass surgery on eating behaviour using objective methodologies under residential conditions: Rationale and study protocol
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Gastric bypass surgery leads to significant and sustained weight loss and a reduction in associated health risks in individuals with severe obesity. While reduced energy intake (EI) is the primary driver of weight loss following surgery, the underlying mechanisms accounting for this energy deficit are not well understood. The evidence base has been constrained by a lack of fit-for-purpose methodology in assessing food intake coupled with follow-up studies that are relatively short-term. This paper describes the underlying rationale and protocol for an observational, fully residential study using covert, objective methodology to evaluate changes in 24-hr food intake in patients (n = 31) at 1-month pre-surgery and 3-, 12- and 24-months post-surgery, compared to weight-stable controls (n = 32). The main study endpoints included change in EI, macronutrient intake, food preferences, and eating behaviours (speed, frequency, and duration of eating). Other physiological changes that may influence EI and weight regulation including changes in body composition, circulating appetite hormones, resting metabolic rate, total energy expenditure and gastrointestinal symptoms were also evaluated. Understanding which mechanisms contribute to a reduction in EI and weight loss post-surgery could potentially help to identify those individuals who are most likely to benefit from gastric bypass surgery as well as those that may need more targeted intervention to optimise their weight loss post-surgery. Furthermore, clarification of these mechanisms may also inform targeted approaches for non-surgical treatments of obesity.
Long-term effect of bariatric surgery on body composition in patients with morbid obesity: A systematic review and meta-analysis
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Of the included studies, only four evaluated dietary intake. As expected, Giusti et al. (2016) [32], Kruseman et al. (2010) [31], Henfridsson, et al. (2019) [26] and Tam et al. (2016) [41] demonstrated there was no significant reduction in protein intake in relation to energy intake in respectively 3, 8, 5 and 2 years after the surgery. Nevertheless, these studies observed a significant reduction in energy intake.
We performed a meta-analysis to provide quantitative estimates of fat mass (FM) and fat-free mass (FFM) changes in patients following bariatric surgery over 1 year. A systematic search of PubMed, SCOPUS and Web of Science databases was conducted; the pooled weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using a random-effects model. Thirty-four studies including Roux en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) biliopancreatic diversion (BPD) and gastric banding (GB) were analyzed. RYGB decreased in body FM (−28.99 kg [31.21, −26.77]) or FM% (−12.73% [−15.14, −10.32]) or FFM (−9.97 kg [−10.93, −9.03]), which were greater than SG and GB. Moreover, the FFM% in RYGB group (11.72% [7.33, 16.11]) was more than SG (5.7% [4.44, 6.95]) and GB (8.1% [6.15, 10.05]) groups. Bariatric surgeries, especially RYGB, might be effective for a decrease in FM and maintenance of FFM in patients with morbid obesity in over 1 year.

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A. Leimgruber is a dietitian, Cantonal Hospital of Fribourg, Fribourg, Switzerland; at the time of the study, she was a student in the Nutrition and Dietetics Department, School of Health Professions, Geneva, University of Applied Sciences Western Switzerland, Carouge, Switzerland.

F. Zumbach is a dietitian, Hospital of Yverdon-les-Bains, Yverdon-les-Beains, Switzerland; at the time of the study, she was a student in the Nutrition and Dietetics Department, School of Health Professions, Geneva, University of Applied Sciences Western Switzerland, Carouge, Switzerland.

A. Golay is a professor and head of service, Therapeutic Education for Chronic Diseases, University Hospitals of Geneva, Geneva, Switzerland.

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ResearchOriginal ResearchDietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass

Abstract

Background and objective

Methods

Results

Conclusions

Section snippets

Methods and Procedures

Statistical Analysis

Baseline Characteristics

Follow-Up Data

Discussion

Conclusions

J Psychosom Res.

Clin Nutr.

Nutrition

Nutrition

Soc Sci Med.

Appetite

Appetite

Obesity: Preventing and Managing the Global Epidemic

Economic burden of obesity and its comorbidities in Switzerland

Soz Praventivmed.

Obesity and its comorbidities: Present and future importance on health status in Switzerland

Soz Praventivmed.

Behavioral and psychological factors in the assessment and treatment of obesity surgery patients

Obes Res.

Bariatric surgery: A systematic review and meta-analysis

JAMA

Surgical treatment of obesity

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Ghrelin and gastric bypass: Is there a hormonal contribution to surgical weight loss?

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Obes Surg.

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Research
Original Research
Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass