Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery

doi:10.1016/j.soard.2008.04.013

Surgery for Obesity and Related Diseases

Volume 4, Issue 5, September–October 2008, Pages 640-646

https://doi.org/10.1016/j.soard.2008.04.013 Get rights and content

Abstract

Background

To investigate the relationship between preoperative eating behavior, postoperative dietary adherence and weight loss after gastric bypass surgery in a major, urban medical center with a comprehensive bariatric surgery program. Despite the significant weight loss and dramatic improvements in co-morbidities associated with bariatric surgery, a significant minority of patients appear to experience suboptimal weight loss. The reasons for this are not well understood, but the suboptimal weight loss is often attributed to preoperative psychosocial characteristics and/or eating behaviors, as well as poor adherence to the recommended postoperative diet.

Methods

A prospective investigation was performed of 200 female and male patients who were studied both preoperatively and 20, 40, 66, and 92 weeks postoperatively. All patients underwent either open or laparoscopic Roux-en-Y gastric bypass surgery. The measures were the percentage of weight loss, macronutrient intake, dietary adherence, and eating behavior.

Results

Gender, baseline cognitive restraint, and self-reported adherence to the postoperative diet at postoperative week 20 were associated with the percentage of weight loss at postoperative week 92. Those high in dietary adherence had lost 4.5% more weight at postoperative week 92 than those low in dietary adherence.

Conclusion

Baseline cognitive restraint and adherence to the recommended postoperative diet were associated with the percentage of weight loss after gastric bypass surgery. These results suggest the potential utility of pre- and/or postoperative dietary counseling interventions to improve the postoperative outcomes.

Section snippets

Participants

The study participants were 200 individuals who underwent Roux-en-Y gastric bypass surgery at the Hospital of the University of Pennsylvania from November 2001 to June 2004. The institutional review board of the University of Pennsylvania approved the study, and all participants provided informed consent before entering the study.

Measures

Approximately 4 weeks before surgery, the participants completed a psychosocial/behavioral evaluation to assess their appropriateness for surgery [20].

As a part of

Participants' characteristics

The demographic and descriptive variables are presented in Table 1. Most (n = 164, 82%) participants were women. The women had a mean preoperative age of 42.6 ± 9.9 years, weight of 139.4 ± 25.6 kg, and body mass index of 51.4 ± 9.0 kg/m². The men (n = 36) had a mean preoperative age of 45.7 ± 9.4 years, weight of 181.3 ± 37.2 kg, and body mass index of 55.5 ± 10.0 kg/m². Approximately 87% of all participants were European American, 9% were African American, and the remainder were of other

Discussion

The results of the present study add to a growing body of data on the characteristics associated with weight loss after bariatric surgery. Our participants lost approximately 25% of their preoperative body weight within the first 20 weeks of gastric bypass surgery. They lost another 10% during the next 20 weeks and almost 40% of their initial body weight by the second postoperative year. Of the potential predictor variables of interest investigated, gender, baseline cognitive restraint, and

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

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Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence.
To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence.
University hospital; public practice.
Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery.
A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence.
Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS.
Ecological momentary assessment of changes in eating behaviors, appetite, and other aspects of eating regulation in Roux-en-Y gastric bypass and sleeve gastrectomy patients
2023, Appetite
Bariatric surgery can have profound impacts on eating behaviors and experiences, yet most prior research studying these changes has relied on retrospective self-report measures with limited precision and susceptibility to bias. This study used smartphone-based ecological momentary assessment (EMA) to evaluate the trajectory of change in eating behaviors, appetite, and other aspects of eating regulation in 71 Roux-en-Y gastric bypass and sleeve gastrectomy patients assessed preoperatively and at 3, 6, and 12-months postoperative. For some outcomes, results showed a consistent and similar pattern for SG and RYGB where consumption of sweet and high-fat foods and hunger, desire to eat, ability to eat right now, and satisfaction with amount eaten all improved from pre-to 6-months post-surgery with some degree of deterioration at 12-months post-surgery. By contrast, other variables, largely related to hedonic hunger and craving and desire for specific foods, showed less consistent patterns that differed by surgery type. While the findings suggest an overall pattern of improvement in eating patterns following bariatric surgery, they also highlight how a return to preoperative habits may begin as early as 6 months after surgery. Additional research is needed to understand mechanisms that promote changes in eating behavior after surgery, and how best to intervene to preserve beneficial effects.
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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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.
Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry
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Adherence to follow-up visits is often unsatisfactory after bariatric surgery.
To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015–2018).
Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45–60, and >60 years).
Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m². More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non–insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (P_s < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (P_s < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45–60 years, respectively.
Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.
Preoperative weight loss is linked to improved mortality and leaks following elective bariatric surgery: an analysis of 548,597 patients from 2015–2018
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The effects of preoperative weight loss on bariatric surgery outcomes are still unclear, despite the practice being adopted by bariatric centers worldwide. Ongoing studies are needed for routine adoption of this practice given the multiple issues patients face with following difficult preoperative weight loss protocols.
The aim of this study was to characterize the prevalence of preoperative weight loss and evaluate its impact on outcomes following elective bariatric surgery.
This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015–2018.
All primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) procedures were included, whereas prior revisional surgeries and emergency surgeries were excluded. Cases were then divided into preoperative weight loss (PWL) and control cohorts. PWL was defined categorically if the highest 30-day preoperative weight was greater than the closest recorded weight before surgery. Primary outcomes included identifying the impact of PWL on postoperative complications. Multivariable logistic regression modelling was used to examine the influence of PWL on serious complications and mortality after adjusting for patient co-morbidities and procedure type.
A total of 548,597 patients were identified with the majority experiencing preoperative weight loss (n= 459,500; 83.8%). The PWL cohort was older (44.8 ± 12.0 versus 43.2 ± 11.9 yr), had a reduced body mass index (BMI) (45.0 ± 7.4 versus 46.1 ± 7.6 kg/m²), and was more likely to be male (20.3% versus 18.7%). Patients with preoperative weight loss also were more likely to have metabolic co-morbidities including medication and insulin-dependent diabetes (27.0% versus 23.2%), hypertension (HTN) (48.9% versus 44.7%), dyslipidemia (DLP ) (24.6% versus 21.0%), and sleep apnea (39.6% versus 32.3%). No clinically significant differences were observed for operative length between cohorts (85.3 ± 46.9 min PWL versus 83.9 ± 46.2 min control). The protective benefit was found to be most significant for patients experiencing greatest weight loss with those experiencing a >10% PWL showing 30% decreased odds of leak (OR .68%; 95% CI [confidence interval] .56–.84; P < .0001) and a 40% decrease in odds of mortality versus those with no PWL (OR .60; 95% CI .39–.92; P = .02).
Preoperative weight loss before bariatric surgery is common, occurring in >80% of elective cases. Our findings suggest that preoperative weight loss is associated with improved odds of 30-day mortality and leaks but no differences in bleeds or overall serious complications. Additional prospective trials are needed to further evaluate the role of routine PWL in addition to ongoing development of tolerable preoperative weight-loss protocols.
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: Supported, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases (grant K23-DK60023 to D. B. Sarwer and grant K24-DK065018 to T. A. Wadden).

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Allied health articlePreoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery

Abstract

Background

Methods

Results

Conclusion

Section snippets

Participants

Measures

Participants' characteristics

Discussion

Disclosures

J Psychosom Res

Am J Surg

J Clin Epidemiol

J Am Diet Assoc

Trends in bariatric surgical procedures

JAMA

Bariatric surgery: a systematic review and meta-analysis

JAMA

Treatment of obesity I: adult obesity

Does obesity surgery improve psychosocial functioning?A systematic review

Int J Obes Relat Metab Disord

Psychosocial and behavioral aspects of bariatric surgery

Obes Res

Psychological profile of the morbidly obese

Obes Surg

Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery

N Engl J Med

Nonsurgical factors that influence the outcome of bariatric surgery

Psychosom Med

Binge eating disorder in extreme obesity

Int J Obes Relat Metab Disord

Binge Eating among gastric bypass patients: a long-term follow-up

Obes Res

Allied health article
Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery