What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year?

doi:10.1016/j.soard.2014.01.030

Surgery for Obesity and Related Diseases

Volume 10, Issue 4, July–August 2014, Pages 697-704

https://doi.org/10.1016/j.soard.2014.01.030 Get rights and content

Abstract

Background

Prior evidence indicates that predictors of weight loss outcomes after gastric bypass surgery fall within 5 domains: 1) presurgical factors, 2) postsurgical psychosocial variables (e.g., support group attendance), 3) postsurgical eating patterns, 4) postsurgical physical activity, and 5) follow-up at postsurgical clinic. However, little data exist on which specific behavioral predictors are most associated with successful outcomes (e.g.,≥50% excess weight loss) when considering the 5 domains simultaneously. The objective of this study was to specify the behavioral variables, and their respective cutoff points, most associated with successful weight loss outcomes.

Methods

Signal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables (within the 5 domains) and successful weight loss at≥1 year in 274 postgastric bypass surgery patients.

Results

Successful weight loss was highest (92.6%) among those reporting dietary adherence of>3 on a 9-point scale (median = 5) who grazed no more than once-per-day. Among participants reporting dietary adherence<3 and grazing daily or less, success rates more than doubled when highest lifetime body mass index was<53.7 kg/m². Success rates also doubled for participants with dietary adherence = 3 if attending support groups. No variables from the physical activity or postsurgical follow-up domains were significant, nor were years since surgery. The overall model’s sensitivity = .62, specificity = .92.

Conclusions

To our knowledge, this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss. Such data may inform prospective study designs and postsurgical interventions.

Section snippets

Data collection

The study’s sample was gathered from the general membership of an online bariatric support website, which sought out our team for assistance with refining a previously administered survey. The survey was e-mailed to all website members to assess whether and how much they complied with website-provided postsurgical recommendations (e.g., weighing oneself daily, drink at least 64 ounces fluid daily, etc.). The revised 100 item self-report survey was derived from several sources of information and

Data selection

Of the 539 participants who originally began the survey, 48 who did not report surgery type were excluded. Of the 491 remaining, 72% (n = 353) reported gastric bypass, 15% (n = 74) lap band, 9% (n = 44) gastric sleeve, and 4% (n = 20) other (e.g., revision surgery) as their surgery type. To maintain as homogenous a sample as possible, only gastric bypass patients were included. Thirty-two were excluded due to having surgery<1 year prior (leaving insufficient time to achieve postsurgical outcome

Discussion

Bariatric surgery is currently considered the most successful treatment for refractory morbid obesity [1], [2]. The present study employed SDA, a nonparametric technique used to identify characteristics of subgroups at risk for a clinically relevant binary outcome such as a successful versus unsuccessful outcome after bariatric surgery. Unlike linear models, the SDA does not rely on assumptions of a normal distribution and instead, iteratively tests hypothesized variables until either a

Disclosures

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

Acknowledgments

This research was funded in part by a grant from the National Institute of Mental Health K23 MH085732 awarded to Athena Robinson, Ph.D.

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Integrated health articleWhat variables are associated with successful weight loss outcomes for bariatric surgery after 1 year?

Abstract

Background

Methods

Results

Conclusions

Section snippets

Data collection

Data selection

Discussion

Disclosures

Acknowledgments

Surg Obes Relat Dis

J Affect Disord

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

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Ann Intern Med

Behavioral factors associated with successful weight loss after gastric bypass

Am Surg

Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey

Obesity (Silver Spring)

Comparison of those who succeed in losing significant excessive weight after bariatric surgery and those who fail

Surg Endosc

Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years

Ann Surg

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

Int J Obes

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Surg Obes Relat Dis

Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss

Obesity

Binge eating in the bariatric surgery population: a review of the literature

Int J Eat Disord

Integrated health article
What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year?