Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

McGrice, Melanie; Paul, Kathlene Don

doi:10.2147/dmso.s57054

Cited by 127 publications

(109 citation statements)

References 67 publications

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“…However, an intervention study in which participants are randomly assigned to groups who consume diets with different macronutrient compositions is required to determine the causal effect of dietary changes on long-term weight loss and disease-risk profiles in individuals who have received bariatric surgery. In the meantime, patients should be encouraged to adopt a restricted eating pattern and to self-monitor their dietary intake, physical activity, and weight because these practices have been shown to be protective strategies against weight regain after bariatric surgery (36).…”

Section: Discussionmentioning

confidence: 99%

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Kanerva

Larsson

Peltonen

et al. 2017

The American Journal of Clinical Nutrition

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Background: Approximately 20-30% of obese patients do not achieve successful weight outcomes after bariatric surgery. Objective: We examined whether short-term changes (#0.5 y postsurgery) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change. Design: Participants were recruited from the Swedish Obese Subjects (SOS) study, which was a matched (nonrandomized) prospective trial that compared bariatric surgery with usual care for obese patients. A total of 2010 patients who underwent bariatric surgery were included in the study. Physical examinations (e.g., weight) and questionnaires (e.g., dietary questionnaire) were completed before and 0.5, 1, 2, 3, 4, 6, 8, and 10 y after surgery. For the main analytic strategy, a linear mixed model was implemented, which included repeated measures with a random intercept and an unstructured covariance matrix. Results: Short-term changes in energy intake (P , 0.001) and in relative proportions of energy from carbohydrates (P , 0.001), fat (P , 0.001), and protein (P , 0.05) were associated with 10-y weight change after bariatric surgery. At the 10-y follow-up, men and women with the largest reductions in energy intake had lost 7.3% and 3.9% more weight, respectively, compared with that of subjects with the smallest intake reductions (P , 0.001). Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition (P , 0.05). Conclusions: The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss. Weight loss is also associated with a changing dietary macronutrient composition. This trial was registered at clinicaltrials.gov as NCT01479452.Am J Clin Nutr 2017;106:136-45.

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Section: Discussionmentioning

confidence: 99%

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Kanerva

Larsson

Peltonen

et al. 2017

The American Journal of Clinical Nutrition

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“…The findings also highlight the importance of identifying risk groups among bariatric surgery patients who may require additional support with dietary and psychological follow-up [100••].…”

Section: Discussionmentioning

confidence: 99%

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

2017

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Purpose of ReviewLittle is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.Recent FindingsFindings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings.SummaryReframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.

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“…A review of the current literature [28] showed that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. The authors recommend focusing on pre-and postoperative education sessions to ensure that the patient understands how the procedure works.…”

Section: Specific Health Knowledgementioning

confidence: 99%

Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study

Köhler¹,

Dorozhkina²,

Gruner-Labitzke³

et al. 2020

Obes Facts

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Background: It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. Methods: Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12-74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. Results: The pre-and postop-erative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). Conclusion: The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points. associated with better weight loss nor with postoperative complications and do not replace the lifelong practical application of dietary recommendations and physical activity.Further longitudinal studies with knowledge assessment at various time points (before the start of training, before and after the surgery) are necessary for the evaluation of retained knowledge in the same patients over time.

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Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

Cited by 127 publications

References 67 publications

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study

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