Lifestyle Management for Enhancing Outcomes after Bariatric Surgery

Abstract

Bariatric surgery has been safe and effective for treatment of severe obesity and comorbidities like type 2 diabetes mellitus (T2D). Nonetheless, weight loss and health outcomes vary considerably across individuals. Although the factors associated with outcomes are not fully understood, postoperative weight loss following any type of bariatric surgery is largely dependent on the extent to which patients can make and sustain changes in eating and activity. Therefore, lifestyle management including diet, exercise, and behavior modification is critical to helping patients achieve long-term weight loss. Pharmacotherapy and reoperation may also play a role after bariatric surgery. In this article, we highlight recent research findings in all of these areas to provide suggestions for how to enhance outcomes following bariatric surgery. Research on the mechanisms for weight loss and improvements in T2D following the different surgical procedures is needed to support the development of more personalized approaches to the multidisciplinary management of severe obesity.

Age increases MCP-1 level in association with bariatric surgery operating time and metabolic risk severity

“…This later observation is consistent with the view that increased visceral adiposity is associated with metabolic syndrome severity and insulin resistance . Together, these findings suggest that targeting reductions in abdominal fat inflammation may reduce surgical difficulty, complication rates and operating time . Thus, understanding the role of MCP‐1 on surgical difficulty may have clinical and public health relevance for identification of metabolic profiles in ageing individuals that lead to improved patient care.…”

“…Prolonged operating time was directly correlated with increased MCP‐1 protein concentration in omental but not subcutaneous adipose tissue (Figure ). This association suggests that MCP‐1 secreted from omental fat depots is related to increased surgical difficulty . How MCP‐1 secreted from visceral adiposity promotes increased operating time is beyond the scope of this study, but MCP‐1 is established to promote insulin resistance and increase risk for atherosclerosis .…”

“…How MCP‐1 secreted from visceral adiposity promotes increased operating time is beyond the scope of this study, but MCP‐1 is established to promote insulin resistance and increase risk for atherosclerosis . To combat this pro‐inflammatory adipose tissue depot, very low calorie diet interventions ranging from 2 to 4 weeks are often advised to patients pre‐operatively to shrink liver size and central adiposity . It is also important to recognize that a lack of aerobic fitness may have played a role in explaining the present relationships between adipose derived‐inflammation and operating time .…”

RYGB Produces more Sustained Body Weight Loss and Improvement of Glycemic Control Compared with VSG in the Diet-Induced Obese Mouse Model

“…On the one hand, the effects of counselling and the resulting changes in eating behavior could be a major driver of metabolic improvements, independent of surgery [18]. On the other hand, non-compliance with behavioral and dietary instructions could be driving weight regain.…”

British Obesity Metabolic Surgery Society endorsed guidelines for psychological support pre‐ and post‐bariatric surgery

“…2,[14][15][16] In particular, differences in weight loss trajectories seem to appear between 6 and 12 months alongside the re-emergence of loss of control over eating at 6 months which has led to the suggestion that post-operative interventions are often too late. 6,14,[17][18][19] Some studies also suggest that baseline psychological issues including diet, binge eating, depression and anxiety may relate to outcomes following surgery 16,19,20 although this evidence is mixed. 20,21 In line with this, several research teams 21-24 have argued that bariatric patients require psychological input pre-and post-…”