Multi-sensor ecological momentary assessment of behavioral and psychosocial predictors of weight loss following bariatric surgery: study protocol for a multicenter prospective longitudinal evaluation

Abstract

BackgroundBariatric surgery is currently the most effective strategy for producing significant and durable weight loss. Yet, not all patients achieve initial weight loss success and some degree of weight regain is very common, sometimes as early as 1–2 years post-surgery. Suboptimal weight loss not fully explained by surgical, demographic, and medical factors has led to greater emphasis on patient behaviors evidenced by clinical guidelines for appropriate eating and physical activity. However, research to inform such guidelines has often relied on imprecise measures or not been specific to bariatric surgery. There is also little understanding of what psychosocial factors and environmental contexts impact outcomes. To address research gaps and measurement limitations, we designed a protocol that innovatively integrates multiple measurement tools to determine which behaviors, environmental contexts, and psychosocial factors are related to outcomes and explore how psychosocial factors/environmental contexts influence weight. This paper provides a detailed description of our study protocol with a focus on developing and deploying a multi-sensor assessment tool to meet our study aims.MethodsThis NIH-funded prospective cohort study evaluates behavioral, psychosocial, and environmental predictors of weight loss after bariatric surgery using a multi-sensor platform that integrates objective sensors and self-report information collected via smartphone in real-time in patients’ natural environment. A target sample of 100 adult, bariatric surgery patients (ages 21–70) use this multi-sensor platform at preoperative baseline, as well as 3, 6, and 12 months postoperatively, to assess recommended behaviors (e.g., meal frequency, physical activity), psychosocial indicators with prior evidence of an association with surgical outcomes (e.g., mood/depression), and key environmental factors (e.g., type/quality of food environment). Weight also is measured at each assessment point.DiscussionThis project has the potential to build a more sophisticated and valid understanding of behavioral and psychosocial factors contributing to success and risk after bariatric surgery. This new understanding could directly contribute to improved (i.e., specific, consistent, and validated) guidelines for recommended pre- and postoperative behaviors, which could lead to improved surgical outcomes. These data will also inform behavioral, psychosocial, and environmental targets for adjunctive interventions to improve surgical outcomes.Trial registrationRegistered trial NCT02777177 on 5/19/2016.Electronic supplementary materialThe online version of this article (10.1186/s40608-018-0204-6) contains supplementary material, which is available to authorized users.

Real‐time versus retrospective self‐report assessment of loss‐of‐control eating in adults undergoing bariatric surgery

“…Data were drawn from a multimethod, prospective cohort study investigating behavioral and psychosocial predictors of bariatric surgery outcomes among adults (age ≥21 years) with severe obesity (body mass index [BMI] ≥ 35.0 kg/m 2 ) [19]. Participants were recruited from two academic medical center–based bariatric surgery clinics in the Northeastern United States.…”

Associations of physical activity and sedentary behavior with appetite sensations and eating regulation behaviors before and during the initial year following bariatric surgery

“…The present study involves analysis of data collected as part of a parent prospective cohort study that aimed to evaluate multiple behavioral and psychosocial predictors of outcomes after bariatric surgery using different digital assessment tools (e.g., accelerometry, smartphone EMA) 33 . Eligibility required participants to have a body mass index (BMI) ≥35.0 kg/m 2 , be ≥21 years old, and be scheduled to undergo Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at one of two university‐based hospitals in the Northeastern United States.…”

“…All aspects of the parent study protocol relevant to the present analyses are described below; a full description of the protocol is published elsewhere. 33 Graph GT9X Link wrist-worn accelerometer (ActiGraph, LLC). A valid wear day was defined as ≥10 h and ≥4 days of valid wear at each assessment was required to be included in analyses.…”

“…The present study involves analysis of data collected as part of a parent prospective cohort study that aimed to evaluate multiple behavioral and psychosocial predictors of outcomes after bariatric surgery using different digital assessment tools (e.g., accelerometry, smartphone EMA). 33 Eligibility required participants to have a body mass index (BMI) ≥35.0 kg/m 2 , be ≥21 years old, and be scheduled to undergo Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at one of two university‐based hospitals in the Northeastern United States. Participants were excluded if they were receiving weight management treatment outside the context of standard surgical care, or reported presence of a condition (e.g., uncontrolled severe mental illness) or factors (e.g., plans to geographically relocate) that could preclude adherence to the study protocol.…”

“…All aspects of the parent study protocol relevant to the present analyses are described below; a full description of the protocol is published elsewhere. 33 Participants were recruited between May 2017 and April 2018 using a study recruitment brochure that clinic staff provided to patients between 3‐ and 8‐weeks pre‐surgery during a regularly scheduled clinic visit. Interested individuals provided their contact information to clinic staff and were then contacted by research staff to complete an eligibility phone screen.…”