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Post-operative guidelines

Adhering to post-op dietary, exercise and smoking guidance

After their bariatric surgery, neither RYGB nor SG patients changed their smoking habits, which were positively correlated with age and female gender in SG patients

Bariatric surgery patients are more likely to improve their eating habits and adhere to dietary guidelines following surgery however, they are less likely to increase their physical activity and stop smoking according to researcher published online at Springer Open. The study authors state that patients should be encouraged to work with their multidisciplinary team (physician, registered dietitian, mental health care professional and exercise physiologist) before and after surgery to maximise their outcomes.

The researchers from the University of Pavia, the University of Milan, the National Research Council of Italy, Istituto Clinico S Ambrogio and Massachusetts General Hospital, Harvard Medical School, note in their paper, ‘Evaluation of eating habits and lifestyle in patients with obesity before and after bariatric surgery: a single Italian center experience’, that although bariatric surgery has shown to be effective in morbidly obese patients varied weight loss and some weight regain is evident even for patients “undergoing the same surgical procedure depending on eating behavior modifications, food consumption frequency, and physical activity which may affect weight changes postoperatively.”

They added that previous studies have shown that adhering to post-operative dietary regimes, exercise routines and stopping smoking correlate to effective, long-term outcomes. Therefore, the investigators designed a study to evaluate and compare dietary habits and lifestyle patterns, especially physical activity and smoking habits, of patients with obesity who have undergone roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG) by using a validated self-administered questionnaire to ascertain the adequacy of lifestyle changes.


Their study analysed the food frequency (FF), food habits (FH), physical activity and life style (PA) as well as smoking habits (SH) were analyed in 50 RYGB (25 male; aged: 24–64) and 50 SG patients (25 male; aged: 22–63) by means of a validated questionnaire, before (T0) and six months (T1) post-surgery. A score for each section (FF, FH, PA, SH) was calculated.

After bariatric surgery, all patients received dietetic counselling and education in nutrition was provided by dietitians and health coaches at every visit, as well as encouraged to increase their physical activity.

The questionnaire consisted of questions with the following response categories: always, often, sometimes, never. The score assigned to each response ranged from 0 to 3, with the maximum score assigned to the healthiest one and the minimum score to the least healthy one.


At baseline, the patients’ characteristics did not differ significantly for age, height, weight, and BMI, between the RYGB and SG groups.

On average section FF and FH, questionnaire scores improved more in subjects who underwent RYGB surgery, even without reaching statistical significance (mean score delta 6.6 vs. 4.4 for FF- score; mean score delta 9.9 vs. 8.8 for FH-score; respectively). Mixed models by surgery reported that FF section score was not correlated with age, gender, weight, or BMI, either in RYGB patients or in SG patients; however FH section score was negatively correlated both with weight (β = −0.34; p=0.002) and with BMI (β = −0.15; p=0.003) respectively in RYGB and SG.

No statistically significant difference in PA score was detected although both RYGB and SG patients showed a greater PA- section score at T1 than at T0. As for FF-section, mixed models by surgery reported that PA-section score was not correlated with age, gender, weight, or BMI, either in RYGB patients or in SG patients.

After their bariatric surgery, neither RYGB nor SG patients changed their smoking habits, which were positively correlated with age (β = 0.15; p=0.002) and female gender (β = 3.8, p=0.004) in SG patients. Where questionnaire scores did not differ significantly by surgery group, a pooled analysis on the overall sample was performed, but results did not change substantially.

They researchers note that although the weight loss was due primarily to the bariatric procedures, the eating habit modifications they detected is a positive feature and definitely should be considered a positive outcome factor. They add that this may be in part due to the nutrition counselling the patients received in the postoperative period and underlines the importance of persistent nutritional and medical care of these patients.

“While bariatric surgeries are a stimulus to promote change, these procedures must be coupled with proper information about necessary lifestyle changes to achieve the highest likelihood of long term success,” the authors write. “Therefore, long-term multidisciplinary care after bariatric surgery is likely to help patients achieve more weight loss and decrease the likelihood of significant weight regain in the post-operative course.”

The article was edited from the original article, under the Creative Commons license. To access the article, please click here

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