Bariatric patients need continued support to help them maintain benefits of surgery

Updated: Jun 21

In a long-term study of adults who have undergone bariatric weight loss surgery, University of Florida researchers have found participants’ physical activity and diet quality improved after surgery, but fell short of federal physical activity guidelines. The findings, ‘Assessment of Physical Activity and Healthy Eating Behaviors Among US Adults Receiving Bariatric Surgery’, which appear in JAMA Network Open, suggest patients may need continued support to help them maintain weight loss and other health benefits of the surgery.

“Although evidence has established the association between bariatric surgery and improvement in cardiometabolic outcomes, postoperative lifestyle patterns — which could help patients achieve long-term health benefits of bariatric surgery — are not well understood,” said the study’s lead author, Dr Young-Rock Hong, an assistant professor of health services research, management and policy in the UF College of Public Health and Health Professions and a member Health Cancer Center.


Patients who have had bariatric surgery might regain weight due to several factors, and a fraction of patients may have significant weight regain several years after surgery, said Crystal Johnson-Mann, a study author, an assistant professor and a minimally invasive/bariatric surgeon in the division of gastrointestinal surgery at the UF College of Medicine. Providing patients access to continued treatment by dietitians, clinical psychologists and bariatric physicians can help mitigate weight regain.


“Obesity is a chronic disease process and must be managed as one, like hypertension or diabetes,” she said. “Patients have the best outcomes from bariatric surgery when it is fully utilised as an adjunct to lifestyle/behavioural changes, such as changes in physical activity and diet. Not all patients post-surgery can be as physically active as desired due to ongoing neurologic, musculoskeletal or other factors, but physical activity should be highly encouraged in those who can engage in order to maximize the benefits of their metabolic surgery.”

For the study, investigators analysed 2015-2018 data from the National Health and Nutrition Examination Survey, a nationally representative study that collects data from a combination of interviews, physical examinations and laboratory tests. The researchers looked at self-reported data on physical activity and diet for more than 4,600 adult participants in three categories: people who had received bariatric surgery; people who met eligibility requirements for bariatric surgery but had not undergone the procedure; and people who had normal weight.


Of 4,659 study participants (2,638 women) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was seven (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in moderate-to-vigorous physical activity (MVPA) than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (40.8% to 52.4%) reported meeting physical activity guidelines, almost two times higher than those in the bariatric surgery (23.1%; 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 15.6% to 25.1%).


Propensity-score weighted overall Healthy Eating Index (HEI) was higher for individuals with normal weight (54.4; 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 47.2 to 52.9) or were eligible for the surgery (48.0; 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d).


People who had undergone bariatric surgery reported spending more time per week doing moderate-to-vigorous physical activity than people who were eligible for surgery, but did not receive it. Yet, only 23% of patients who had bariatric surgery met federal physical activity guidelines, compared with 45% of people at normal weight. Current guidelines published by the US Department of Health and Human Services recommend 150 minutes a week of moderate-intensity aerobic exercise or 75 minutes a week of vigorous aerobic activity.


An analysis of self-reported calorie intake and diet showed that patients who received bariatric surgery consumed the lowest number of calories a day of the three groups, but the quality of the food they ate, as measured by the Healthy Eating Index, was lower than participants in the normal weight group.


Beyond surgery-related factors that may affect weight regain, adults who have undergone bariatric surgery face the same environmental, social and cultural barriers as anyone attempting to maintain weight loss, said the study’s senior author, Kathryn Ross, an associate professor of clinical and health psychology in the College of Public Health and Health Professions. These include maintaining a healthy diet in an environment where highly palatable, highly processed, high-calorie foods are cheap and plentiful, and the ability to engage in physical activity may be hampered by sedentary jobs, lack of access to safe spaces for walking and biking, and time restrictions due to work or caregiving responsibilities.

“The provision of nutritional counselling and support to help patients make and maintain post-surgical changes in their dietary intake and physical activity is key to supporting long-term weight loss maintenance,” Ross said. “Offering positive, non-judgmental support while helping patients set realistic, achievable goals can also benefit postoperative patients trying to make changes in their eating and activity patterns.”

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