Living in close proximity and being able to take a quick walk to a nearby food retail store may be a significant factor in long-term weight loss after bariatric surgery, two recent studies have suggested. Although the researchers from Ohio State University found that simply living close to a food store is not an automatic key to sustained weight-loss, living within a five-minute walk of a store with a low-quality selection of foods (one that carries mostly highly processed convenience foods), was actually linked to less weight loss at the two-year post-operative point.
"Being in closer proximity to lower-quality stores predicted less weight loss, but being in closer proximity to higher-quality stores didn't predict more weight loss," said Dr Keeley Pratt, associate professor of human sciences at The Ohio State University and the lead author of two studies detailing these findings. "So, the lower-quality stores were really driving poor outcomes."
In the first study, ‘The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record, census, and county data’, published in SOARD, the research team examined neighbourhood characteristics and other social determinants of health that may help or hinder continued weight loss in the two years after bariatric surgery. The analysis included select data from the electronic health records of all patients who received bariatric surgery at The Ohio State University Wexner Medical Center from 2015 to 2019 in Franklin County, Ohio. Data included race, insurance type, procedure and percentage of total weight loss from two to 24 months after surgery.
Researchers combined health records with census and county data, which enabled the team to count not just the number of food stores, parks/recreational areas and fitness facilities in the county, but precisely where they were relative to patients' home addresses.
"What we see then is from six months to a year and after a year, if that volume of food increases because of not maintaining healthy behaviours or returning to previously eaten foods that weren't as healthy, that weight can come back on," said Pratt, who also has a faculty appointment in general surgery. "That being said, that doesn't mean that what patients can eat is readily available to them where they live - that's the link we're trying to figure out. Our patients know what to eat, so it's not an education or a knowledge issue, but it could be an access issue."
Previous research has shown that living in healthier areas has helped people manage their weight, but very few studies had looked at the social determinants of health that affect patients who have had a significant surgery to achieve their weight loss, she said.
The patient sample consisted of 772 patients who had a gastric bypass (48.7%) or sleeve gastrectomy (51.3%). Of those, 60% were white and 82% were women. Access to a higher number of food stores within a 10-minute walk was linked to a greater percentage of weight loss among all patients over 24 months (p=0.029). Black patients with access to more food stores within a 10-minute (p=0.017) and White patients with more access within a 5-minute walk (p=0.015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (p=0.036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas.
In the second study, The outcomes were reported in the papers, ‘Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months’, published in Obesity Surgery, the researchers categorised food stores as low-, moderate- or high-diversity based on their product selection, which roughly translated to corner or convenience stores, specialty markets and full-service supermarkets.
Eight hundred eleven patients (82.1% female; 60.0% White) who had primary bariatric surgery (48.6% gastric bypass) from 2015 to 2019 at The Ohio State University were included. Proximity from patients’ home addresses to food stores within a 5- (0.25 mile)- and 10-min (0.50 mile) walk were totalled for low (LD) and moderate/high (M/HD) diversity food selections.
The investigators found there were no significant differences for patients living within a 5- (p=0.523) and 10-min (p=0.580) walk in proximity to M/HD food selection stores and weight loss through 24 months. However, patients living in proximity to at least 1 LD selection store within a 5- (p=0.027) and 1 or 2 LD stores within a 10-min (p=0.015) walk had less weight loss through 24 months.
The researchers noted that living near these stores was not an indicator that patients actually shopped at the markets closest to their homes, but the nature of the most available food stores could be an indicator of larger economic forces at play.
"The real goal is to figure out how to make linkages from the clinic to the community and the community to the clinic," Pratt said, suggesting Ohio State could partner with stores to upgrade their food selection and with fitness facilities to provide patient discounts. "This is really a starting point to figuring out how we can aid patients in Franklin County and, eventually, beyond, to make sure post-operative weight loss is equitable, and the resources are equitable, for all patients following surgery."
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