Personal behaviors, practices tied to weight loss after bariatric surgery

Last Updated: 2016-04-21

By Larry Hand

NEW YORK (Reuters Health) - Eating behaviors and weight-control practices are significantly associated with how much weight a person loses after bariatric surgery, according to a new study.

"Both before and after surgery, clinicians should inquire in detail about problematic weight-control practices and eating behaviors," Dr. James E. Mitchell, of the Neuropsychiatric Research Institute in Fargo, North Dakota, told Reuters Health by email.

Dr. Mitchell and colleagues conducted a multicenter observational study involving more than 2,000 participants at 10 U.S hospitals in six geographically diverse areas in 2006-2009. They reported their results in an article online April 20 in JAMA Surgery.

Study participants included first-time bariatric surgery patients, including 1,513 who underwent Roux-en-Y gastric bypass (RYGB) and 509 who underwent laparoscopic adjustable gastric binding (LAGB). Median participant age was 47, median body mass index was 46, and 78% were women.

Participants completed surveys on eating and weight-control behaviors before surgery and yearly afterward for three years. Researchers divided the behaviors into categories: never present before or after surgery, always present, and ones that underwent a healthy change after surgery. The healthy change could be either development of a positive behavior or omission of a negative behavior.

The researchers analyzed 25 postoperative behaviors tied to eating problems and weight-control practices, as well as smoking and use of alcohol and illegal drugs. The three behaviors that explained the most variability in weight loss were weekly self-weighing, continuing to eat when feeling full more that once a week, and eating continuously during the day.

The researchers found the observed median weight-loss percentage three years after surgery to be 31.5% for RYGB patients and 16% for LAGB patients. Median three-year weight loss was 40 kg for RYGB patients and 20 kg for LAGB patients.

Individuals who, after surgery, started weighing weekly, stopped eating when full, and stopped eating continuously during the day lost a mean of 38.8% of baseline weight. This came out to be 14 percentage points more than in individuals who made no postoperative changes in those behaviors (p<0.001) and 6 percentage points greater than individuals who always reported positive on these behaviors (p>0.001).

"This suggests that structured programs to modify problematic eating behaviors and eating patterns following bariatric surgery should be evaluated as a method to improve weight outcomes among patients undergoing bariatric surgery. The results also underscore the need for health care professionals to target these behaviors in the postoperative period," the researchers conclude.

Dr. Amir A. Ghaferi, of the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, who coauthored an accompanying commentary, told Reuters Health by email, "There remains uncertainty about how bariatric surgery achieves weight loss and thus how to maintain the beneficial effects of surgery. Nonetheless, like all things in medicine, there is no one-size-fits-all approach or solution to obesity."

"We are still seeking the ideal predictors of short- and long-term weight loss. The single-best thing we could do at this point is to maintain close follow-up with patients in order to continue to encourage best practices for weight loss and maintenance," he said.

"Bariatric surgery remains the single-best treatment for morbid obesity with proven short- and long-term benefits. Keeping with the medical mantra "First, do no harm", the benefits far outweigh the risks and we need to continue advocating for improved access, research, and education about bariatric surgery," he concluded.

SOURCE: http://bit.ly/1Sl4lX4 and http://bit.ly/22OjtRH

JAMA Surg 2016.