Assessing certain weight control practices and eating behaviours after bariatric surgery can significantly influence the amount of weight loss after surgery, according to a study published by researchers from the Neuropsychiatric Research Institute, Fargo, ND. The paper, ‘Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery’, published in JAMA Surgery, suggests that the utility of programmes to modify problematic eating behaviours and eating patterns should be addressed in research.
“The results of this study suggest that certain behaviours, many of which are modifiable, are associated with weight loss differences of significant impact in patients undergoing RYGB or LAGB,” the authors write. “The magnitude of this difference is large and clinically meaningful. In particular, the data suggest that developing positive changes in behaviour, including ceasing negative behaviours or increasing positive behaviours, can affect the amount of weight loss.”
Bariatric surgery has been proven to induce weight loss, but the amount can vary. Most research in this area has focused on preoperative factors and post-operative predictors of weight loss have not been adequately examined. Therefore, the researchers led by Dr James E Mitchell and colleagues examined postoperative eating behaviours and weight control, and their effects on change in weight among adults undergoing first-time bariatric surgical procedures.
Data was gathered from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study, a multi-centre observational cohort study at ten US hospitals in six geographically diverse clinical centres. Adults undergoing first-time bariatric surgical procedures as part of routine clinical care were recruited between 2006 and 2009 and followed up until September 2012. Participants completed detailed surveys regarding eating and weight control behaviours prior to surgery and then annually after surgery for three years.
Participants completed detailed surveys regarding eating and weight control behaviours prior to surgery and then annually after surgery for three years. Twenty-five postoperative behaviours related to eating behaviour, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs were examined.
Behaviours examined were divided into those that were never present (pre-operatively or post-operatively), those that were always present (pre-operatively and post-operatively), and those that underwent a healthy change after surgery (development of a positive behaviour or omission of a negative behaviour).
The study included a total of 2,022 participants (median age 47 years, range 38-55 years; median BMI 46; 78% women): 1,513 who had undergone Roux-en-Y gastric bypass and 509 who had undergone laparoscopic adjustable gastric banding. The researchers found that the three behaviours that explained most of the variability (16 percent) in three-year percent weight change following RYGB were weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day.
A participant who postoperatively started to self-weigh, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose an average of 39 percent of their baseline weight, which is about 14 percent greater weight loss compared with participants who made no positive changes in these variables, and 6% greater weight loss compared with participants who always reported positive on these healthy behaviours.
The outcomes “suggests that structured programmes to modify problematic eating behaviours 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 behaviours in the postoperative period,” the authors write.