Dietary intake and eating behavior after bariatric surgery: Threats to weight loss maintenance and strategies for success

Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 09/2011; 7(5):644-51. DOI: 10.1016/j.soard.2011.06.016
Source: PubMed

ABSTRACT During the past decade, bariatric surgery has become an increasingly popular treatment option for the growing number of individuals with extreme obesity. For most individuals, the size and durability of the weight loss and improvements in co-morbidity and mortality have far surpassed those typically seen with behavioral modification and pharmacotherapy. A significant minority of patients, however, will experience suboptimal outcomes, including less than expected weight loss, premature weight regain, and frequent vomiting and/or gastric dumping. The reasons for these outcomes are not well understood, but likely involve both behavioral and physiologic processes. The present review highlights current knowledge on the changes in dietary intake and eating behavior that occur after bariatric surgery in terms of the potential threats these changes might pose to long-term postoperative success. The paper also identifies several strategies from the nonsurgical weight loss literature that might help optimize long-term weight maintenance after surgery.

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    • "However, bariatric surgery must be partnered with postoperative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated . Specifically, bariatric surgery patients are encouraged to adopt a healthy diet and regular physical activity postsurgery, because both of these changes have been shown to increase the likelihood of success in patients after surgery [12] [16]. Little is known regarding how the adoption of postoperative healthy lifestyle modifications may impact and/or be affected by other family members living in the household . "
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    ABSTRACT: Background Bariatric surgery must be partnered with post-operative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated. Little is known about how these lifestyle modifications may be affected by the involvement of other family members living in the household; therefore, this review describes current family-based approaches to improving post-operative outcomes in bariatric surgery patients and their families. Methods A MEDLINE search of publications between 1999-to-2014 was conducted in January 2014. Retrieved titles and abstracts were assessed by two authors to determine relevance to the topic surrounding family-based approaches to improve post-bariatric surgery outcomes. All study designs except case studies were considered if they included some aspect of family as a predictor in relation to improved health outcomes after surgery. Results Initial searches yielded 650 publications (bariatric surgery + family n=193; bariatric surgery + child n=338; bariatric surgery + spouse n=4; bariatric surgery + social support n=115). Two studies met criteria for a family-based approach to improving metabolic outcomes in bariatric patients. Seven studies discussed the impact of bariatric surgery on families. All other studies were excluded for not discussing family-based approaches. Conclusions Despite limited documentation of family-based approaches on improving health outcomes in patients who underwent bariatric surgery, evidence suggests that such an approach may be advantageous if planned a priori to occur before, during, and after bariatric surgery. Future studies could test the combination of bariatric surgery and a family-based approach for improved metabolic outcomes in both the patient and involved family member(s).
    Surgery for Obesity and Related Diseases 08/2014; 11(2). DOI:10.1016/j.soard.2014.08.004 · 4.07 Impact Factor
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    • "More alarming still, the 6.3% prevalence of severely obesity (BMI ≥ 40) [1] is projected to increase by 130% over the next 2 decades [2]. Although bariatric surgery is the recommended treatment for severely obese individuals and/or moderately obese individuals (BMI 35 ≤ 40) with comorbidities [3], its implementation is limited by access, cost, recidivism, and complications [4] [5]. Only 1%- 2% of obese people eligible for insurance coverage of surgical treatment receive it, compelling an urgent need of alternative treatment strategies for this subpopulation [6]. "
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    ABSTRACT: Objective: To examine whether baseline obesity severity modifies the effects of two different, primary care-based, technology-enhanced lifestyle interventions among overweight or obese adults with prediabetes and/or metabolic syndrome. Patients and methods: We compared mean differences in changes from baseline to 15 months in clinical measures of general and central obesity among participants randomized to usual care alone (n = 81) or usual care plus a coach-led group (n = 79) or self-directed individual (n = 81) intervention, stratified by baseline body mass index (BMI) category. Results: Participants with baseline BMI 35+ had greater reductions in mean BMI, body weight (as percentage change), and waist circumference in the coach-led group intervention, compared to usual care and the self-directed individual intervention (P < 0.05 for all). In contrast, the self-directed intervention was more effective than usual care only among participants with baseline BMIs between 25 ≤ 35. Mean weight loss exceeded 5% in the coach-led intervention regardless of baseline BMI category, but this was achieved only among self-directed intervention participants with baseline BMIs <35. Conclusions: Baseline BMI may influence behavioral weight-loss treatment effectiveness. Researchers and clinicians should take an individual's baseline BMI into account when developing or recommending lifestyle focused treatment strategy. This trial is registered with NCT00842426.
    12/2013; 2013:191209. DOI:10.1155/2013/191209
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    • "Factors that predict weight regain after weight loss include a loss of >15–30% of initial weight, early weight regain, and not responding to early regain [2]. Interventions and strategies for weight regain that have been found effective in the nonsurgical literature include self monitoring, continued patient-provider contact, and increased physical activity [3]. "
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    ABSTRACT: Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20-30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20-25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.
    Gastroenterology Research and Practice 11/2013; 2013(8):256145. DOI:10.1155/2013/256145 · 1.75 Impact Factor
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