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Physical activity and quality of life in severely obese individuals seeking bariatric surgery or lifestyle intervention

Authors:
Dale Bond at Hartford Hospital
Dale Bond
Jessica L Unick at Alpert Medical School - Brown University
Jessica L Unick
John M Jakicic at University of Kansas Medical Center
John M Jakicic
Sivamainthan Vithiananthan at Alpert Medical School - Brown University
Sivamainthan Vithiananthan
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Abstract and Figures

Given that bariatric surgery (BS) and lifestyle intervention (LI) represent two vastly different approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA) and sedentary behaviors (SB), and examined between-group differences in health-related quality of life (HRQoL), while controlling for PA. A sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m2). PA and SB were assessed over a 7-day period via the SenseWear Armband (SWA). HRQoL was measured using the SF-36, with scores standardized to a population normal distribution (M=50, SD=10). Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62) or light (136.4±76.1 vs. 145.5±72.5, p=0.59) and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59; ≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17) PA. BS-seekers reported significantly lower SF-36 physical functioning (42.4±10.9 vs. 49.0±6.8, p=0.004) and physical component summary (43.9±10.1 vs. 48.9±7.0) scores versus LI-seekers. BS-seeker group status was related to lower physical functioning (β=0.30, p=0.009), independent of gender, age, BMI, and daily PA. Findings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower subjective physical functioning is not associated with lower overall PA levels in BS-seekers.
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S H O R T R E P O R T Open Access
Physical activity and quality of life in severely
obese individuals seeking bariatric surgery or
lifestyle intervention
Dale S Bond
1*
, Jessica L Unick
1
, John M Jakicic
2
, Sivamainthan Vithiananthan
3
, Jennifer Trautvetter
1
,
Kevin CO’Leary
1
and Rena R Wing
1
Abstract
Background: Given that bariatric surgery (BS) and lifestyle intervention (LI) represent two vastly different
approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also
differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA)
and sedentary behaviors (SB), and examined between-group differences in health-related quality of life (HRQoL),
while controlling for PA.
Findings: A sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily
wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m
2
). PA and SB were assessed over a 7-day period via the
SenseWear Armband (SWA). HRQoL was measured using the SF-36, with scores standardized to a population
normal distribution (M=50, SD=10). Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from
LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62) or light
(136.4±76.1 vs. 145.5±72.5, p=0.59) and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59;
≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17) PA. BS-seekers reported significantly lower SF-36 physical functioning
(42.4±10.9 vs. 49.0±6.8, p=0.004) and physical component summary (43.9±10.1 vs. 48.9±7.0) scores versus LI-seekers.
BS-seeker group status was related to lower physical functioning (β=0.30, p=0.009), independent of gender, age,
BMI, and daily PA.
Conclusions: Findings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower
subjective physical functioning is not associated with lower overall PA levels in BS-seekers.
Keywords: Bariatric surgery, Lifestyle intervention, Physical activity, Sedentary, Health-related quality of life,
Sensewear armband
Introduction
Two options for treating severe obesity are bariatric sur-
gery and lifestyle intervention. To achieve weight loss,
bariatric surgery procedures force modification of eating
behavior and alter appetite regulation via surgical re-
striction of food intake, inducing nutrient malabsorption,
and producing favorable changes in gut peptides/hor-
mones [1]. Conversely, the goal of lifestyle intervention,
a more conservative approach, is to promote voluntary
modification of eating and physical activity behaviors to
lose weight [2].
Given that bariatric surgery and lifestyle intervention
are substantially different approaches to weight loss,
there is a question of whether individuals who seek bar-
iatric surgery versus lifestyle interventions may also dif-
fer in important ways. Research has shown that bariatric
surgery-seekers, compared to lifestyle intervention-
seekers, are heavier, more often diagnosed with comor-
bidities, and report poorer health-related quality of life
(HRQoL) impairments [3-5]. However, it is less clear
whether these groups also differ on weight-related beha-
viors. Studies comparing eating behaviors of bariatric
* Correspondence: dbond@lifespan.org
1
Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight
Control and Diabetes Research Center, Warren Alpert Medical School of
Brown University, 196 Richmond Street, Providence, RI 02903, USA
Full list of author information is available at the end of the article
© 2012 Bond et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Bond et al. Health and Quality of Life Outcomes 2012, 10:86
http://www.hqlo.com/content/10/1/86
surgery- and lifestyle intervention-seekers have produced
mixed findings [3,5]. To our knowledge, no study has
compared physical activity and sedentary behaviors in
these groups.
Our previous research using objective measures shows
that bariatric surgery-seekers have low physical activity
levels and spend 80% of their time in sedentary beha-
viors [6,7]. However, it is not known whether equally
overweight individuals seeking to lose weight via lifestyle
intervention have similar levels of physical activity and
sedentary behaviors. Thus, the primary aim of this study
was to compare objectively-measured daily time spent in
physical activity and sedentary behaviors between baria-
tric surgery- and lifestyle intervention-seekers. Addition-
ally, while previous research has found that lower
physical activity is associated with worse HRQoL in bar-
iatric surgery-seekers [8,9], this has not been shown in
lifestyle intervention-seekers. Thus, a secondary aim was
to examine HRQOL differences between these groups,
while controlling for physical activity, body mass index
(BMI) and demographics.
Methods
Participants and procedures
Participants were 21–65 years of age, with a
BMI ≥35 kg/m
2
and no medical contraindications for
physical activity, who were seeking to lose weight via
bariatric surgery or lifestyle intervention. Participants
seeking bariatric surgery in the current study were ini-
tially recruited from local surgery clinics and patient
support groups to participate in a wider study investigat-
ing behavioral changes in this population. Lifestyle
intervention-seekers were recruited from the community
via internet and newspaper advertisements. Prior to
treatment, both groups completed questionnaires and
were given an activity monitor to wear for 7 consecutive
days. Study procedures were approved by The Miriam
Hospital institutional review board (Providence, RI,
USA).
Measures
Objective physical activity
The SenseWear Armband (SWA; BodyMedia, Pitts-
burgh, PA) simultaneously integrates motion data from a
biaxial accelerometer and physiological metrics from
multiple sensors to provide minute-by-minute estimates
of energy expenditure at different intensity levels. The
SWA has been shown to produce valid energy expend-
iture estimates when evaluated against indirect calorim-
etry and doubly labeled water [10,11]. For data to be
considered valid, participants had to wear the SWA for
≥8 h/d on 4 days. The intensity of activity for each mi-
nute of wear time was calculated and expressed using
metabolic equivalents (METs) to determine average daily
time (min/d) spent in sedentary (<1.5 METs) activities,
and light (1.5-2.9 METs), moderate-to-vigorous (MVPA:
≥3 METs; ≥1 and ≥10-min bouts), and total (≥1.5 METs)
PA.
HRQoL
The Medical Outcomes Study Short Form-36 (SF-36) is
a widely used and psychometrically sound HRQoL meas-
ure. Scores from 8 domains relating to physical (physical
function, role-physical, bodily pain, general health) and
mental (vitality, social functioning, role-emotional, men-
tal health) health are individually weighted into physical
Table 1 Characteristics of severely obese participants seeking bariatric surgery or lifestyle intervention
Bariatric Surgery (N = 34) Lifestyle Intervention (N = 34) P
Age (yrs) 43.3 ± 9.4 40.9 ± 10.5 0.33
% Female 76.5 76.5 1.00
% Race 0.25
White 79.4 70.6
African-American 5.9 14.7
American Indian/Alaskan Native 2.9 0.0
Native Hawaiian/Other Pacific Islander 2.9 0.0
Other 8.8 5.9
Don’t know 0.0 8.8
% Ethnicity 1.00
Non-Hispanic 91.2 91.2
Hispanic 8.8 8.8
BMI (kg/m
2
) 46.2 ± 7.8 45.0 ± 4.9 0.49
Weight (kg) 129.9 ± 27.6 127.7 ± 19.6 0.71
Note. Pvalues are based on independent samples t-tests for continuous variables and χ
2
tests for categorical variables. BMI = body mass index.
Bond et al. Health and Quality of Life Outcomes 2012, 10:86 Page 2 of 5
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(PCS) and mental (MCS) component summary scales.
Scores are transformed to a 0–100 scale and standar-
dized to a population normal distribution (M = 50, SD =
10), with higher scores representing better HRQoL
[12,13].
Statistical Analysis
Analyses were performed using SPSS for Windows (Ver-
sion 18.0, Chicago, IL). A sample of 34 lifestyle
intervention-seekers was matched with 34 bariatric sur-
gery-seekers, selected from a wider study database
(n = 130), on gender, age, BMI, and daily SWA wear
time. Independent t-tests examined group differences in
continuous variables. Chi-square analyses compared pro-
portions across categories. Linear regression examined
the association of group status (bariatric surgery- vs. life-
style intervention-seekers) with HRQoL, adjusting for
total physical activity min/d, BMI, age, and sex.
Results
Participants
As shown in Table 1, bariatric surgery-seekers and life-
style intervention-seekers did not differ significantly on
demographics or weight characteristics. Overall, partici-
pants on average were 42.1±10.0 years of age, mostly fe-
male (76.5%) and non-Hispanic White (75%), with
BMI=45.6±6.5 kg/m
2
and weight=128.8 ±23.8 kg.
Differences in PA and SB
Participants wore the SWA for 13.7±1.6h/day over a 7-day
period. Table 2 shows that bariatric surgery- and lifestyle
intervention-seekers did not differ in average daily min/d
spent performing sedentary behaviors and physical activ-
ity of different intensities (p’s>0.50).
Additionally, overall, the groups did not differ in aver-
age daily moderate-to-vigorous physical activity minutes
accumulated in ≥10-min bouts across the 7-day wear
period (bariatric surgery-seeker: 5.7±8.3 vs. lifestyle inter-
vention-seeker: 10.2±7.1, p=0.17). However, a significantly
smaller proportion of bariatric surgery-seekers performed
at least one 10-min bout versus lifestyle intervention-
seekers (47.1%/n=16 vs. 82.4%/n=28, p=0.005). Among
these participants, the groups did not differ in the num-
ber (bariatric surgery-seeker: 5.8±3.4 vs. lifestyle inter-
vention-seeker: 6.8±9.4, p=0.68) or average duration
(bariatric surgery-seeker: 14.4±4.9 vs. lifestyle interven-
tion-seeker: 13.4±3.9, p=0.46) of bouts performed.
Differences in HRQoL
Bariatric surgery-seekers reported lower scores on the
physical function domain and the PCS, compared to life-
style intervention-seekers (p’s<0.05) (Table 2). In regres-
sion analyses, bariatric surgery-seeker group status was
associated with lower physical function scores (β=0.30,
p=0.009), independent of gender, age, BMI, and total PA
Table 2 Comparison of time spent performing activities of varying intensity and reported health-related quality of life
between severely obese participants seeking bariatric surgery or lifestyle intervention
Bariatric Surgery (N = 34) Lifestyle Intervention (N = 34) P
Activity intensity (METs)
Sedentary (min/d) 641.0 ± 117.7 638.4 ± 133.4 0.62
Light (min/d) 136.4 ± 76.1 145.5 ± 72.5 0.59
Moderate-to-vigorous (min/d) 36.4 ± 26.2 40.2 ± 31.3 0.59
Total physical activity (min/d) 172.8 ± 94.3 185.7 ± 94.1 0.58
Health-Related Quality of Life (SF-36)
Physical function 42.4 ± 10.9 49.0 ± 6.8 0.004
Role-physical 46.7 ± 11.1 49.0 ± 10.7 0.39
Bodily pain 50.6 ± 7.6 52.8 ± 7.1 0.22
General health 41.8± 9.6 42.3 ± 8.6 0.83
Physical component summary 43.9 ± 10.1 48.9 ± 7.0 0.02
Vitality 46.2 ± 10.0 47.0 ± 10.1 0.12
Social functioning 46.6 ± 8.6 47.6 ± 10.3 0.73
Role-emotional 49.1± 10.1 48.2 ± 12.1 0.52
Mental health 49.5± 9.0 48.1 ± 10.0 0.54
Mental component summary 49.1 ± 9.3 47.2 ± 11.3 0.44
Note. Pvalues are based on independent t-tests. Values are presented as mean ± standard devia tion. METs = metabolic equivalents. Activity intensity (METs)
thresholds = sedentary (<1.5 METs), light (1.5-2.9 METs), moderate-to- vigorous (≥3 METS), and total physical activity (≥1.5 METs). SF-36 scores are standardized to a
population normal distribution with a mean of 50 and standard deviation of 10 to provide context for reported degree of health-related quality of life
impairment [12].
Bond et al. Health and Quality of Life Outcomes 2012, 10:86 Page 3 of 5
http://www.hqlo.com/content/10/1/86
min/d [Model R
2
=0.20, F(5, 67)=3.1, p=0.02]. The SF-36
PCS model was not significant.
Discussion
Given that bariatric surgery is the most aggressive ap-
proach for treating severe obesity, there is interest in
whether individuals who seek bariatric surgery engage in
less favorable weight-control behaviors than those who
opt for a less aggressive lifestyle intervention approach.
However, previous research in this area has been limited
to eating behaviors [3,5].
The current study compared daily time spent in phys-
ical activity and sedentary behaviors among individuals
seeking bariatric surgery versus lifestyle intervention. We
found that these groups exhibited a remarkably similar
profile characterized by high levels of sedentary behavior
and infrequent engagement in structured or bout-related
moderate-to-vigorous physical activity. Overall, bariatric
surgery- and lifestyle intervention-seekers engaged in
similar low levels of bout-related moderate-to-vigorous
physical activity; however, a greater proportion of lifestyle
intervention-seekers actually performed this type of ac-
tivity. Future studies are needed to investigate possible
barriers to bout-related moderate-to-vigorous physical
activity in bariatric surgery-seekers (e.g., low motivation,
confidence, fear of injury, etc.) that may account for this
difference [14].
We also compared bariatric surgery- and lifestyle
intervention-seekers on HRQoL. Similar to previous
studies [4,5], bariatric surgery-seekers reported lower
physical HRQoL than lifestyle intervention-seekers.
Interestingly, however, this difference occurred despite
the groups having similar body weight and physical ac-
tivity levels. While reasons for this difference are not en-
tirely clear, one possibility may be that lower perceived
physical functioning is a primary reason why severely
obese individuals opt for bariatric surgery, a more ag-
gressive treatment modality, over lifestyle intervention, a
more conservative treatment modality. It is also possible
that this finding is due in part to differences between the
groups on actual or perceived health indicators (e.g.,
duration of severe obesity, severity of weight-related
comorbidities) that were not directly measured.
Importantly, the above finding also suggests that lower
subjective physical functioning in bariatric surgery-
seekers is not a barrier to PA. This discordance between
subjective and objective physical functioning in bariatric
surgery-seekers was also shown in another recent study,
where 41 % of bariatric surgery-seekers reported having
walking limitations yet did not demonstrate limitations
during an objective walking test [9].
Study strengths include use of an objective physical ac-
tivity measure and matching of lifestyle intervention and
bariatric surgery participants on potential confounding
variables. This study also has certain limitations includ-
ing relatively small sample size, non-random assignment
of participants, and exclusion of participants with med-
ical contraindications for physical activity, that may limit
generalizability to all severely obese individuals.
In summary, to our knowledge, this is the first study
to compare severely obese individuals seeking bariatric
surgery or lifestyle intervention on patterns of physical
activity and sedentary behaviors. We found that these
groups engaged in similar levels of physical activity and
sedentary behaviors, and that lower subjective physical
functioning among bariatric surgery-seekers was not
associated with lower overall physical activity levels. The
results suggest that similar prescriptions can be used to
increase physical activity and decrease sedentary behav-
ior in severely obese individuals seeking bariatric surgery
or lifestyle intervention. Further research is needed to
determine whether interventions can produce similar
physical activity and sedentary behavior changes in these
groups.
Competing Interests
The authors declare that they have no competing interests.
Author Contributions
DSB, JLU, JMJ and RRW conceived of the design of the study and
contributed to analysis and interpretation of the data. SV, JT, and KO
contributed to data acquisition and analysis of data. DB drafted the
manuscript and all authors assisted in revising it critically for important
intellectual content. All authors gave final approval of the version to be
published.
Acknowledgements
This research was funded by grants from the National Institute of Diabetes
and Digestive and Kidney Diseases (K01 DK08348-04) and the National Heart,
Lung and Blood Institute (5 T32 HL076134-04). Appreciation is expressed to
the following surgeons who contributed patients to this study: G. Dean
Roye, MD, Beth A. Ryder MD, Department of Surgery, Warren Alpert Medical
School of Brown University, Providence, RI; and Dieter Pohl, MD, Jeannine
Giovanni, MD, Roger Williams Medical Center, Providence RI.
Author details
1
Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight
Control and Diabetes Research Center, Warren Alpert Medical School of
Brown University, 196 Richmond Street, Providence, RI 02903, USA.
2
Department of Health and Physical Activity, Physical Activity and Weight
Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
3
Department of Surgery, The Miriam Hospital, Warren Alpert Medical School
of Brown University, Providence, RI, USA.
Received: 18 May 2012 Accepted: 16 July 2012
Published: 28 July 2012
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doi:10.1186/1477-7525-10-86
Cite this article as: Bond et al.:Physical activity and quality of life in
severely obese individuals seeking bariatric surgery or lifestyle
intervention. Health and Quality of Life Outcomes 2012 10:86.
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... As características sociodemográficas, antropométricas, distribuição de NAF e NE são apresentadas na Tabela 1. Os resultados demonstraram um número maior de pacientes mulheres em relação ao número de homens. Embora a amostragem por conveniência possa contribuir para este resultado, os achados estão em consonância com aqueles reportados por estudos anteriores (Bond et al., 2006(Bond et al., , 2010(Bond et al., , 2012 (Bond et al., 2012). Os domínios com maior preservação foram AS e SM, achado similar ao de outro estudo realizado no Brasil (Vasconcelos & Costa Neto, 2008). ...
... As características sociodemográficas, antropométricas, distribuição de NAF e NE são apresentadas na Tabela 1. Os resultados demonstraram um número maior de pacientes mulheres em relação ao número de homens. Embora a amostragem por conveniência possa contribuir para este resultado, os achados estão em consonância com aqueles reportados por estudos anteriores (Bond et al., 2006(Bond et al., , 2010(Bond et al., , 2012 (Bond et al., 2012). Os domínios com maior preservação foram AS e SM, achado similar ao de outro estudo realizado no Brasil (Vasconcelos & Costa Neto, 2008). ...
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... 50 Perceived poor physical functioning is also associated with seeking bariatric surgery versus lifestyle intervention for severe obesity. 51 Moreover, mobility limitations, pain or discomfort, impairments in sleep or energy, and anxiety are reported to mediate the relationship between SB and depression. 52 Similar to previous studies, participants experienced delayed, ineffective or lack of treatment, and lack of access to care for underlying medical or mental health conditions 53,54 which they perceived affected their ability to reduce their SB. ...
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Introduction Both obesity and sedentary behaviour (SB), are associated with negative health consequences including cardiovascular disease, diabetes, certain cancers and all‐cause mortality. To date, perceived barriers and facilitators to interrupting SB in adults living with obesity have not been identified. Objective This study aimed to identify these perceived barriers and facilitators by conducting a behavioural analysis underpinned by the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation‐Behaviour (COM‐B) model, to enhance knowledge and inform future intervention development. Methods A purposive and snowball sample (N=21) of adults living with obesity took part in semi‐structured interviews, guided by the TDF, to investigate perceived barriers or facilitators to interrupting SB. Transcribed interviews were inductively coded using reflexive thematic analysis. Key themes and subthemes were generated by grouping similar and recurring codes. Finally, subthemes were mapped to the TDF and COM‐B. Results Five key themes were identified, which influence SB across all domains of living. These relate to (i) physical and mental wellbeing; (ii) motivational readiness; (iii) roles, responsibilities and support; (iv) weight bias and stigma and (v) the environment. These themes were then deductively mapped to all 14 TDF domains and all six of the COM‐B constructs. Conclusion A complex interplay of individual, societal and policy factors contribute to the development and habituation of SB patterns for adults living with obesity. Factors identified in this study could assist in the development of interventions, strategies and policies designed to interrupt or reduce sedentary behaviour for this population. This article is protected by copyright. All rights reserved.
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... Data collected using wearable devices shows that candidates for bariatric surgery participate in low levels of physical activity (PA) and spend most of their waking hours in sedentary behaviors [1][2][3][4][5][6]. These findings are corroborated by reports that this population finds participation in regular PA challenging [7], and associate it with negative experiences and low self-efficacy [8]. ...
Patterns of Change in Device-Based Physical Activity and Sedentary Time Following Bariatric Surgery: a Longitudinal Observational Study
Article
Full-text available
  • Jul 2021
  • OBES SURG
PurposeThe aim of this study is to investigate changes in physical activity (PA) and sedentary time (ST) over 12 months following bariatric surgery.Methods Pre-surgery and at 3, 6, 9, and 12 months post-surgery, wearable devices were used to measure PA at different intensities, grouped according to energy expenditure and daily step count, and ST. Measures were also collected of weight and self-efficacy for exercise. Pre- and 12 months post-surgery, measures were collected of body composition and cardiovascular fitness.ResultsThirty adults scheduled for bariatric surgery were recruited (20 females, 44.1 [range, 22.0 to 65.0] years, body mass index 39.6 [range, 30.9 to 50.9] kg/m2). When compared to pre-surgery measures, over the 12 months post-surgery, there were no changes in the percentage of waking hours (mean [95% CI]) spent in ST (− 2% [− 6 to 3]), light intensity PA (1% [− 3 to 5]), and moderate-to-vigorous intensity PA (1% [− 1 to 3]). At all time points, participants spent most (> 70%) of their waking hours accumulating ST, with little time spent in light intensity PA (~ 21%) and almost no time in moderate-to-vigorous intensity PA (~ 5%). Step count and cardiovascular fitness were also unchanged. There were significant changes in weight, self-efficacy for exercise, and body composition.Conclusions Although bariatric surgery resulted in substantial weight loss and improved self-efficacy for exercise, it was insufficient to effect change in PA, ST or cardiovascular fitness. Complementing surgical intervention with behavioral interventions may optimize change in PA and ST.Graphical abstract
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... En el primer caso, por la etapa del ciclo vital que atraviesan, parecería que hay más conciencia de la prevención de enfermedades (Bautista-Castaño et al., 2004), así como una mejor gestión de las emociones que favorece conductas pro salud (López-Pérez et al., 2017); y en el segundo, por las experiencias de sufrimiento relacionadas con intervenciones quirúrgicas, uso de medicina continua y dolor físico (Prasad et al., 2014). Esto es consistente con los hallazgos referentes a la calidad de vida de estos pacientes, en los que obtienen puntuaciones muy bajas, principalmente en Función física (Bond et al., 2012). Estos resultados también dan luces sobre la motivación que los diferentes grupos humanos tienen al optar por la CB. ...
Creencias en obesidad y cirugía bariátrica: Análisis de contenido para diseñar una escala
Article
Full-text available
  • Jan 2021
El objetivo de este estudio fue describir el proceso por el cual se generaron los ítems de una escala de creencias en obesidad y cirugía bariátrica mediante métodos mixtos. Participaron 22 pacientes bariátricos, ecuatorianos entre 22 y 50 años (M = 37.5, DE = 8.91). Se construyó, validó y aplicó una entrevista semiestructurada; la información se procesó mediante análisis de contenido dirigido por las dimensiones del Modelo de creencias en salud. Las creencias variaron en función de características sociodemográficas y clínicas, particularmente edad, sexo, técnica quirúrgica y evolución. El nivel de susceptibilidad, gravedad y beneficios percibidos se asoció principalmente a las consecuencias de perder el bienestar psicológico y aceptación social. Además, se encontró una mayor percepción de barreras en tres subpoblaciones: mujeres, personas que experimentaron emociones negativas y quienes reportaron menos soporte social.
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... One study comparing women based on severity of obesity [28] found greater physical activity barrier scores for lack of self-discipline, lack of good health, and fear of injury in women with more severe obesity when compared to women with less severe obesity, and underlined that more psychological barriers were reported in women with more severe obesity. Collectively, findings from several studies support the idea that results derived from data on people with obesity may not be transferable to adults with severe obesity because they present poorer mental and physical health compared to adults within lower obesity classes, but better health and quality of life than patients awaiting bariatric surgery; this highlights the necessity to consider them separately [9,29,30]. ...
Living with severe obesity: adults’ physical activity preferences, self-efficacy to overcome barriers and motives
Article
  • Jun 2020
Background: This study aimed to explore the preferences, self-efficacy to overcome barriers and motives for physical activity of individuals with severe obesity (body mass index ≥35 kg/m²). Methods: 44 adults with severe obesity (50.5 ± 13.3 years, 80% female) consented to participate in this study. Accelerometers, the 6-minute walking test, and questionnaires were used to collect data on participants’ sociodemographic and medical characteristics, physical fitness, physical activity behaviour, preferences for physical activity, self-efficacy to overcome physical activity barriers and motives for physical activity. Results: A preference for walking (89%) and engaging in supervised physical activity (61%) at moderate intensity (46%) was reported. Most participants (71%) preferred engaging in physical activity outdoors for a duration of 30 to 60 min (84%), either in the morning (64%) or in the evening (48%). Participants had the lowest self-efficacy to overcome physical activity barriers when they had poor health and pain. The two most frequently reported physical activity motives were: preventing health problems and having better health. Conclusions: A preference-based program focusing on health motives and addressing health and pain issues may help to promote physical activity behaviour among adults with severe obesity. Nevertheless, experimental studies are needed to determine if such strategies effectively increase physical activity behaviour in this population. • Implications for rehabilitation • Physical activity preferences (i.e., walking, biking and swimming performed at a moderate intensity and outdoors for a duration of 30 minutes to 1 hour with supervision) can be used to enhance motivation in people with severe obesity. • Addressing the main barriers of regular physical activity (e.g., poor health, pain, depression) could ensure better adherence to physical activity in people with severe obesity. • Using motives of health improvement and health problems prevention could lead to increased physical activity in people with severe obesity.
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Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy
Article
Full-text available
  • Jan 2024
Introduction COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined. Methods 297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014–September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020–April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment. Results Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline. Conclusion During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.
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10 Quality-Nuñez Sánchez
Preprint
Full-text available
  • Mar 2019
625Salud Uninorte. Barranquilla (Col.) 2018; 34 (3): 625-632Vol. 34, N° 3, 2018ISSN 0120-5552eISSN 2011-7531artículo original/original articleFecha de recepción: 29 de marzo de 2017Fecha de aceptación: 11 de agosto de 2017Quality of life in patients subjected to bariatric surgery
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Quality of life in patients subjected to bariatric surgery
Article
Full-text available
  • Feb 2019
Objective: To determine the perception of quality of life in patients with type I obesity and metabolic disorder and types II and III, six months after having bariatric surgery at Hernando Moncaleano Perdomo University Hospital from September 2011 to March 2015. Method: Quasi-experimental research, clinical series and before-and-after studies. Central tendency measures, dispersion and comparison of before-and-after averages were calculated. Results: It is apparent that patients who were treated with bariatric surgery have improved their perception of quality of life, demonstrated by an improvement in mental and physical health according to the SF 36 quality of life scale. Conclusions: Bariatric surgery positively affects the quality of life of patients with a body mass index classified as type I obesity with metabolic disorder and types II and III in the medium term.
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Calidad de vida en pacientes sometidos a cirugia bariatrica
Article
Full-text available
  • Feb 2019
Objective: To determine the perception of quality of life in patients with type I obesity and metabolic disorder and types II and III, six months after having bariatric surgery at Hernando Moncaleano Perdomo University Hospital from September 2011 to March 2015. Method: Quasi-experimental research, clinical series and before-and-after studies. Central tendency measures, dispersion and comparison of before-and-after averages were calculated. Results: It is apparent that patients who were treated with bariatric surgery have improved their perception of quality of life, demonstrated by an improvement in mental and physical health according to the SF 36 quality of life scale. Conclusions: Bariatric surgery positively affects the quality of life of patients with a body mass index classified as type I obesity with metabolic disorder and types II and III in the medium term. Keywords: Quality of life, bariatric surgery, psychiatry, psychology.
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Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions
Article
Full-text available
  • Dec 2011
  • OBES SURG
Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical exercise. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions changed at 1 and 2 years post-surgery and whether exercise cognitions predict physical activity. Forty-two bariatric patients (38 women, 4 men; mean age 38 ± 8 years, mean body mass index prior to surgery 47 ± 6 kg/m(2)) filled out self-report instruments to examine physical activity and exercise cognitions pre- and post-surgery. A large increase in physical activity and favorable changes in exercise cognitions were observed after surgery, viz. a decrease of fear of injury and embarrassment and an increase of the perception of exercise benefits and confidence in exercising. Perceiving less exercise benefits and having less confidence in exercising before surgery predicted less physical activity 2 years after surgery. High fear of injury 1 year after surgery predicted less physical activity 2 years after surgery. After bariatric surgery, favorable changes in physical activity and beliefs about the benefits and barriers of exercising are observed. Our results suggest that targeting exercise cognitions before and after surgery might be relevant to improve physical activity.
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Objective Assessment of Time Spent Being Sedentary in Bariatric Surgery Candidates
Article
Full-text available
  • Jun 2011
  • OBES SURG
Bariatric surgery candidates spend very little time in moderate-to-vigorous intensity physical activity (≥ 3 metabolic equivalents [METs]). This study examined (1) how much of their remaining time is spent in sedentary behaviors (SB < 1.5 METs) compared to light-intensity activities (1.5–2.9 METs) and (2) whether sedentary time varies by BMI. Daily time (hours, %) spent in SB was examined in 42 surgery candidates (BMI = 49.5 ± 7.9 kg/m2) using the SenseWear Pro2 Armband. Participants were stratified by BMI to assess the relationship between degree of obesity and SB. Participants wore the armband for 5.4 ± 0.7 days and 13.3 ± 1.7 h/day. On average, 81.4% (10.9 ± 2.1 h/day)of this time was spent in SB. Participants with BMI ≥ 50 spent nearly an hour more per day in SB than those with BMI 35–49.9 (p = 0.01). Bariatric surgery candidates spend over 80%of their time in SB. Reducing SB may help to increase physical activity in these patients.
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Pre- to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self Report vs. Objective Measures
Article
Full-text available
  • Apr 2010
  • OBESITY
Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre-op BMI = 50.8 ± 9.7 kg/m(2)) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥ 1-min and ≥ 10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥ 1-min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥ 10-min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated ≥ 150-min/week of MVPA in bouts ≥ 10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes.
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Expert Panel on Weight Loss Surgery: Executive Report Update
Article
Full-text available
  • Jun 2009
Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
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SF-36 Health Survey update
Article
Full-text available
  • Jan 2001
Ware JE, Jr.: SF-36 Health Survey Update, in Maruish M (ed): The Use of Psychological Testing for Treatment Planning and Outcome Assessment, Volume 3. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2004, pages 693-718. ISBN 0805843310, 9780805843316.
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Behavioral interventions for the treatment of obesity in women with or at risk of cardiovascular disease
Article
  • May 2009
More than one-third of women in the United States are obese. This fact is of particular concern given that obesity contributes to increased risk of several diseases that affect women, including cardiovascular disease. Even modest weight loss, however, can prevent and improve cardiovascular risk factors in obese women. Behavioral interventions for the treatment of obesity that aim to produce weight loss via modification of diet and exercise habits appear to be particularly effective in this regard. This article summarizes research on the effects of behaviorally produced weight loss on cardiovascular risk, principal strategies to improve behavioral weight loss outcomes, and key components of successful long-term weight maintenance.
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Walking Capacity of Bariatric Surgery Candidates
Article
  • Jul 2011
This study characterizes the walking limitations of bariatric surgery candidates by age and body mass index (BMI) and determines factors independently associated with walking capacity. The setting was multi-institutional at research university hospitals in the United States. Participants of the Longitudinal Assessment of Bariatric Surgery study (n=2458; age 18-78 yr, BMI 33-94 kg/m(2)) attended a preoperative research visit. Their walking capacity was measured by self-report and the 400 m Long Distance Corridor Walk (LDCW). Almost two thirds (64%) of subjects reported limitations with walking several blocks, 48% had an objectively defined mobility deficit, and 16% reported at least some walking aid use. In multivariate analysis, BMI, older age, lower income, and greater bodily pain were independently associated (P < .05) with walking aid use, physical discomfort during the LDCW, an inability to complete the LDCW, and a slower time to complete the LDCW. Female gender, Hispanic ethnicity (but not race), greater heart rate at rest, a history of smoking, several co-morbidities (history of stroke, ischemic heart disease, diabetes, asthma, sleep apnea, venous edema with ulcerations), and depressive symptoms were also independently related (P < .05) to at least one measure of reduced walking capacity. Walking limitations are common in bariatric surgery candidates, even among the least severely obese and youngest patients. Physical activity counseling must be tailored to individuals' abilities. Although several factors identified in the present study (eg, BMI, age, pain, co-morbidities) should be considered, directly assessing the patient's walking capacity will facilitate appropriate goal setting.
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Accuracy of Armband Monitors for Measuring Daily Energy Expenditure in Healthy Adults
Article
  • Apr 2010
  • MED SCI SPORT EXER
There is a need to develop accurate devices for measuring daily energy expenditure under free-living conditions, particularly given our current obesity epidemic. The purpose of the present study was to evaluate the validity of energy expenditure estimates from two portable armband devices, the SenseWear Pro3 Armband (SWA) monitor and the SenseWear Mini Armband (Mini) monitor, under free-living conditions. Participants in the study (30 healthy adults aged 24-60 yr) wore both monitors for 14 consecutive days, including while sleeping. Criterion values for total energy expenditure (TEE) were determined using doubly labeled water (DLW), the established criterion standard method for free-living energy expenditure assessment. The average TEE estimates were within 112 kcal·d−¹ for the SWA and within 22 kcal·d−¹ for the Mini, but the absolute error rates (computed as the average absolute value of the individual errors) were similar for the two monitors (SWA = 8.1% ± 6.8%, Mini = 8.3% ± 6.5%). Using intraclass correlation (ICC) analysis, significant agreements were found between the SWA and DLW estimates of energy expenditure (ICC = 0.80, 95% CI = 0.89-0.70) and between the Mini and DLW (ICC = 0.85, 95% CI = 0.92-0.76). Graphical plots of the DLW TEE values against the difference between DLW and monitor estimates of TEE showed that the agreement was consistent across a range of TEE values. The SenseWear Pro3 and the SenseWear Mini armbands show promise for accurately measuring daily energy expenditure under free-living conditions. However, more work is needed to improve the ability of these monitors to accurately measure energy expenditure at higher levels of expenditure.
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Becoming Physically Active After Bariatric Surgery is Associated With Improved Weight Loss and Health-Related Quality of Life
Article
  • Nov 2008
The purpose of this study was to determine whether pre- to postoperative increases in physical activity (PA) are associated with weight loss and health-related quality of life (HRQoL) following bariatric surgery. Participants were 199 Roux-en-Y gastric bypass (RYGB) surgery patients. The International Physical Activity Questionnaire (IPAQ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level: (i) Inactive/Active (<200-min/week/>or=200-min/week), (ii) Active/Active (>or=200-min/week/>or=200-min/week) and (iii) Inactive/Inactive (<200-min/week/<200-min/week). The Medical Outcomes Study Short Form-36 (SF-36) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes. Inactive/Active participants, compared with Inactive/Inactive individuals, had greater reductions in weight (52.5 +/- 15.4 vs. 46.4 +/- 12.8 kg) and BMI (18.9 +/- 4.6 vs. 16.9 +/- 4.2 kg/m(2)). Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other. Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary (MCS) score and the general health, vitality and mental health domains (P < 0.01). Although the direction of causation is not clear, these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active. Future randomized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes.
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