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
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.
Available from: Denise Vidot
- "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  . 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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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.
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.
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.
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).
- "Only 12 out of the initial 39 included statistical data on the frequency, associated psychological features or weight outcomes in bariatric surgery patients (see Table 3)[2,6,7,9,10,13,161718192021, and 6 studies were found with data on these eating behaviors in nonbariatric surgery samples[15,2223242526. Seventeen studies were excluded because they mentioned grazing without providing statistical data or a new definition of the behavior[1,5,8,2728293031323334353637383940, and one because it surveyed a group of bariatric patients on their ideas about the definition of grazing. "
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Grazing, characterized by a repetitive eating pattern, has received increased attention among bariatric surgery patients. However, different definitions and terminology have been used, preventing the accurate measurement of this phenomenon and comparison of data across studies.
To review existing definitions and associated clinical features of grazing among different samples and to propose a standardized definition that will allow for consistency in future work.
University and Clinical Research Institute.
Of the 39 studies found, 9 provided an original definition and 12 provided data of its association with weight outcomes. Six were studies of non-bariatric surgery populations. Based on this literature review, the most common criteria used in previous studies to define grazing were included in a survey that was sent to 24 individuals who have published work in the field. These experts were asked to provide their opinion on what should constitute grazing.
Grazing is a frequent behavior in the bariatric surgery population as well as in eating disordered and community samples. Its association with psychopathology is not clear, but its negative impact on weight outcomes after bariatric surgery generally has been supported. Survey data provided a consensus regarding the definition of grazing as an eating behavior characterized by the repetitive eating (more than twice) of small/modest amounts of food in an unplanned manner, with what we characterize as compulsive and non-compulsive subtypes.
Given the clinical relevance of grazing among bariatric surgery patients, a unique definition is crucial to better study its associated features and impact on different populations.
- "More alarming still, the 6.3% prevalence of severely obesity (BMI ≥ 40)  is projected to increase by 130% over the next 2 decades . Although bariatric surgery is the recommended treatment for severely obese individuals and/or moderately obese individuals (BMI 35 ≤ 40) with comorbidities , its implementation is limited by access, cost, recidivism, and complications  . 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 . "
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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.
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.
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 ClinicalTrials.gov NCT00842426.
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