Skip to main content
SpringerLink
Log in

Behavioral Predictors of Weight Regain after Bariatric Surgery

  • Research
  • Clinical
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB).

Methods

In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects’ medical records; pre- and postoperative well-being scores were compared.

Results

Of the study population, mean age was 50.6 ± 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 ± 23.6 kg (295 ± 52 lb) and 170.0 ± 29.1 kg (374.0 ± 64.0 lb) for females and males, respectively, p < 0.0001. The mean follow-up after bariatric surgery was 28.1 ± 18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p = 0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of ≥15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83–14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50–183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73–93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91– 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30–0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model.

Conclusions

Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.

    Article  PubMed  Google Scholar 

  2. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    PubMed  Google Scholar 

  3. Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  4. Sjöström L, Narbro K, Sjöström CD, et al. Swedish obese subjects study effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  5. McGuire MT, Wing RR, Klem ML, et al. What predicts weight regain in a group of successful weight losers? J Consult and Clin Psychol. 1999;67:177–85.

    Article  CAS  Google Scholar 

  6. Elfhag K, Rossner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6:67–85.

    Article  CAS  PubMed  Google Scholar 

  7. Foreyt JP. Need for lifestyle intervention: how to begin. Am J Crdiol. 2005;96:11E–4.

    Article  Google Scholar 

  8. Levy RL, Finch EA, Crowell MD, et al. Behavioral intervention for the treatment of obesity: strategies and effectiveness data. Am J Gastroenterol. 2007;102:2314–21.

    Article  PubMed  Google Scholar 

  9. Tamashiro KL, Nguyen MM, Ostrander MM, et al. Social stress and recovery: implications for body weight and body composition. Am J Physiol Regul Integr Comp Physiol. 2007;293(5):R1864–74.

    CAS  PubMed  Google Scholar 

  10. Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28:151–70.

    Article  PubMed  Google Scholar 

  11. Weiss EC, Galuska DA, Kettel Khan L, et al. Weight regain in U.S. adults who experienced substantial weight loss. Am J Prev Med. 2007;33:34–40.

    Article  PubMed  Google Scholar 

  12. Hsu LK, Benotti PN, Dwyer J. Non-surgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.

    CAS  PubMed  Google Scholar 

  13. Sarwer DL, Wadden T, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639–48.

    Article  PubMed  Google Scholar 

  14. Schauer PR, Ashton K. Addictions after bariatric surgery retrieved April 28, 2008. http://www.obesityhelp.com/forums/rny/cmsID,11273/mode,content/a,cms/

  15. Buchwald H. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. American College of Surgeons. 2004;10:39.

    Google Scholar 

  16. Orth WS, Madan AK, Taddeucci RJ, et al. Support group meeting attendance is associated with better weight loss. Obes Surg. 2008;18(4):391–4.

    Article  PubMed  Google Scholar 

  17. Villanueva EV. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001;1:11.

    Article  CAS  PubMed  Google Scholar 

  18. Buffington CK, Daley DL, Warthen M, et al. Changes in alcohol sensitivity and effects with gastric bypass. Abstracts: Poster Session. 2006;2:310–34.

    Google Scholar 

  19. Hagedorn JC, Encernacion B, Brat GA, et al. Does gastric bypass alter alcohol metabolism? Surg Obes Relat Dis. 2007;5:543–8.

    Article  Google Scholar 

  20. Klem ML, Wing RR, McGuire MT, et al. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66(2):239–46.

    CAS  PubMed  Google Scholar 

  21. Dymek MP, Le Grange D, Neven K, et al. Quality of life and psychosocial adjustment in patients after Roux-en-Y gastric bypass: a brief report. Obes Surg. 2001;11:32–9.

    Article  CAS  PubMed  Google Scholar 

  22. Song Z, Reinhardt K, Buzdon M, et al. Association between support group attendance and weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(2):100–3.

    Article  PubMed  Google Scholar 

  23. Harper J, Madan AK, Ternovits CA, et al. What happens to patients who do not follow-up after bariatric surgery? Am Surg. 2007;73(2):181–4.

    PubMed  Google Scholar 

  24. Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609–14.

    Article  PubMed  Google Scholar 

  25. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient oriented approach. Obesity. 2006;14(Suppl 2):53–62S.

    Article  Google Scholar 

  26. Poole NA, Al Atar A, Kuhanendran D, et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15(2):261–5.

    Article  PubMed  Google Scholar 

  27. de Zwaan M, Lancaster KL, Mitchell JE, et al. Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg. 2002;12(6):773–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, 4949 Coolidge, Royal Oak, MI, 48073, USA

    Jacqueline Odom, Kerstyn C. Zalesin, Tamika L. Washington, Wendy W. Miller, Basil Hakmeh, Danielle L. Zaremba, Mohamed Altattan, Mamtha Balasubramaniam, Deborah S. Gibbs, Kevin R. Krause, David L. Chengelis, Barry A. Franklin & Peter A. McCullough

Authors
  1. Jacqueline Odom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerstyn C. Zalesin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tamika L. Washington
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wendy W. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Basil Hakmeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danielle L. Zaremba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohamed Altattan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mamtha Balasubramaniam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Deborah S. Gibbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kevin R. Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. David L. Chengelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Barry A. Franklin
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Peter A. McCullough
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter A. McCullough.

Additional information

No conflicts of interest to disclose from any author.

Appendix

Appendix

Rights and permissions

Reprints and permissions

About this article

Cite this article

Odom, J., Zalesin, K.C., Washington, T.L. et al. Behavioral Predictors of Weight Regain after Bariatric Surgery. OBES SURG 20, 349–356 (2010). https://doi.org/10.1007/s11695-009-9895-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-9895-6

Keywords

Search

Navigation