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.
Similar content being viewed by others
References
Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.
Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
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.
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.
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.
Foreyt JP. Need for lifestyle intervention: how to begin. Am J Crdiol. 2005;96:11E–4.
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.
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.
Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28:151–70.
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.
Hsu LK, Benotti PN, Dwyer J. Non-surgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.
Sarwer DL, Wadden T, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13:639–48.
Schauer PR, Ashton K. Addictions after bariatric surgery retrieved April 28, 2008. http://www.obesityhelp.com/forums/rny/cmsID,11273/mode,content/a,cms/
Buchwald H. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. American College of Surgeons. 2004;10:39.
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.
Villanueva EV. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001;1:11.
Buffington CK, Daley DL, Warthen M, et al. Changes in alcohol sensitivity and effects with gastric bypass. Abstracts: Poster Session. 2006;2:310–34.
Hagedorn JC, Encernacion B, Brat GA, et al. Does gastric bypass alter alcohol metabolism? Surg Obes Relat Dis. 2007;5:543–8.
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.
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.
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.
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.
Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609–14.
Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient oriented approach. Obesity. 2006;14(Suppl 2):53–62S.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
No conflicts of interest to disclose from any author.
Appendix
Appendix
Rights 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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-9895-6