Effects of the Postoepartive Dietetic/Behavioral Counseling on the Weight Loss After Bariatric Surgery

S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study

BACKGROUND

Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education.

PURPOSE

To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes.

METHODS

This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care.

RESULTS

A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results.

CONCLUSION

Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.

Behavioral Interventions After Bariatric Surgery

Purpose of Review

Bariatric surgery is the most effective and durable treatment for severe obesity. Postoperative behavioral weight management approaches are available for optimizing weight change for both short- and long-term outcomes.

Recent Findings

Varying settings such as groups and telemedicine along with techniques such as cognitive behavioral therapy have been assessed in the post-bariatric surgery population. The assessment and application of these programs have been limited due to methodological, financial, and attrition-related constraints.

Summary

This review aims to summarize the current evidence for different postoperative behavioral interventions on postoperative outcomes, specifically highlighting weight loss. Future opportunities for study include mechanisms for overcoming some of the barriers to implementing these programs in clinical, non-research settings.

Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes

Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9 years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7 years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.

Assessment of the Quality and Reliability of Information on Nutrition After Bariatric Surgery on YouTube

BACKGROUND

YouTube™ is a platform that many people, including patients, use to access health information. Recent studies have revealed that videos on YouTube™ are misleading or that medical videos may not contain appropriate information. This study aimed to assess the quality and reliability of videos on nutrition after bariatric surgery.

MATERIALS AND METHODS

The keywords "after bariatric surgery diet" and "weight loss surgery postop diet" were used, and the first 100 videos for each keyword on YouTube™ were analyzed by considering the source, duration, content, and the number of likes of the video. The popularity of the video was calculated using the video power index (VPI) and view rate. The educational quality of the videos was evaluated using the DISCERN score, the Journal of the American Medical Association (JAMA) score, the Global Quality Score (GQS), the usefulness score, and a novel postoperation nutrition score (PONS).

RESULTS

One hundred fourteen patients were included in the study. The mean duration and number of views were 12.51 min and 87,558.46, respectively. The DISCERN score, JAMA score, GQS, and usefulness score of the physicians or dietician-based videos were significantly higher than those of the patient-based videos (p < 0.001). Positive correlations were found between the VPI and view ratio, as well as between the duration and number of likes. Additionally, the DISCERN score was significant correlated with the duration and number of likes. Significantly positive correlations were found between the usefulness score and duration, usefulness score and number of likes, and PONS and duration (p < 0.01).

CONCLUSIONS

Informational videos on nutrition after bariatric surgery on YouTube™ are of low quality. Although the videos uploaded by physicians and dieticians have higher quality, only a few are available. Additionally, patients prefer to watch low-quality videos.