Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2)

Formation Mechanisms, Interrelationships, and Effects of Cognitive Factors on Diet and Physical Activity During the Post-Bariatric Surgery Period: A Cross-Sectional Study Based on Compensatory Carry-Over Action Model

Background

Diet and physical activity (PA) are pivotal behaviors for managing energy balance post-bariatric surgery. Given the need for dual behavioral management, understanding the interplay of cognitive factors influencing these behaviors is crucial. This study applied the compensatory carry-over action model (CCAM) to explore the impact of cognitive factors on behaviors and their subsequent effects on subjective health outcomes.

Methods

This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. Data on diet and PA status, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life) were collected. Structural equation model (SEM) was employed to test hypotheses in CCAM and assess mediation relationships.

Results

Analysis of data from 239 patients revealed the following: (1) Among antecedent cognitive factors, only compensatory belief significantly influenced diet (P<0.001). (2) Intention and self-efficacy directly correlated with their respective behaviors, while compensatory belief affected intention, and transfer cognition impacted self-efficacy (P<0.05), aligning with CCAM hypotheses. (3) PA demonstrated significant influence only on perceived stress (P=0.004), whereas diet significantly affected all subjective health outcomes (P<0.05). (4) Mediation analysis indicated intention partially mediated the relationship between compensatory belief and diet and fully mediated the relationship between compensatory belief and PA. Self-efficacy completely mediated the relationship between transfer cognition and diet and PA.

Conclusion

Transfer cognition's carry-over effect did not directly influence behaviors among antecedent cognitions. Interventions should primarily target improving diet by mitigating compensatory belief. Moreover, diet exhibited a more pronounced impact on overall health compared to PA. Consequently, prioritizing dietary intervention over PA intervention is warranted based on the analysis of CCAM and the aim of promoting joint behaviors post-bariatric surgery.

Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I)

BACKGROUND

Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA.

METHODS

This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention.

RESULTS

Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention.

CONCLUSION

Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.

Do patients with obesity undergoing bariatric surgery modify their objectively measured physical activity? A systematic review and meta-analysis

BACKGROUND

Obesity is a chronic disease associated with adverse outcomes and its prevalence is increasing, which makes it a concern. One of the obesity treatment options is bariatric surgery, which effectively reduces calorie absorption and total body mass, but its effects on physical activity (PA) levels need to be clarified, considering the protective effect of the PA against cardiovascular disease, independently of the weight loss alone.

OBJECTIVES

To carry out a systematic review and meta-analysis of observational studies that evaluated PA in pre- and post-bariatric surgery periods through objective evaluation.

METHODS

A systematic search was carried out following the PRISMA criteria of studies with adult individuals who underwent bariatric surgery and were objectively evaluated for PA pre- and post-surgery. Studies with interventions were excluded.

RESULTS

A total of 419 records were found, and after excluding duplicates and applying the eligibility criteria, 10 studies remained. This meta-analysis found a significant increase in the steps by day (MD = 1340; 95% CI = 933.90; 1745.35, p < 0.001) and the light physical activity level (MD = 16.8 min/day; 95% CI = 2.60; 30.98, p = 0.02), but not in moderate to vigorous physical activity (MD = 0.24; 95% CI = -0.08; 1.57, p = 0.92).

CONCLUSIONS

Patients undergoing bariatric surgery increased their steps by day and light physical activity but did not increase moderate to vigorous physical activity.

Weight loss trend after bariatric surgery in a population of obese patients

BACKGROUND AND AIMS

Bariatric Surgery (BS) is a therapeutic option in patients with severe obesity whose non-surgical techniques have failed. No work has previously explored trajectories of weight loss and how long this was maintained. Aim of study is to describe effect of BS and nutritional intervention on body weight trend in patients with obesity.

METHODS

792 patients who underwent BS from 1996 to 2021 were included. The Protocol provides Laparoscopic Sleeve Gastrectomy (LSG), Vertical Gastroplasty (VBG) and Roux-en-Y Gastric Bypass (GB). %Total Weight Loss (%TWL) and %Excess Weight Loss (%EWL) were evaluated in three cohort of patients. Cumulative incidence of clinical goal after surgery was calculated at two and five years after BS.

RESULTS

At two years of follow-up, average %TWL and %EWL were 31.2% (95% CI = 29.0-33.4%) and 71% (95% CI = 65.4-76.5%) for VBG, 34.7% (95% CI = 33.8-35.6%) and 78.0% (95% CI = 75.9-89.1%) for GB and 33.8% (95% CI = 32.5-35.1%) and 68.8% (95% CI = 66.1-71.6%) for LSG. At two years from surgery the cumulative incidence of clinical goal was 70.7% (95% CI = 59.1-79.1%) for VBG, 86.4% (95% CI = 82.4-89.6%) for GB and 83.4% (95% CI = 76.0-87.1%) for LSG. At five years from surgery, average % TWL and % EWL were 22.5% (95% CI = 10.2-34.8%) and 58.2% (95% CI = 28.4-88.1%) for VBG, 31.8% (95% CI = 30.2-33.3%) and 70.8% (95% CI = 67.5-74.1%) for GB and 29.5% (95% CI = 26.2-32.8%) and 62.0% (95% CI = 53.4-70.6%) for LSG respectively. At five years after having reached clinical goal the share of people who were able to maintain their weight was 49.5% (95% CI = 30.8-79.6%) for VBG, 69.5% (95% CI = 58.3-82.8%) for GB and 55.9% (95% CI = 42.1-74.3%) for LSG. The median time of clinical goal maintaining was 4.8 years for VBG (95% CI lower limit = 4.1), 6.6 years for GB (95% CI lower limit = 6.2) and 5.3 years for LSG (95% CI lower limit = 4.8).

CONCLUSIONS

Our work confirm effectiveness of BS in patients with obesity and show that who do not reach clinical goal within 2 years, hardly will reach it later and suggest necessity for a medium and long-term follow-up to prevent weight regain.

Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline

Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.

Long-term Engagement in Physical Activity Among Bariatric Surgery Patients: Associations with Treatment Outcomes at 5-Year Follow-up

PURPOSE

Physical activity studies involving bariatric surgery patients tend to be short-term or cross-sectional investigations. Longer-term studies are limited and typically consist of relatively brief objective measurement periods used to generalize activity patterns. Very little research combines objective measurements with structured interviews to determine both the patterns and related factors of long-term physical activity among patients undergoing bariatric surgery.

MATERIALS AND METHODS

Previous volunteers in a perioperative physical activity study were invited to participate in a mixed methods study investigating physical activity among bariatric patients over a 5-year postoperative period. Fifty-one patients (M_age = 45.4 years; 76.5% female, 90.2% White; 86.3% Roux-en-Y procedure) provided interview, survey, accelerometer, and anthropometric data.

RESULTS

Participants were divided into four exercise quartiles, based on self-report of their length of regular exercise involvement from 1 year before through 5 years after surgery. Those reporting the most periods of regular exercise took the most measured steps per day, had greater moderate-to-vigorous physical activity and more bout-related activity, experienced the largest decrease in BMI, and reported the most adherence to nutritional guidelines. Participants reporting the most and least physical activity found the measurement periods to be most similar to their normal activity patterns. While physical activity increased significantly after surgery, measured physical activity did not reach recommended levels for steps or exercise bout minutes.

CONCLUSIONS

Measured physical activity and self-reported physical activity show congruent trends among patients undergoing bariatric surgery. More research is needed to determine optimal long-term monitoring and promotion of physical activity among patients.

Associations Between Physical Activity and Changes in Depressive Symptoms and Health-related Quality of Life Across 7 Years After Roux-en-Y Gastric Bypass Surgery: A Multicenter Prospective Cohort Study

OBJECTIVE

To examine associations of objectively-measured free-living physical activity (PA) with changes in depressive symptoms and mental and physical health-related quality of life (HRQoL) over 7 years after Roux-en-Y gastric bypass surgery (RYGB).

BACKGROUND

The contributions of PA to improvements in mental and physical health after RYGB, independent of weight loss, are unclear.

METHODS

Adults undergoing RYGB in a US multi-center cohort study wore an activity monitor and completed the Beck depression inventory (BDI) and 36-Item Short Form Health Survey (SF-36) annually ≤7 years (N = 646; 78% female, median age 47 years, median body mass index 46kg/m 2 ). Linear mixed models estimated associations of quartiles of steps, sedentary behavior (SB), and moderate-to-vigorous intensity physical activity (MVPA), respectively, with pre-to-post-surgery changes in the BDI and SF-36 mental component summary and physical component summary scores, respectively, over 1-7 years post-surgery, with adjustment for sex, age, race, pre-surgerybody mass index, the respective pre-surgery score, treatment for depression (time-varying) and pre-to-post-surgery weight change (time-varying).

RESULTS

There were dose-response associations between steps, SB (inverse) and MVPA quartiles, respectively, with improvements in each score. Across follow-up, mean improvements in the BDI, Mental Component Summary and physical component summary scores, were 1.9 [95% confidence interval (CI), 1.0-2.8], 3.1 (95% CI, 1.5-4.7), and 4.0 (95% CI, 2.7-5.4) points higher, respectively, in the highest versus lowest steps quartile.

CONCLUSION

Among adults who underwent RYGB, multiple objective PA measures were associated with decreases in depressive symptoms and improvements in mental and physical HRQoL throughout 7 years, independent of weight loss, indicating PA is a modifiable behavior to augment outcomes.

A Positive Emotion-Focused Intervention to Increase Physical Activity After Bariatric Surgery: Protocol for a Pilot Randomized Controlled Trial

Background

Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement.

Objective

The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting.

Methods

The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology–motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures.

Results

This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention.

Conclusions

Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial.

Trial Registration

ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032

International Registered Report Identifier (IRRID)

PRR1-10.2196/39856

Computational approaches to predicting treatment response to obesity using neuroimaging

Obesity is a worldwide disease associated with multiple severe adverse consequences and comorbid conditions. While an increased body weight is the defining feature in obesity, etiologies, clinical phenotypes and treatment responses vary between patients. These variations can be observed within individual treatment options which comprise lifestyle interventions, pharmacological treatment, and bariatric surgery. Bariatric surgery can be regarded as the most effective treatment method. However, long-term weight regain is comparably frequent even for this treatment and its application is not without risk. A prognostic tool that would help predict the effectivity of the individual treatment methods in the long term would be essential in a personalized medicine approach. In line with this objective, an increasing number of studies have combined neuroimaging and computational modeling to predict treatment outcome in obesity. In our review, we begin by outlining the central nervous mechanisms measured with neuroimaging in these studies. The mechanisms are primarily related to reward-processing and include "incentive salience" and psychobehavioral control. We then present the diverse neuroimaging methods and computational prediction techniques applied. The studies included in this review provide consistent support for the importance of incentive salience and psychobehavioral control for treatment outcome in obesity. Nevertheless, further studies comprising larger sample sizes and rigorous validation processes are necessary to answer the question of whether or not the approach is sufficiently accurate for clinical real-world application.

Effects of pre-surgical aerobic dance-based exercise on lower extremity in people with morbid obesity awaiting bariatric surgery: Randomized controlled study

To investigate what are the effects of pre-surgical aerobic dance-based exercise programme (PSADBE) and physical activity counselling (PAC) programme on lower extremity functions after surgery in people with morbid obesity awaiting bariatric surgery (PMOABS). This study was a single-blind, randomized controlled study. Groups were divided into Group I (PSADBE and PAC) and Group II (PAC). Both groups received PAC, Group I completed the PSADBE programme accompanied by music for 60 min/2 days/8 weeks. Thirty-four PMOABS were included in the study. The 6-Minute Walking Test, as primary outcomes, and The Stair Climbing Up-Down Test for evaluating functional capacity, Biodex Isokinetic Test and Exercise System® for evaluating muscle strength were used. Besides, muscle endurance, physical activity (PA) level, fatigue and quality of life (QoL) were also assessed. All measurements were repeated three times; pre-treatment, post-treatment and the fifth-month post-surgery. After 8 weeks, significant changes were found in functional capacity, muscle strength and endurance, PA level, fatigue and QoL in both groups (p < .05). Comparing the groups, the changes in functional capacity, muscle strength and endurance, PA and fatigue scores after treatment and the fifth-month post-surgery were statistically superior in Group I (p < .05). Adding an 8-week PSADBE programme to PAC is an effective treatment option for improving postoperative functional capacity, muscle strength and endurance, PA level and fatigue in PMOABS.

Preoperative Physical Activity Level and Exercise Prescription in Adults With Obesity: The Effect on Post-Bariatric Surgery Outcomes

This systematic review summarizes current evidence on the relation between preoperative physical activity (PA) levels with bariatric surgery (BS) outcomes and on the beneficial role of preoperative exercise/PA program among BS candidates. This systematic review suggests that candidate patients accumulating the preoperative PA level improved several BS outcomes. These improvements were reported mainly for anthropometric and cardiometabolic parameters and physical function. Observed improvements manifested during a distinct period of time in response to a wide variety of exercise programs. Evidence on the preoperative PA level as well as on preoperative exercise implementation on BS outcomes is advocated despite the small number of participants and lack of control. Thus, further studies are required to explore the most effective and suitable form of exercise prescription prior to BS while considering physical and psychological limitations of obese patients.

The Need for Objective Physical Activity Measurements in Routine Bariatric Care

Purpose

This study aims to (1) quantify physical behavior through self-reports and sensor-based measures, (2) examine the correlation between self-reported and sensor-based physical activity (PA) and (3) assess whether bariatric patients adhere to PA guidelines.

Methods

A Fitbit accelerometer was used to collect minute-to-minute step count and heart rate data for 14 consecutive days. Total physical activity levels (PAL), moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) were used to quantify physical behavior. Self-reported PA was assessed with the International Physical Activity Questionnaire (IPAQ). To analyze the association between sensor-based and self-reported PA, Spearman’s correlation was used. A minimum of 150 MVPA minutes per week was considered as compliance with the PA guidelines.

Results

Fitbit data of 37 pre- and 18 post-surgery patients was analyzed. Participants averaged 7403 ± 3243 steps/day and spent most of their time sedentary (832 min, IQR: 749 – 879), especially in prolonged periods of ≥ 30 min (525, IQR: 419 – 641). Median MVPA time was 5.6 min/day (IQR: 1.7 – 10.6). Correlations between self-reported and sensor-based MVPA and SB were respectively 0.072 and 0.455. Only 17.1% was objectively adherent to MVPA guidelines ≥ 150 min/week, while 94.3% met the guidelines in case of self-reports.

Conclusion

PA quantification confirmed that bariatric patients are highly sedentary and rarely engage in MVPA, despite a relatively high daily step count. Moreover, bariatric patients are not able to assess MVPA and moderately their SB by self-reports. Our results indicate the need for sensor-based PA monitoring in routine bariatric care.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11695-022-06165-y.

Assessment of Physical Activity and Healthy Eating Behaviors Among US Adults Receiving Bariatric Surgery

IMPORTANCE

Bariatric surgery effectively treats severe obesity and metabolic diseases. However, individual outcomes vary depending on sustainable lifestyle change. Little is known about lifestyle patterns after bariatric surgery among the US population.

OBJECTIVE

To compare the level of physical activity and eating behavior among postbariatric surgery patients, individuals eligible for surgery, and those with normal weight.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study using nationally representative survey data from National Health and Nutrition Examination Survey 2015-2018. Respondents included for analysis were age 18 years or older, and categorized by individuals with normal weight, individuals who received bariatric surgery, and individuals clinically eligible for bariatric surgery. Analyses were performed from February to October 2021.

MAIN OUTCOMES AND MEASURES

Self-reported measures were used to assess physical activity (moderate-to-vigorous physical activity [MVPA], sedentary activity, and whether PA guidelines were met) and eating behaviors (total energy intake and Healthy Eating Index [HEI]-2015 diet quality scores).

RESULTS

Of 4659 study participants (mean [SD] age, 46.1 [18.6] years; 2638 [weighted percentage, 58.8%] women; 1114 [weighted percentage, 12.7%] Black, 1570 [weighted percentage, 68.6%] White), 132 (3.7%) reported that they had undergone any bariatric surgery. Median (IQR) time since surgery was 7 (3-10) years. After propensity-score weighting, individuals who underwent bariatric surgery reported more time spent in MVPA than those eligible for surgery (147.9 min/wk vs 97.4 min/wk). Among respondents with normal weight, 45.6% (95% CI, 40.8% to 52.4%) reported meeting PA guidelines, almost 2 times higher than those in the bariatric surgery (23.1%; 95% CI, 13.8% to 32.4%) or in the surgery-eligible group (20.3%; 95% CI, 15.6% to 25.1%). Propensity-score weighted overall HEI was higher for individuals with normal weight (54.4; 95% CI, 53.0 to 55.9) than those who underwent bariatric surgery (50.0; 95% CI, 47.2 to 52.9) or were eligible for the surgery (48.0; 95% CI, 46.0 to 50.0). Across all HEI components, mean scores were similar between the bariatric surgery and surgery-eligible groups. Total energy intake was the lowest among those who underwent bariatric surgery (1746 kcal/d; 95% CI, 1554 to 1937 kcal/d), followed by those with normal weight (1943 kcal/d; 95% CI, 1873 to 2013 kcal/d) and those eligible for bariatric surgery (2040 kcal/d; 1953 to 2128 kcal/d).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, individuals who underwent bariatric surgery had beneficial lifestyle patterns compared with those eligible for surgery; however, these improvements seemed suboptimal based on the current guidelines. Efforts are needed to incorporate benefits of physical activity and a healthy, balanced diet in postbariatric care.

A systematic review of interventions to increase physical activity and reduce sedentary behaviour following bariatric surgery

Background

Objectives

Eligibility

Study appraisal and synthesis methods

Results

Limitations

Conclusion and implications of key findings

Systematic review registration number

Acceptability and feasibility of the TELEhealth BARIatric behavioural intervention to increase physical ACTIVity (TELE-BariACTIV): A single-case experimental study protocol (Preprint)

Background

Regular physical activity (PA) is recommended to optimize weight and health outcomes in patients who have undergone metabolic and bariatric surgery (MBS). However, >70% of patients have low PA levels before MBS that persist after MBS. Although behavioral interventions delivered face-to-face have shown promise for increasing PA among patients who have undergone MBS, many may experience barriers, preventing enrollment into and adherence to such interventions. Delivering PA behavior change interventions via telehealth to patients who have undergone MBS may be an effective strategy to increase accessibility and reach, as well as adherence.

Objective

This paper reports the protocol for a study that aims to assess the feasibility and acceptability of the protocol or methods and the Telehealth Bariatric Behavioral Intervention (TELE-BariACTIV). The intervention is designed to increase moderate-to-vigorous intensity PA (MVPA) in patients awaiting bariatric surgery and is guided by a multitheory approach and a patient perspective. Another objective is to estimate the effect of the TELE-BariACTIV intervention on presurgical MVPA to determine the appropriate sample size for a multicenter trial.

Methods

This study is a multicenter trial using a repeated (ABAB’A) single-case experimental design. The A phases are observational phases without intervention (A1=pre-MBS phase; A2=length personalized according to the MBS date; A3=7 months post-MBS phase). The B phases are interventional phases with PA counseling (B1=6 weekly pre-MBS sessions; B2=3 monthly sessions starting 3 months after MBS). The target sample size is set to 12. Participants are inactive adults awaiting sleeve gastrectomy who have access to a computer with internet and an interface with a camera. The participants are randomly allocated to a 1- or 2-week baseline period (A1). Protocol and intervention feasibility and acceptability (primary outcomes) will be assessed by recording missing data, refusal, recruitment, retention, attendance, and attrition rates, as well as via web-based acceptability questionnaires and semistructured interviews. Data collected via accelerometry (7-14 days) on 8 occasions and via questionnaires on 10 occasions will be analyzed to estimate the effect of the intervention on MVPA. Generalization measures assessing the quality of life, anxiety and depressive symptoms, and theory-based constructs (ie, motivational regulations for PA, self-efficacy to overcome barriers to PA, basic psychological needs satisfaction and frustration, PA enjoyment, and social support for PA; secondary outcomes for a future large-scale trial) will be completed via web-based questionnaires on 6-10 occasions. The institutional review board provided ethics approval for the study in June 2021.

Results

Recruitment began in September 2021, and all the participants were enrolled (n=12). Data collection is expected to end in fall 2023, depending on the MBS date of the recruited participants.

Conclusions

The TELE-BariACTIV intervention has the potential for implementation across multiple settings owing to its collaborative construction that can be offered remotely.

International Registered Report Identifier (IRRID)

DERR1-10.2196/39633

Designing Digital Health Technology to Support Patients Before and After Bariatric Surgery: Qualitative Study Exploring Patient Desires, Suggestions, and Reflections to Support Lifestyle Behavior Change

Background

A patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery.

Objective

This study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey.

Methods

Patients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority.

Results

A total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study.

Conclusions

Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies.

Can exercise promote additional benefits on body composition in patients with obesity after bariatric surgery? A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Bariatric surgery is the most effective treatment for patients with severe obesity, but success rates vary substantially. Exercise is recommended after bariatric surgery to reduce weight regain but the effectiveness remains undetermined on weight loss due to conflicting results. It is also unclear what should be the optimal exercise prescription for these patients. A systematic review and meta-analysis of randomized controlled trials on the effects of exercise on body weight (BW), anthropometric measures, and body composition after bariatric surgery was performed.

METHODS

PubMed/MEDLINE®, EBSCO®, Web of Science® and Scopus® databases were searched to identify studies evaluating exercise effectiveness.

RESULTS

The analysis comprised 10 studies (n = 487 participants). Exercise favored BW (-2.51kg; p = 0.02), waist circumference (-4.14cm; p = 0.04) and body mass index (-0.84kg·m-2; p = 0.02) reduction but no improvements in body composition. Combined exercise interventions were the most effective in reducing BW (-5.50kg; p < 0.01) and body mass index (-1.86kg·m-2; p < 0.01). Interventions starting >6-months after bariatric surgery were more successful in reducing BW (-5.02kg; p < 0.01) and body mass index (-1.62kg·m-2; p < 0.01).

CONCLUSION

Exercise, combined exercise regimens and interventions starting >6-months after bariatric surgery were effective in promoting BW, waist circumference and body mass index reduction. Exercise following bariatric surgery does not seem to favor body composition improvements.

Patients Undergoing Bariatric Surgery: a Special Risk Group for Lifestyle, Emotional and Behavioral Adaptations During the COVID-19 Lockdown. Lessons from the First Wave

Objectives

To determine how the COVID-19 lockdown influenced the lifestyle, eating behavior, use of substances, mental health, and weight in patients who had undergone bariatric surgery (BS) and explore the self-perception of one’s own health and fears related to COVID-19.

Methods

We performed a cross-sectional exploratory study in obesity patients who had undergone BS surgery > 1 year previously in a university hospital. Assessment was performed 40 days after initiating lockdown and included 2 periods: from April 24 until May 8 and during the initial de-escalation period: from May 9 until 22, 2020. A structured telephone interview and an online survey were administered.

Results

One hundred eighty-eight patients were interviewed; 156 also responded to the online survey (77% females, mean age 53.46 ± 10.48 years, mean follow-up 5.71 ± 4.30 years). Dietary habits were affected in 72% of the participants, with 15% reporting better diet planning; 83.5% reported having more sedentary behaviors; 27% and 36% showed depression and anxiety, respectively; and 45% of participants reported bad sleep quality. In relation to changes in the use of any substance, the use increased in the majority of patients who were previously users. Self-perception of one’s own health and fears related to COVID-19 were only moderate. Finally, emotional eating and time since BS were statistically significant risk factors for predicting weight gain.

Conclusions

Lockdown during COVID-19 pandemic negatively influenced the lifestyle, mental health, substance use, and weight in BS patients. These alterations were somewhat similar to those observed in the general population but more severe and with important clinical implications.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s11695-021-05792-1.

The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial

BACKGROUND

The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG).

METHODS

Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA).

RESULTS

Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m²) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (-6.8 ± 3.7% vs. -6.0 ± 3.6%; P = 0.646) and of the femoral neck (-7.1 ± 5.8% vs. -7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003).

CONCLUSIONS

SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline.

One-year impact of bariatric surgery on left ventricular mechanics: results from the prospective FatWest study

Aims

Patients with severe obesity are predisposed to left ventricular (LV) hypertrophy, increased myocardial oxygen demand, and impaired myocardial mechanics. Bariatric surgery leads to rapid weight loss and improves cardiovascular risk profile. The present prospective study assesses whether LV wall mechanics improve 1 year after bariatric surgery.

Methods and results

Ninety-four severely obese patients [43 ± 10 years, 71% women, body mass index (BMI) 41.8 ± 4.9 kg/m², 57% with hypertension] underwent echocardiography before, 6 months and 1 year after gastric bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We assessed LV mechanics by midwall shortening (MWS) and global longitudinal strain (GLS), LV power/mass as 0.222 × cardiac output × mean blood pressure (BP)/LV mass, and myocardial oxygen demand as the LV mass-wall stress-heart rate product. Surgery induced a significant reduction in BMI, heart rate, and BP (P < 0.001). Prevalence of LV hypertrophy fell from 35% to 19% 1 year after surgery (P < 0.001). The absolute value of GLS improved by—4.6% (i.e. 29% increase in GLS) while LV ejection fraction, MWS, and LV power/mass remained unchanged. In multivariate regression analyses, 1 year improvement in GLS was predicted by lower preoperative GLS, larger mean BP, and BMI reduction (all P < 0.05). Low 1-year MWS was associated with female sex, preoperative hypertension, and higher 1-year LV relative wall thickness and myocardial oxygen demand (all P < 0.001).

Conclusion

In severely obese patients, LV longitudinal function is largely recovered one year after bariatric surgery due to reduced afterload. LV midwall mechanics does not improve, particularly in women and patients with persistent LV geometric abnormalities.

ClinicalTrials.gov identifier

NCT01533142, 15 February 2012.

Effects of a 12-Week Transtheoretical Model-Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial

PURPOSE

This study aims to investigate the effectiveness of the transtheoretical model (TTM)-based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS).

MATERIALS AND METHODS

We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle.

RESULTS

Retention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention.

CONCLUSION

The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients' exercise adherence and physical function immediately after BS.

TRIAL REGISTRATION

This study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn , registry number: ChiCTR2000039319).

Factors Related to Weight Loss Maintenance in the Medium-Long Term after Bariatric Surgery: A Review

Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015–2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness–complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut–brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions.

Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery

Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.

The transtheoretical model (TTM) to gain insight into young women's long-term physical activity after bariatric surgery: a qualitative study

BACKGROUND

Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC).

METHODS

Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints.

CONCLUSIONS

This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.

Physical Activity Patterns Among Individuals Before and Soon After Bariatric Surgery

PURPOSE

Post-operative changes in moderate-to-vigorous physical activity (MVPA) may contribute to improved weight loss and long-term weight maintenance of individuals after bariatric surgery. Patients experience minimal changes in MVPA > 6 months after surgery, but no studies have investigated early changes in physical activity after surgery. This study aims to assess MVPA changes during the rapid weight loss phase through self-reporting and objective measures.

METHODS

Physical activity patterns were assessed as minutes per day spent doing MVPA. A walking cadence of ≥ 100 steps per minute defined MVPA. Individuals completing gastric bypass (N = 7) and sleeve gastrectomy (N = 17) procedures (21 females, 3 males, age 42.2 ± 12.6 years, body mass 121.8 ± 24.8 kg, BMI 44.0 ± 6.5) completed office visits at 12 ± 6 days pre- and 35 ± 10 days post-operative. Each wore an ActiGraph GT3X tri-axial accelerometer at the hip for 7 days before and again for 7 days 30.6 ± 10 days after surgery. Assessments also included a subjective question about their anticipated and perceived post-operative MVPA (scale of - 3 to 3 with 3 being much more physically active and - 3 being much less).

RESULTS

Participants did not change their minutes per day of MVPA significantly (pre-operative 1.5 ± 2.1; post-operative 2.6 ± 5.6, NS). Participants predicted their post-operative physical activity level would increase (2.8 ± 0.4). The self-reported activity level on the same scale after surgery was significantly less than predicted (1.9 ± 1.0, p < 0.05) but still suggested that participants thought they were more physically active.

CONCLUSION

Consistent with reports > 6 months after surgery, MVPA did not increase in the early post-operative period, despite patient expectations. The early post-operative period may be a time for behavioral intervention.

Patterns of Change in Device-Based Physical Activity and Sedentary Time Following Bariatric Surgery: a Longitudinal Observational Study

PURPOSE

The 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.

RESULTS

Thirty 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.

Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review

Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, mechanisms, clinical significance, preoperative predictors, and preventive and treatment approaches including behavioral, pharmacological, and surgical management strategies of WR and IWL. Many definitions exist for WR, less so for IWL, resulting in inconsistencies in the reported prevalence of these two conditions. Mechanisms and preoperative predictors contributing to WR are complex and multifactorial. A range of the current knowledge gaps are identified and questions that need to be addressed are outlined. Therefore, there is an urgent need to address these knowledge gaps for a better evidence base that would guide patient counseling, selection, and lead to improved outcomes.

Approach to the Patient: Management of the Post-Bariatric Surgery Patient With Weight Regain

CONTEXT

Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because there are no current guidelines for timely diagnosis and assessment of the severity of this condition.

OBJECTIVE

We present a practical approach for the early recognition of WR, based on 11-year follow-up data from our multiethnic bariatric surgery patient population.

METHODS

We classify WR according to the rate of increase in weight relative to nadir weight, normalized per 30-day interval. We also review pertinent literature about the etiologic factors contributing to WR after bariatric surgery.

RESULTS

According to our algorithm, mild, moderate, and rapid WR are defined as weight increases of 0.2% to <0.5%, 0.5% to 1.0%, and more than 1.0% of nadir weight per 30 days, respectively. Treatment options, including dietary counseling, use of antiobesity medication, and consideration of surgical revision, are described. A case is presented to illustrate the utility of timely identification of WR and the importance of collaboration between bariatric surgeons, obesity medicine specialists, and dietitians.

CONCLUSION

Our approach emphasizes the importance of regular long-term follow-up for all bariatric surgery patients.

Digital technology to support lifestyle and health behaviour changes in surgical patients: systematic review

BACKGROUND

Digital technologies (such as smartphone applications, activity trackers, and e-learning platforms) have supported patients with long-term conditions to change their lifestyle health behaviours. The aim of this study was to examine the effectiveness of digital technologies in supporting patients undergoing elective surgery to change their health behaviours.

METHODS

A systematic review was conducted of articles reporting a digital intervention supporting behaviour change in adult patients who underwent elective bariatric, oncological or orthopaedic surgery. MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Scopus were searched from inception to March 2019 for quantitative intervention studies with a specific focus on physical activity, dietary intake, and weight loss in patients before and after surgery (PROSPERO: CRD42019127972). The Joanna Briggs Institute critical appraisal checklist was used to assess study quality.

RESULTS

Of 3021 citations screened, 17 studies were included comprising 4923 surgical patients; these included experimental (pre-post design, feasibility studies, and RCTs) and observational studies. Three factors were identified as effective for supporting health behaviour change in elective surgical populations: digital technology delivery, implementation, and theoretical underpinning. Six of eight studies that referred to behaviour change theories observed significant improvements in health behaviour relating to reduced weight regain, and improved lifestyle choices for physical activity and diet. Meta-analysis was not possible because of heterogeneous outcome measures.

CONCLUSION

Digital technologies may effectively support behavioural change in patients undergoing elective surgery.

Physical activity, musculoskeletal disorders, sleep, depression, and quality of life before and after bariatric surgery

Objectives

This study aims to evaluate physical activity, sleep, depression, quality of life, and musculoskeletal problems pre- and postoperatively in morbidly obese patients who underwent bariatric surgery and analyze the factors that are strongly associated with physical activity.

Patients and methods

This prospective study conducted between January 2016 and May 2017 included 27 patients (4 males, 23 females; mean age 37.1±10.4 years; range, 18 to 52 years) who underwent bariatric surgery and 20 healthy controls (3 males, 17 females; mean age 32.0±5.7 years; range, 26 to 46 years). All patients were evaluated by using the short form of International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and short form 36 (SF-36). Patients were evaluated for regional musculoskeletal pain including back, waist, hip, knee, ankle, heel, and metatarsal pain using Visual Analog Scale. Presence of pes planus was recorded. The examinations and tests performed in the preoperative period were repeated at postoperative six months and the results were compared with the control group.

Results

The body mass index was 46.2±5.2 kg/m² preoperatively and 33.8±5.0 kg/m² postoperatively (p<0.001). The total IPAQ was 345.4±172.8 metabolic equivalent (MET)-min/week preoperatively and 672.8±227.8 MET-min/week postoperatively (p<0.001). Pittsburgh Sleep Quality Index was 7.6±3.0 preoperatively and 3.5±2.4 postoperatively, whereas BDI was 20.2±8.5 preoperatively and 9.9±7.4 postoperatively. The results were statistically significant (p<0.001, p<0.001, respectively). A statistically significant improvement was found in all subsections of the SF-36. Pre- and postoperative results of the 27 patients were compared with those of the control group.

Conclusion

Obesity is significantly associated with joint pain, physical function impairment, depression, and sleep disorders. Significant weight loss after bariatric surgery improves functional recovery and patient's psychology in a short time.

The use of an activity tracker to objectively measure inpatient activity after bariatric surgery

BACKGROUND

Early postoperative ambulation reduces length of stay and prevents postoperative complications after bariatric surgery. Rarely is postoperative inpatient activity objectively measured despite readily available commercial activity trackers.

OBJECTIVES

Evaluate the impact of using activity trackers to record number of inpatient steps taken after bariatric surgery and assess how patient characteristics may affect the number of steps recorded.

SETTING

University Hospital, United States.

METHODS

Using an activity tracker, the number of steps taken during the postoperative hospital stay was recorded for 235 patients undergoing either laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy. Patients were randomly assigned to either being informed about the devices' ability to record the number of steps taken or blinded to the purpose of the devices. Descriptive statistics were used to summarize study sample, a t test was used to compare number of steps recorded between groups, and a multivariate regression model was used to examine the effect of age, sex, preoperative body mass index (BMI), types of surgery, and length of stay on number of steps recorded.

RESULTS

One hundred twenty-five patients (52.8%) were randomized to the blinded group while 111 (47.2%) were informed that the device would record the number of steps taken. There were no differences in the number of steps recorded between the 2 groups. Patients with prolonged length of stay recorded lower numbers of steps taken on postoperative day 0. Increasing age was seen to reduce the number of steps recorded on postoperative day number 1. There were no significant differences in number of steps recorded based on sex, preoperative BMI, or surgery type.

CONCLUSION

The present study found that knowledge of an activity tracker being used did not affect the patient's activity level as measured by steps recorded. Increasing age correlated to reduced number of steps recorded on postoperative day 1 after bariatric surgery.

Psychosocial factors associated with physical activity in patients who have undergone bariatric surgery

BACKGROUND

Identifying psychosocial variables associated with physical activity may lead to the development of interventions that better address the challenges to participating in physical activity experienced by postbariatric surgery patients.

OBJECTIVE

To examine associations between select psychosocial variables and physical activity in patients who had undergone bariatric surgery within the past 2 years.

SETTINGS

Bariatric surgery candidates were recruited from the Greater Pittsburgh region.

METHODS

Eighty-three patients who had undergone bariatric surgery self-reported current physical activity and select psychosocial constructs. In addition, participants provided retrospective information on physical activity and psychosocial constructs before surgery.

RESULTS

Patients increased physical activity from baseline (median = 156.00 [25th, 75th percentiles: 53.00, 600.00] kcal/week) to post surgery (median = 976.00 [25th, 75th percentiles: 344.00, 1832.00] kcal/week) (P < .001). A number of pre- to postsurgery changes in psychosocial variables were associated with change in physical activity; however, only change in fitness orientation (P = .001), change in social support from friends (P = .005), and change in self-reported weight (P = .012) emerged as predictors of change in physical activity from pre- to postsurgery. Several postsurgery psychosocial factors were also significantly associated with postsurgery physical activity, but only postsurgery fitness orientation (P < .001), social support from co-workers (P = .002), and physical function (P = .023) emerged as predictive of the amount of postsurgical PA.

CONCLUSIONS

Pre- and postbariatric surgery interventions aimed at increasing physical activity participation may need to target important constructs that include the encouragement of social support and strategies to enhance the effort individuals put forward to engage in physical activity, as well as a focus on enhancing physical function and awareness of weight status.

Physical Activity, Sedentary Behavior, and Sleep Before and After Bariatric Surgery and Associations with Weight Loss Outcome

PURPOSE

Physical activity, sedentary behavior, and sleep have been linked to the likelihood of maintaining healthy body weight. This study aimed to determine objectively measured movement behaviors before and up to 18 months after bariatric surgery and to investigate whether preoperative levels of these movement behaviors and potential changes of these behaviors were associated with changes in body weight and boy composition.

MATERIALS AND METHODS

Accelerometer determined total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, and sleep (for six consecutive days and seven nights) were assessed approximately 3 months and 1-2 weeks before surgery as well as 6 and 18 months after surgery (n = 41). Body weight and body composition (waist circumference, fat mass, and fat-free mass) were determined at each visit.

RESULTS

Mean weight loss 18 months after surgery was 42.0 ± 1.9 kg. There were no pre- to postoperative improvements in physical activity, sedentary behavior, or sleep. However, greater increases in levels of total physical activity and time spent in MVPA from 3 months before to 6 months after surgery predicted better weight loss and larger reductions in fat mass and waist circumference. Unexpectedly, a lower level of physical activity and a higher level of sedentary behavior before surgery predicted better weight loss outcomes.

CONCLUSION

Objectively measured movement behaviors do not improve after bariatric surgery despite a substantial weight loss. However, increasing total physical activity and/or more time spent in MVPA after surgery may increase weight loss and lead to favorable changes in body composition.

Body Composition, Serum Sclerostin and Physical Function After Bariatric Surgery: Performance of Dual-Energy X-ray Absorptiometry and Multifrequency Bioelectrical Impedance Analysis

INTRODUCTION

The aim of this study was to determine the effects of bariatric surgery and weight loss on body composition, serum sclerostin and physical performance.

METHODS

Seventy-three consecutive patients (36 non-surgical controls and 37 who underwent bariatric surgery) were evaluated by means of laboratory tests, multifrequency bioelectrical impedance analysis (BIA), total-body dual-energy X-ray absorptiometry (DXA), gait speed and handgrip strength.

RESULTS

The differences between non-surgical and surgical patients were as follows: body mass index (BMI) 42.9 ± 5.7 vs 34.8 ± 6.0 kg/m² (p < 0.001); handgrip strength 31.3 ± 7.0 vs 27.1 ± 9.3 kg (p < 0.033); skeletal muscle mass index (SMI)-BIA 12.3 ± 1.2 vs 10.6 ± 1.2 kg/m²; fat-free mass index (FFMI)-BIA 21.9 ± 1.9 vs 18.9 ± 2.1 k/m² (p < 0.001 for all comparisons); Baumgartner-DXA 10.8 ± 1.5 vs 9.0 ± 1.4 kg/m² (p < 0.001); fat mass BIA 55.4 ± 12.5 vs 36.8 ± 9.6; fat mass DXA 54.3 ± 12.38 vs 35.1 ± 7.5 kg (p < 0.001 for both comparisons) and serum sclerostin 30.9 ± 31.9 vs 26.9 ± 21.1 pmol/L (p = 0.516). Positive correlation was found between BIA and DXA: SMI × Baumgartner (r = 0.842; p < 0.001) and fat mass (r = 0.970; p < 0.001). Gait speed was relatively preserved in sleeve gastrectomy (SG) compared with Roux-en-Y gastric bypass (RYGB) (1.2 ± 0.3 and 0.9 ± 0.1 m/s; p = 0.038).

CONCLUSION

Bariatric surgery leads to lower values of lean and fat mass and of handgrip strength with no differences in serum sclerostin concentrations. There was a positive correlation between BIA and DXA for fat and lean mass parameters. Physical performance was better after SG than in RYGB.

Approach bias modification training to increase physical activity: A pilot randomized controlled trial in healthy volunteers

Regular physical activity is associated with better physical and mental health outcomes as well as higher quality of life. This pilot randomized controlled trial examined whether approach bias modification, an economical and easily accessible computerized cognitive training, could increase objectively and subjectively measured physical activity in individuals aiming for more physical activity. Forty healthy volunteers of normal weight were randomly allocated to six sessions of approach bias modification or no treatment. The approach bias modification adopted an implicit learning paradigm that trained participants to show approach behavior in response to visual cues of physical activity. Approach bias modification did not increase objectively and subjectively measured physical activity.

Emotional Impact on Health Behavior Adherence After Bariatric Surgery: What About Positive Psychological Constructs?

INTRODUCTION

Health behaviors are critical for weight loss maintenance after weight loss surgery (WLS), and emotional factors often play a role in adherence. Positive psychological constructs (e.g., optimism, positive affect) have predicted health outcomes in other medical populations but have been infrequently examined in post-WLS patients.

METHODS

This study measured optimism and positive affect in post-WLS patients recruited from online support groups. A hierarchical linear regression analysis tested their association with health behavior adherence, physical activity, and weight loss, controlling for demographic and weight-related covariates. It also tested depression and anxiety symptoms as moderators.

RESULTS

In 95 participants, positive affect was associated with better adherence (b = 0.41, p < 0.01) and greater moderate-to-vigorous physical activity (b = 0.20, p < 0.001) controlling for demographic/weight-related covariates, and independently with more weight loss (b = 0.24, p < 0.05). Optimism was independently associated with better adherence (b = 0.32, p < 0.05) and with greater moderate-to-vigorous physical activity controlling for demographic/weight-related covariates (b = 0.16, p < 0.05). These associations no longer reached statistical significance controlling for depression and anxiety symptoms. Anxiety symptoms moderated the relationship between positive affect and adherence (b = 0.06, p < 0.01), and depression (b = 0.15, p < 0.01) and anxiety (b = 0.02, p < 0.05) symptoms each moderated the relationship between optimism and walking, such that there was a stronger relationship between positive psychological constructs and health behaviors for those with higher anxiety or depression scores.

CONCLUSIONS

Positive psychological states should be included when assessing emotional factors related to health behaviors in post-WLS patients. Interventions targeting health behaviors may be improved with inclusion of skills to boost positive psychological states.

Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance-mandated preoperative psychosocial evaluation is also discussed.

Tracking physical activity using smart phone apps: assessing the ability of a current app and systematically collecting patient recommendations for future development

Background

Within the United Kingdom’s National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients’ physical activity and other health-related variables could provide healthworkers with a more ‘ecologically valid’ picture of these patients’ behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively.

Methods

Participants with a BMI > 35 kg/m² being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The ‘Moves’ app automatically tracked participants’ physical activity and the ‘WLCompanion’ app prompted participants to set goals and input other health-related information. Then, to learn about participants’ facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics.

Results

Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18–65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants’ activity levels pre- and post-surgery did not differ. In addition, 54 participants’ survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain.

Conclusions

The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps.

Trial registration

ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.

Prolonged sedentary time adversely relates to physical activity and obesity among preoperative bariatric surgery patients

BACKGROUND

Bariatric surgery patients spend much of their waking time sedentary. Yet, little is known about their patterns of accumulation of sedentary time (ST) and whether more prolonged ST is associated with lower physical activity (PA), independent of total ST, or obesity severity.

OBJECTIVES

To characterize variability in prolonged ST among bariatric patients preoperatively and assess the importance of a "prolonger" pattern in relation to PA and weight status.

SETTING

Two university hospital clinics, United States.

METHODS

Adult patients (n = 76) wore a wrist-based accelerometer for 10 days preoperatively. ST and time spent in light and moderate-to-vigorous PA was determined using validated thresholds. Percent of total ST accumulated in ≥30-consecutive ST minute bouts was calculated, and participants were trichotomized into low, medium, and high "prolongers" based on this value. The associations of prolonged ST with PA and obesity were examined.

RESULTS

On average, participants accumulated a mean ± standard deviation of 10.5 ± 2.1 hours of ST per day, 30% of which was prolonged (prolonger groups: low = 7.2%-24.5%, medium = 24.5%-33.0%, and high = 34.0%-52.6% of ST in ≥30-min bouts). Adjusting for covariates including total ST, high prolongers had fewer light PA minutes per day (P < .01), and a greater percentage of prolonged ST related to lower likelihood of meeting the national guideline of ≥150 moderate-to-vigorous PA minutes per week (P = .012). High (versus low) prolongers had more severe obesity (P < .05).

CONCLUSIONS

Accumulating a greater percentage of ST in prolonged bouts appears to be adversely related to PA and obesity severity among bariatric patients. Future research should determine whether interrupting prolonged ST with brief breaks can favorably modify PA and weight in this population.

Associations of dietitian follow-up counselling visits and physical exercise with weight loss one year after sleeve gastrectomy

PURPOSE

To examine associations of patients' attendance to follow-up meetings with a registered dietitian (RD) and physical exercise practices with weight loss during the 1 year following laparoscopic sleeve gastrectomy (SG).

METHODS

Of 241 patients with obesity who underwent SG during 2012, 184 (76.3%) participated in a 1-year follow-up telephone interview and had information on number of RD follow-up meetings. Clinical information was available from computerized patient files. Multiple logistic regression analysis, adjusting for propensity score, was computed to reveal factors associated with greater weight loss.

RESULTS

The mean %TWL was 31.4 ± 6.1 and the mean number of reported RD meetings during the year following SG was 4.6. The proportion of physically active patients increased by 15% (from 23 to 42) among those who attended at least 3 RD follow-up meetings (n = 123), and by 5% (from 18 to 23) among those who attended fewer than 3 meetings (n = 61) (p = 0.05). Patients conducting physical exercise reported a lower level of pain/discomfort on the EQ5D quality-of-life questionnaire (p = 0.03). The adjusted regression model revealed no association between the number of RD follow-up meetings and weight-reduction success, but physical exercise during the year following SG conferred a 2.6 times greater odds of belonging to the upper two tertiles of the % excess body weight loss ( 95% CI 1.2-5.3).

CONCLUSIONS

Patients with better adherence to RD follow-up meetings were also more physically active. Patients on physical exercise also achieved greater weight reduction following SG, and reported less pain or discomfort. Nutritional counselling and physical exercise are necessary to ensure maximal and sustainable benefits from SG.  LEVEL OF EVIDENCE: Level III, Cohort study.

The Impact of Timing of Exercise Initiation on Weight Loss: An 18-Month Randomized Clinical Trial

OBJECTIVE

This study aimed to evaluate the impact of timing of exercise initiation on weight loss within a behavioral weight loss program.

METHODS

Adults with overweight or obesity (N = 170; age 18-55 years; BMI 25-42 kg/m² ; 83.5% women) were enrolled in an 18-month behavioral weight loss program consisting of a reduced-calorie diet, exercise, and group-based support. The standard group (STD) received a supervised exercise program (progressing to 300 min/wk of moderate-intensity aerobic exercise) during months 0 to 6. The sequential group (SEQ) was asked to refrain from changing exercise during months 0 to 6 and received the supervised exercise program during months 7 to 12. On completion of supervised exercise, both groups were instructed to continue 300 min/wk of moderate-intensity exercise for the study duration.

RESULTS

At 6 months, the STD group exhibited greater reductions in body weight (-8.7 ± 0.7 kg) compared with the SEQ group (-6.9 ± 0.6 kg; P = 0.047). Between 6 and 18 months, the STD group regained more weight (2.5 ± 0.8 kg vs. 0.0 ± 0.8 kg; P = 0.02). At 18 months, there were no between-group differences in changes in weight (STD: -6.9 ± 1.2 kg; SEQ: -7.9 ± 1.2 kg), fat mass, lean mass, physical activity, or attrition.

CONCLUSIONS

Both immediate and delayed exercise initiation within a behavioral weight loss program resulted in clinically meaningful weight loss at 18 months. Thus, timing of exercise initiation can be personalized based on patient preference.

Changes in Physical Activities and Body Composition after Roux-Y Gastric Bypass Surgery

PURPOSE

Given the importance of physical activities for health outcomes, it is still unclear whether bariatric surgery per se and the standard care after surgery would result in an increase of physical activity level. This study aimed to determine physical activities preoperatively and at 6 and 12 months postoperatively among female patients who underwent bariatric surgery, and to investigate its relationship with body composition changes.

MATERIAL AND METHODS

Thirty-four women who had Roux-Y gastric bypass (RYGB) surgery completed the study. Physical activity was measured objectively for 7 consecutive days by using an ActiGraph GT3X+ accelerometer. Body composition was estimated by using multifrequency bioimpedance analysis.

RESULTS

The percentage of time spent in moderate-to-vigorous physical activity (MVPA) changed significantly from preoperatively to 6 months postoperatively; however, no difference was observed at 12 months. No significant changes were detected for other physical activity variables. Multivariable regression analysis suggested that the percentage of time spent in sedentary activity was associated with fat-free mass loss at 6 months (β = - 0.323; 95% CI = - 0.649 to 0.003) and 12 months (β = - 0.510; 95% CI = - 0.867 to - 0.154) postoperatively.

CONCLUSION

The overall MVPA increased at 6 months post-RYGB surgery; however, this change was not maintained at 12 months. Despite the considerable body mass loss postoperatively, most of the subjects were classified as being physically inactive and did not change their sedentary behavior. These findings indicate that female patients undergoing bariatric surgery should be encouraged to increase their physical activity level.

Relationship of Consistency in Timing of Exercise Performance and Exercise Levels Among Successful Weight Loss Maintainers

OBJECTIVE

This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry.

METHODS

Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location).

RESULTS

Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants.

CONCLUSIONS

Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers.

A multidimensional analysis of the longitudinal effects of roux en y gastric bypass on fatigue: An association with visceral obesity

BACKGROUND AND OBJECTIVES

Severe obesity is associated with fatigue, however, the effects of weight loss after bariatric surgery on particular dimensions of fatigue are unknown. In a secondary analysis of a prospective cohort study of women undergoing roux-en-y gastric bypass (RYGB) we explored relationships among multiple dimensions of fatigue and improving adiposity, insulin resistance and inflammation.

METHODS

Before, and 1 and 6 months after RYBG, dimensions of fatigue were assessed using the validated, self-report, Multidimensional Fatigue Inventory. Total, abdominal visceral (VAT) and subcutaneous (SAT) adiposity, insulin sensitivity (Si and HOMA) and plasma concentrations of leptin, C-reactive protein (CRP) and interleukin-6 (Il-6) were measured using air displacement plethysmography, computed tomography, glucose tolerance testing and enzyme-linked immunoassay. Associations were assessed using Spearman correlations and linear regression.

RESULTS

At baseline, the majority of our female participants (N = 19, body mass index, 46.5 kg/m², age 37.2 years) were experiencing elevated levels of fatigue. By 6 months, dimensions of physical (-43%), reduced activity (-43%), reduced motivation (-38%), general (-31%; all p < .005), and mental (-18%, p < .05) fatigue improved, concomitant with decreases in markers of adiposity, inflammation and insulin resistance. The decrease in VAT was associated with improvement in mental fatigue (beta, 0.447 ± 0.203, p = .045), independent of other indices of adiposity, IL-6 concentrations, or Si.

CONCLUSIONS

In the 6 months after RYGB, fatigue improved, especially physical fatigue. Decreases in mental fatigue were strongly associated with decreases in visceral adiposity. Nevertheless, the biologic mechanisms underlying changes in these specific fatigue dimensions remain undetermined.

Meta-analysis of the effect of bariatric surgery on physical activity

BACKGROUND

Obesity leads to impairment of physical activity as measured by an inability to perform activities of daily living. Literature on the effect of bariatric surgery on physical activity is conflicting.

OBJECTIVE

The aim of this study was to perform a meta-analysis of the effect of bariatric surgery on physical activity from studies employing objective measurement and self-reporting of physical activity before and after bariatric surgery.

METHODS

Bibliographic databases were searched systematically for relevant literature until December 31, 2018. Studies employing objective and self-reported measurement of physical activity were included. Study quality was assessed using Risk of Bias in Nonrandomized Studies - of Interventions tool. Meta-analysis was performed using random effects model and presented as standardized mean difference (SMD) with 95% confidence intervals (CI).

RESULTS

Twenty studies identified 5886 patients suitable for the analysis. Physical activity showed significant improvement at 0-6 months (SMD: .50; 95% CI: .25-.76; P = .0001), >6-12 months (SMD: .58; 95% CI: .26-.91; P = .0004), and >12-36 months (SMD: .82; 95% CI: .27-1.36; P = .004) after bariatric surgery. Self-reported assessment after bariatric surgery showed significant improvement at 0-6 months (SMD: .65; 95% CI: .29-1.01; P = .0004), >6 to 12 months (SMD: .53; 95% CI: .18-.88; P = .003), and >12-36 months (SMD: .51; 95% CI: .46-.55; P < .00001). Objective assessment after bariatric surgery did not show improvement at 0-6 months (SMD: .31; 95%CI:-.05-.66; P = .09), but showed significant improvement at >6-12 months (SMD: .85; 95% CI:-.07-1.62; P = .03), and >12-36 months (SMD: 1.99; 95% CI: 1.13-2.86; P < .00001) after bariatric surgery.

CONCLUSIONS

Bariatric surgery improves physical activity significantly in a population with obesity up to 3 years after surgery. Objective measurement of physical activity does not show significant improvement within 6 months of bariatric surgery but begins to improve at >6 months. Self-reported measurement of physical activity begins to show improvement within 6 months of a bariatric procedure.

Physical activity and its association with psychosocial health following bariatric surgery

Physical activity (PA) helps sustain weight loss and may also provide psychological benefits in patients undergoing bariatric surgery. Using a set of questionnaires, we demonstrated that bariatric patients with increased level of PA at 1-year follow-up had better psychosocial outcomes including depressive symptoms and mental health-related quality of life compared with those who had reduced or unchanged level of PA. Our findings indicate the benefit of incorporating PA in the postoperative care for bariatric patients. Novelty Postoperative behavioural change in terms of physical activity improves psychosocial health in patients undergoing bariatric surgery.

Assessment of Cardiometabolic Risk Factors, Physical Activity Levels, and Quality of Life in Stratified Groups up to 10 Years after Bariatric Surgery

Obesity is a highly prevalent chronic metabolic disease, with an increasing incidence, and is currently approaching epidemic proportions in developing countries. Ouraim was to evaluate the activity levels, quality of life (QoL), clinical parameters, laboratory parameters, and cardiometabolic risk factors afterbariatric surgery (BS). We classified78 patients who underwentBS into four groups, as follows: Those evaluated 1–2 years after BS (BS2), 2–4 years after BS (BS4), 4–6 years after BS (BS6), and 6–10 years after BS (BS+6). Body weight (BW), body mass index (BMI), comorbidities associated with obesity (ACRO), physical activity level, and QoL were evaluated. Patients exhibited improvements in BW, BMI, cardiometabolic risk, hypertension, dyslipidemia, and diabetes and significant changes in lipid profiles in the first postoperative yearafter BS.The physical activity level inthe BS2, BS4, and BS6 groups was increased, compared with that in the first postoperative year, with a decrease in International Physical Activity Questionnaire scores at 1 year in the BS2 (207.50 ± 30.79), BS4 (210.67 ± 33.69), and BS6 (220.00 ± 42.78) groups. The QoL of patients in theBS2 and BS4 groups was excellent and that of patients in the BS4 and BS+6 groupswas very good. These findings suggest that BS promoted improved physical activity levels and QoL and reduced comorbidities in patients with morbid obesity.

Physical Activity Improves Lipid and Weight-Loss Outcomes After Metabolic Bariatric Surgery in Adolescents with Severe Obesity

OBJECTIVE

This study tested the hypothesis that physical activity improves cardiovascular disease-related lipids beyond that associated with weight loss in adolescents with severe obesity after metabolic/bariatric surgery (MBS).

METHODS

Objective activity monitor data from 108 participants of the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study from baseline to 3 years post MBS were used. Primary outcomes included absolute change in LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) from baseline. Baseline measurement, visit, surgical procedure, and percent change in iliac waist circumference or BMI from baseline in linear regression models were adjusted for use of generalized estimating equations. PROC TRAJ in SAS generated optimal activity trajectories based on individual step count.

RESULTS

Despite low step counts and slow cadence, differences by activity trajectory were found. Greater absolute decreases in LDL-C and non-HDL-C (-15 mg/dL [95% CI: -28 to -2], P  = 0.026; and -15 mg/dL [95% CI: -28 to -1], P  = 0.035), respectively, were associated with more activity. More activity was associated with greater resolution of triglycerides, LDL-C, and non-HDL-C dyslipidemia and with greater weight loss 3 years post MBS.

CONCLUSIONS

More activity in adolescents was associated with improvements in cardiovascular disease-related lipid measures and weight loss after MBS.

Week and Weekend Day Cadence Patterns Long-Term Post-Bariatric Surgery

Obesity can negatively influence walking cadence, reducing the overall intensity of daily activities and increasing the risk of weight gain.

PURPOSE

Objectively describe the walking cadence of individuals' long-term post-bariatric surgery.

METHODS

Fifty-eight participants, 51.2 ± 8.9 years old, with a BMI of 34.6 ± 10.1 kg/m², 10.0 ± 3.1 years post-surgery wore an activPAL accelerometer for 7 consecutive days. Data was analyzed using participants' current BMI, dichotomized by obesity status, < or ≥ 30 kg/m².

RESULTS

On average, participants walked 5124 ± 2549 steps/day on weekdays and 6097 ± 2786 steps/day on weekend days (p = .003). Participants spent the majority (75%) of their daily steps at a slow-walking average cadence (non-obese: week = 65.3 ± 5.0 steps/min and weekend = 63.8 ± 6.7 steps/min; obese: week = 67.8 ± 8.2 steps/min and weekend = 63.3 ± 6.9 steps/min), with no difference between groups for week or weekend days (p = .153 and .774). The cadence of participants with obesity was significantly lower on weekends compared to weekdays for walking events > 30 s (p = .002) and > 60 s (p = .008) in duration. Weekday cadence of participants without obesity was similar to weekend day cadence across all walking event durations. The majority of walking events occurred below 30 s in duration for all participants.

CONCLUSIONS

Long-term post-bariatric surgery, movement occurs in short duration bouts at a slow-walking cadence for the majority of movement. Individuals without obesity had similar movement patterns from week to weekend days while participants with obesity significantly lowered their cadence on weekend days.