Weight loss in adults following bariatric surgery, a systematic review of preoperative behavioural predictors

Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

Background

Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting.

Objective

To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities.

Design

Prospective observational cohort study.

Setting

National Health Service secondary care and private practice in Scotland, United Kingdom.

Participants

Adults (age >16 years) undergoing their first bariatric surgery procedure.

Main outcome measures

Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression.

Data sources

Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System).

Results

Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was -19.0% (±14.1) from the operation and -24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was -5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression.

Limitations

Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years.

Conclusions

Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed.

Future work

Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness.

Study registration

This study is registered as ISRCTN47072588.

Funding details

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.

Preoperative Weight Gain Is Not Related to Lower Postoperative Weight Loss, But to Lower Total Weight Loss up to 3 Years After Bariatric-Metabolic Surgery

INTRODUCTION

Weight loss prior to bariatric-metabolic surgery (BMS) is recommended in most bariatric centers. However, there is limited high-quality evidence to support mandatory preoperative weight loss. In this study, we will evaluate whether weight gain prior to primary BMS is related to lower postoperative weight loss.

METHODS

A retrospective analysis of prospectively collected data was performed. Preoperative weight loss (weight loss from start of program to day of surgery), postoperative weight loss (weight loss from day of surgery to follow-up), and total weight loss (weight loss from start of program to follow-up) were calculated. Five groups were defined based on patients' preoperative weight change: preoperative weight loss of >5 kg (group I), 3-5 kg (group II), 1-3 kg (group III), preoperative stable weight (group IV), and preoperative weight gain >1 kg (group V). Linear mixed models were used to compare the postoperative weight loss between group V and the other four groups (I-IV).

RESULTS

A total of 1928 patients were included. Mean age was 44 years, 78.6% were female, and preoperative BMI was 43.7 kg/m2. Analysis showed significantly higher postoperative weight loss in group V, compared to all other groups at 12, 24, and 36 months follow-up. Up to three years follow-up, highest total weight loss was observed in group I.

CONCLUSION

Weight gain before surgery should not be a reason to withhold a bariatric-metabolic operation. However, patients with higher preoperative weight loss have higher total weight loss. Therefore, preoperative weight loss should be encouraged prior to bariatric surgery.

Personality Profiles Associated with Long-Term Success in Bariatric Surgery: 24-Month Follow-Up

(1) Background: Bariatric surgery (BS) is highly effective for treating severe obesity in the long term. However, studies investigating predictors and personality profiles linked to BS success yield inconsistent results due to varying methodologies and limited research. This paper aims to identify personality profiles associated with BS success. (2) Method: The study involved 67 patients undergoing bariatric surgery, evaluated through clinical and personality measures. Weight loss was monitored at 6, 12, and 24 months post-surgery. Hierarchical case cluster analysis and iterative k-means cluster analysis identified distinct groups based on excess body mass index loss (%EBL) at these intervals. ANOVA was employed to compare personality profiles between groups. (3) Results: Average weight loss after 24 months was 67.2%. Two success profiles emerged: 46.5% showed very good success, achieving 90% EBL in 24 months, while 55% in the second cluster had less than 40% EBL throughout follow-up. The successful profile correlated with greater self-efficacy and improved emotional adjustment. (4) Conclusions: Successful BS outcomes were linked to personality traits promoting sustained weight loss post-surgery.

Changes in Eating Behaviors and Their Associations with Weight Loss in Japanese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

BACKGROUND

Metabolic and bariatric surgery (MBS) has been established to provide long-term weight loss in severe obesity. In this study, we investigated the factors that affect post-operative weight loss, with a particular focus on changes in eating behaviors.

METHODS

Time-course changes in body weight and eating behaviors were examined in 49 Japanese patients who underwent laparoscopic sleeve gastrectomy from the first visit to 12 months after surgery. Each eating behavior was evaluated via the questionnaire of the Japan Society for the Study of Obesity.

RESULTS

Pre-operative weight reduction mediated by dietary and lifestyle interventions showed significant positive correlations with weight loss outcomes at 12 months after surgery. We observed significant decreases in scores for most of the eating behaviors 12 months after surgery. However, "emotional eating behavior" scores declined temporarily in the early post-operative period of one month but thereafter returned to the pre-operative level at 12 months. Furthermore, increases in the scores for "emotional eating behavior" and "sense of hunger" from 1 to 12 months post-operatively were significantly associated with poor weight loss.

CONCLUSIONS

Our results demonstrate the beneficial effects of MBS on obesity-related eating behaviors, as well as highlighting "emotional eating behavior" as requiring particular attention.

Frequency of Short- vs Long-Term Reporting of Bariatric Surgery Outcomes

BACKGROUND AND AIMS

Bariatric surgery is an effective treatment for obesity. Though both short- and long-term outcomes have been reported, most of the published literature reports on short-term outcomes. Identification of post-operative weight regain and re-emergence of comorbidities requires medium- and long-term follow-up. We aimed to identify the distribution of follow-up times within the literature.

METHODS

We screened through 1807 articles from 9 PubMed Indexed bariatric surgery journals published between January to June of 2015 and 2021 and selected articles reporting weight loss as a main outcome. Follow-up intervals were defined as per American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.

RESULTS

Fifty-three and sixty-three articles were identified in 2015 and 2021 respectively. Reported follow-up lengths in 2015 were 60% short-, 26% medium-, and 14% long-term; while in 2021, there were 65% short-, 10% medium-, and 25% long-term articles. Of the articles reporting long-term outcomes in 2015 and 2021, 48%, and 70% of the included patients respectively had > 5 years follow-up.

CONCLUSION

Though reporting of long-term outcomes increased, most published outcomes remain short-term. The UK National Bariatric Surgery Registry is helping to mitigate this. An increased effort and emphasis on reporting long-term outcomes is needed.

Psychosocial and behavioral correlates of weight loss 12 to 15 years after bariatric surgery

While significant weight loss occurs post-bariatric surgery, partial weight regain is common. Psychological and dispositional variables have been examined as predictors of weight change, but most studies have focused on the relationship of preoperative constructs to shorter-term postoperative outcomes. The goal of the current study was to examine associations between weight loss and postoperative psychosocial and behavioral factors up to an average of 13.7 years after surgery. The current study was conducted at a large bariatric center in a Midwestern U.S. city. The sample was comprised of 125 adult patients who participated in the second wave of a long-term bariatric surgery outcome study, examining weight history, physical activity, and psychological health and functioning. Correlations between percent total weight loss (%TWL) and psychosocial and behavioral variables were examined. The variables that had significant correlations with %TWL were used in stepwise linear regressions to determine their contribution to %TWL. These same variables were tested to determine differences among those in the highest and lowest weight loss quartiles. Life satisfaction, conscientiousness, positive affect, and regular exercise were positively associated with weight loss in the entire sample and were significantly higher among those in the highest versus the lowest weight-loss quartile. Experiencing a stressful event and food addiction symptoms were negatively associated with weight loss. Positive affect, fewer food addiction symptoms, and regular exercise significantly predicted weight loss, accounting for 23% of the variance in %TWL. Long-term weight loss maintenance after bariatric surgery may be related to positive affect, conscientiousness, regular physical activity, and an addictive-type relationship with food. Future studies should explore these relationships and develop approaches to deal with the interaction between dispositional tendencies and lifestyle factors.

Psychological functioning and well-being before and after bariatric surgery; what is the benefit of being self-compassionate?

Objective

To investigate whether patients’ psychological well‐being (depression, quality of life, body image satisfaction) and functioning (self‐efficacy for eating and exercising behaviours and food cravings) improve 12 months after bariatric surgery and whether self‐compassion is associated with better psychological outcomes and lower weight after bariatric surgery.

Design

Longitudinal, prospective observational study.

Methods

Bariatric patients (n = 126, 77.8% female, 46.4 ± 10.8 years) completed the Self‐compassion Scale, Center for Epidemiology Studies Depression Scale, Impact of Weight on Quality‐of‐Life questionnaire, Body Image Scale, Weight Efficacy Lifestyle Questionnaire, Spinal Cord Injury Exercise Self‐Efficacy Scale, and G‐Food Craving Questionnaire pre‐operatively and 12 months post‐operatively. A medical professional measured patients’ weight during each assessment. Data were analysed using repeated measures t‐tests and multivariate regression analyses with Benjamini–Hochberg correction for multiple testing.

Results

Patients’ BMI, depression, and food cravings decreased significantly after surgery while quality of life, body image satisfaction, and self‐efficacy to exercise improved. Higher self‐compassion was associated with lower post‐operative depression, greater quality of life, higher body image satisfaction, and better self‐efficacy for eating behaviours (p‐values <.05) but not with post‐operative BMI, self‐efficacy to exercise, or food cravings.

Conclusions

Even though pre‐operative self‐compassion was not directly associated with a lower 12‐month post‐operative BMI, it had a positive relationship with patients’ post‐operative well‐being and self‐efficacy for controlling eating behaviour. In turn, this could help patients to manage their health long after bariatric surgery. Further work regarding the role of self‐compassion on long‐term health outcomes would be worthwhile.

Weight loss in adults following bariatric surgery, a systematic review of preoperative behavioural predictors

Bariatric surgery is effective in treating obesity in many cases, yet as many as 50% of patients may not achieve the desired weight reduction. Preoperative modifiable behavioural factors could help patient selection and intervention design to improve outcomes. Medline, EMBASE, Cochrane Library and PsychINFO were searched to identify studies published between 1 January 2008 and 14 February 2019 reporting on preoperative modifiable behavioural factors associated with postoperative weight loss, with minimum 2 years follow-up. A total of 6888 articles were screened, 34 met the inclusion criteria. Maladaptive eating behaviours (MEB), preoperative weight loss (PWL), and tobacco use were reported 21, 18, and 3 times respectively. Physical activity and substance abuse were each reported once. Most articles on PWL (72.2%) and MEB (52.4%) reported no association. Positive associations were reported in 22.2% and 14.3% of articles for PWL and MEB respectively. Negative associations were reported in 5.6% and 33.3% of articles for PWL and MEB, respectively. Marked heterogeneity in outcome reporting hindered quantitative synthesis. The current paucity of evidence amenable to synthesis leads to ongoing uncertainty regarding the size and direction of association between PWL and MEB with outcomes following bariatric surgery. Long-term studies with common reporting of outcomes are needed.