Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study.

Welch G, Wesolowski C, Zagarins S, Kuhn J, Romanelli J, Garb J, Allen N.

Behavioral Medicine Research, Baystate Medical Center, 140 High Street, Room 2104, Springfield, MA, 01199, USA, [email protected].

BACKGROUND: Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities. However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have characterized research to date. METHODS: We conducted a comprehensive assessment of n=100 LGB patients surveyed 2-3 years following surgery using standardized measures.

RESULTS: Mean %EWL at follow-up was 59.1+/-17.2%. This high level of weight loss was associated with a low rate of metabolic syndrome (10.6%), although medications were commonly used to achieve control. Mean adherence to daily vitamin and mineral supplements important to the management of LGB was only 57.6%, and suboptimal blood chemistry levels were found for ferritin (32% of patients), hematocrit (27%), thiamine (25%), and vitamin D (19%).

Aerobic exercise level (R (2)=0.08) and pre-surgical weight (R (2)=0.04) were significantly associated with %EWL, but recommended eating style, fluid intake, clinic follow-up, and support group attendance were not. Psychosocial adjustment results showed an absence of symptomatic depression (0%), common use of antidepressant medications (32.0%), low emotional distress related to the post-surgical lifestyle (19.8+/-14.0; scale range 0-100), a high level of perceived benefit from weight loss in terms of functioning and emotional well-being (82.7+/-17.9; scale range 0-100), and a change in marital status for 26% of patients.

CONCLUSIONS: At 2-3 years following LGB surgery aerobic exercise, but not diet, fluid intake, or attendance at clinic visits or support groups, is associated with %EWL. Depression is symptomatically controlled by medications, lifestyle related distress is low, and marital status is significantly impacted.