What Contributes to Prolonged Weight-Loss Success After Bariatric Surgery?

results of an on-line survey presented at the 31st Annual Scientific Meeting of The Obesity Society (OBESITY 2013).

By Lorraine L. Janeczko

ATLANTA -- November 19, 2013 -- Dietary support after bariatric surgery, along with pre-operative teaching and post-operative management, may mean the difference between weight-loss success and failure for patients with obesity, according to results of an on-line survey presented at the 31st Annual Scientific Meeting of The Obesity Society (OBESITY 2013).

“This study confirms the need to put into place the resources to support people after bariatric surgery, including the dieticians and behavioural therapists who are actively involved with their patients, and can be critical to their success or failure,” stated American Society for Metabolic and Bariatric Surgery past president, Scott Shikora, MD, Center for Metabolic Health, Brigham and Women’s Hospital, Boston, Massachusetts.

“People who have had bariatric surgery and are complying with the very basic principles of personal accountability, portion control, food intake, vitamins and supplements, proper nutrition and exercise are the ones who have been doing well long-term,” noted lead author Colleen M. Cook, Bariatric Support Centers International, Jordan, Utah, speaking here on November 14.

Cook and colleagues conducted a survey to assess adherence to specific, research-based, behavioural recommendations based on earlier research. Of their 535 total initial respondents, 255 were 5 or more years post-surgery. From this group, they took a final sample of 158 respondents comprised of 117 (74.05%) *****ported achieving at least 80% of their excess body weight loss (the Highly Successful group) and 41 (25.9%) *****ported achieving less than 40% of their excess body weight loss (the Not Highly Successful group).

The groups were compared on self-reported behaviours, including dietary intake, physical exercise, attendance at surgical follow-up visits, and participation in bariatric support groups.

The Highly Successful group reported significantly higher rates of compliance with dietary recommendations (P< .001); fewer total calories per day (1511.9 kCals versus 2190.0 kCals, P< .001 ); consuming a higher percentage of calories from protein (49% vs 36%; P< .001); higher frequency of eating protein first (P =.007); and lower percentage of calories from carbohydrates (31% vs 40%; P = .001).

The Highly Successful group was much more likely to regularly weigh themselves (P< .001); attend support groups (P = .002); and take supplemental multivitamins (P = .029), including calcium (P = .004), iron (P = .011), and B12 (P = .001).

The Highly Successful group was significantly less likely to eat mindlessly (P< .001); to “graze” (P< .001); to eat in front of the TV (P = .002); to eat fast food (P< .001); and to eat food high in sugar (P< .001).

The groups also differed significantly on carbonated beverage (P = .02) and caffeine (P = .005) drinking patterns. The Highly Successful group reported significantly more physical activity at least several times per week than the Not Highly Successful group (P< .001).

The researchers found no significant differences, however, for ingestion of percentage calories from fat or the frequency of eating at sit-down restaurants, drinking calorie-laden liquids, or attending surgical clinic follow-ups.

Participants in this study averaged 51.7 years of age and 8.8 years post-surgery; 96% were female, 59% were married, and 89% were white. Both groups had similar demographics.

Funding for this study was provided by Bariatric Support Centers International.

[Presentation title: Factors Distinguishing Weight Loss Success and Failure at Five or More Years Post Bariatric Surgery. Abstract A-366-P]

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GREAT information! Thank you so much!

Preaching to the choir     I know there are some vets who don't comply with healthful lifestyles and are successful in maintaining their weight, but anyone reading their posts should appreciate that they are the exception and not the rule!  Losing and maintaining that weightloss is only a part of our better health in the long term!

Good healthful eating and drinking, combined with vitamins and exercise are,  and always will be,  the key for most of us ...

Agree!  I an not perfect and will never pretend.  I am aware though of my choices and even when I don't make the best choices I make up for those choices in others way, the same day or the next. 

I also don't do crazy things that are eating disordered thinking......I like food there's not doubt about that, always have and always will.  I'm scared ****less to not take vitamins.  I see the non-compliance all to often and have had some stern conversations with a few IRL friends about their lack of compliance. 

I've seen some of their regain problems and depression, excessive drinking (liquid calories) and denial there's a problem and a few health issues crop up and bite their ass because of vitamins....things such as neuropathy, anemia (which isn't always their fault as we know), seizures (this one for them appears to be from B vitamin deficiency *sigh*)......

How do we that care get the importance of this out there? 

This is awesome! I am saving to my hard drive. THANKS!! :)

Thanks for posting this. There's nothing surprising about anything in the study though, is there.

I enjoyed this also because one of the authors, Dr. Shikora, was my surgeon. I asked him one time if people failed because they stopped following up and attending support groups, or if they stopped following up and attending support groups because they had failed. He didn't know, but would like to find out. Any ideas from you vets?

That would be an interesting survey. 

My guess is they stopped following up and/or attending support groups because they weren't compliant and regained (I don't like to consider someone/anyone a failure).  They are embarrassed to face the reality that WLS isn't a "fix", it still takes work and always will.  I say this because there are MANY long-termers who do not follow up with their surgeon and have rarely or never attended a support group and still remain compliant. 

I hope some other vets chime in......I'd like to see others take on this.

I can only speak for myself ...

I attended my hospital support group for 4 months after surgery because I moved to Singapore and quite frankly I was done with it anyway.   I didn't have any pre-surgery plan - 3 weeks from Google to Operating Room (it was in the olden days ) but at 4 months out it was a bit of a snoozefest - it was cliquey and the same people hijacked the meeting every time ...   

I joined OH immediately following surgery and apart from a small hiatus, when I joined an alternative group, have been around on here for 9 + years!  I absolutely consider this place my support and accountability group and credit my time here with helping me with my long term success!

I don't consider myself a vet at only 2.5 yrs out, but I only attended 2 or 3 support groups.  They were more geared towards early post ops rather than long term post ops.  I can only go to so many groups on how to jazz up protein shakes.  I find support  and ways to stay motivated in other places.

This is GREAT info!  Thank you for sharing!