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Predictors of Lowest Weight and Long-Term Weight Regain Among Roux-en-Y Gastric Bypass Patients

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Abstract

Background

Weight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate the relationship of well-documented (e.g., health, diet, physical activity) and theoretically relevant variables (e.g., substance use and “food addiction”) with both weight nadir and weight regain (WR) following WLS.

Methods

A sample of 97 Roux-en-Y gastric bypass patients (M time since surgery = 8.86 years) were surveyed about pre- and post-WLS weight, health, self-management behaviors, alcohol problems, and clinical symptoms.

Results

Patients lost a mean of 42 % (SD = 10.71 %) of total weight at weight nadir, but 26 % (SD = 19.66 %) of the lost weight was regained by the time of the survey. Correlates of lower weight nadir and WR differed considerably, with minor overlap. Weight nadir was associated with pre-WLS drug use and post-WLS medical comorbidities. WR, on the other hand, was associated with post-WLS adherence to dietary and physical activity modification. Post-WLS nocturnal eating, depression, and problematic alcohol use were also associated with WR. With all associated variables in regression models, number of post-WLS medical comorbidities (β = −.313, p < 0.01) and post-WLS depression (β = 0.325, p < 0.01) accounted for the most variance and remained as significant predictors of weight nadir and WR, respectively.

Conclusions

While weight nadir was associated with relatively few and largely nonmodifiable variables, WR was significantly associated with adherence-related behaviors, mood symptoms, and pathological patterns of food and alcohol use, all of which are potentially modifiable. These findings underscore the importance of long-term behavioral and psychosocial monitoring after surgery.

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References

  1. Aftab H, Risstad H, Sovik T, et al. Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. Surg Obes Rel Dis. 2014;10:71–8.

    Article  Google Scholar 

  2. Adams T, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Cremieux PY, Buchwald H, Shikora S, et al. A study on the economic impact of bariatric surgery. Am J Manag C. 2008;14(9):589–96.

    Google Scholar 

  5. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  6. Laurino Neto RM, Herbella FA, Tauil RM, et al.. Comorbidities remission after Roux-en-Y gastric bypass for morbid obesity is sustained in a long-term follow-up and correlates with weight regain. Obes Surg. 2012;22(10):1580–5.

    Article  PubMed  Google Scholar 

  7. Hatoum IJ, Kaplan LM. Advantages of percent weight loss as a method of reporting weight loss after Roux-en-y gastric bypass. Obes. 2013;21:1519–25.

    Article  Google Scholar 

  8. Still CD, Wood GC, Chu X, et al. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obes. 2014;22:888–94.

    Article  Google Scholar 

  9. Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51.

    Article  PubMed  Google Scholar 

  10. Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31:1248–61.

    Article  CAS  Google Scholar 

  11. Faria SL, Kelly EO, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20:135–9.

    Article  PubMed  Google Scholar 

  12. Freire RH, Borges MC, Alvarez-Leite JI, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28:53–8.

    Article  PubMed  Google Scholar 

  13. Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922–33.

    Article  PubMed  Google Scholar 

  14. Blomain ES, Dirhan DA, Valentino MA, et al. Mechanisms of weight regain following weight loss. ISRN Obes. 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901982/pdf/ISRN.OBESITY2013-210524.pdf. Accessed 9 June 2014

  15. Franks SF, Kaiser KA. Predictive factors in bariatric surgery outcomes: what is the role of the preoperative psychological evaluation? Primary Psychiatry. 2008;15(8):74–83.

    Google Scholar 

  16. Ma Y, Pagoto SL, Olendzki BC, et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg. 2006;16(9):1227–31.

    Article  PubMed  Google Scholar 

  17. Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.

    Article  PubMed  Google Scholar 

  18. Bond DS, Phelan S, Leahey TM, et al. Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods. Int J Obes. 2009;33:173–80.

    Article  CAS  Google Scholar 

  19. Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15:684–91.

    Article  PubMed  Google Scholar 

  20. Colles SL, Dixon JB, O’Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obes. 2008;16(3):615–22.

    Article  Google Scholar 

  21. de Zwaan M. Weight and eating changes after bariatric surgery. In: Mitchell JE, de Zwaan M, editors. Bariatric surgery: a guide for mental health professionals. New York: Routledge; 2005. p. 77–100.

    Google Scholar 

  22. de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Dis. 2011;133(1–2):61–8.

    Article  PubMed  Google Scholar 

  23. Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.

    Article  CAS  PubMed  Google Scholar 

  24. Kinzl JF, Schrattenecker M, Traweger C, et al. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16(12):1609–14.

    Article  PubMed  Google Scholar 

  25. Niego SH, Kofman MD, Weiss JJ, et al. Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord. 2007;40(4):349–59.

    Article  PubMed  Google Scholar 

  26. Cornicelli M, Noli G, Marinari GM, et al. Dietary habits and body weight at long-term following biliopancreatic diversion. Obes Surg. 2010;20(9):1278–80.

    Article  PubMed  Google Scholar 

  27. Latner JD, Wetzler S, Goodman ER, et al. Gastric bypass in a low-income, inner-city population: eating disturbances and weight loss. Obes Res. 2004;12:956–61.

    Article  PubMed  Google Scholar 

  28. Sciamanna CN, Kiernan M, Rolls BJ, et al. Practices associated with weight loss versus weight-loss maintenance. Am J Prev Med. 2011;41(2):159–66.

    Article  PubMed  Google Scholar 

  29. Elkins G, Whitfield P, Marcus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15:546–51.

    Article  PubMed  Google Scholar 

  30. Schwartz RW, Strodel WE, Simpson WS, et al. Gastric bypass revision: lessons learned from 920 cases. Surgery. 1988;104:806–12.

    CAS  PubMed  Google Scholar 

  31. Maniscalco M, Zedda A, Giardiello C, et al. Effect of bariatric surgery on the six minute walk test in severe uncomplicated obesity. Obes Surg. 2006;16:836–41.

    Article  PubMed  Google Scholar 

  32. Serés L, Lopez-Averbe J, Coll R, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obes. 2006;14:273–9.

    Article  Google Scholar 

  33. Howard L, Malone M, Michalek A, et al. Gastric bypass and vertical banded gastroplasty: a prospective randomized comparison and 5-year follow-up. Obes Surg. 1995;5(1):55–60.

    Article  PubMed  Google Scholar 

  34. Olbers T, Fagevik-Olsen M, Maleckas A, Lonroth H. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity. Brit J Surg. 2005;92(5):557–62.

    Article  CAS  PubMed  Google Scholar 

  35. van de Laar A, de Caluwé L, Dillemans B. Relative outcomes measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obes Surg. 2011;21:763–7.

    Article  PubMed  Google Scholar 

  36. Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Babor TF, Higgins-Biddle JC, Saunders JB, et al. The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva: World Health Organization; 2001.

    Google Scholar 

  38. Hays RD, Merz JF, Nicholas R. Response burden, reliability, and validity of the CAGE, Short MAST, and AUDIT alcohol screening measures. Behav Res Meth Instrum Comput. 1995;27:277–80.

    Article  Google Scholar 

  39. Bohn MJ, Babor TF, Kranzler HR. The alcohol use disorders identification test (AUDIT): validation of a screening instrument for use in medical settings. JSAD. 1995;56:423–32.

    CAS  Google Scholar 

  40. Humeniuk R, Ali R, Babor TF, et al. Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47.

    Article  PubMed  Google Scholar 

  41. Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale food addiction scale. Appetite. 2009;52(2):430–6.

    Article  PubMed  Google Scholar 

  42. American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision). Washington, DC; 2000.

  43. Clark SM, Saules KK. Validation of the Yale food addiction scale among a weight-loss surgery population. Eat Behav. 2013;14(2):216–9.

  44. Meule A, Heckel D, Kubler A. Factor structure and item analysis of the Yale food addiction scale in obese candidates for bariatric surgery. Eur Eat Disord Rev. 2012;20:419–22.

  45. Kroenke K, Spitzer RL, Williams JB. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Martin A, Rief W, Klaiberg A, et al. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiat. 2006;28:71–7.

    Article  Google Scholar 

  47. Welch G, Wesolowski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. Obes Surg. 2005;18(5):517–24.

    Article  Google Scholar 

  48. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. MSSE. 2000;32(9):498–504.

    Google Scholar 

  49. de Zwaan M, Hilbert A, Swan-Kremeier L, et al. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2010;6:79–87.

    Article  PubMed  Google Scholar 

  50. Spitzer RL, Yanovski SZ, Marcus MD. Questionnaire on Eating and Weight Patterns Revised. Mclean: Behavioral Measurement and Database Services (Producer); BRS Search Service (Vendor); 1994.

    Google Scholar 

  51. de Zwaan M, Mitchell JE, Specker SM, et al. Diagnosing binge eating disorder: level of agreement between self-report and expert rating. Int J Eat Disord. 1993;14(3):289–95.

    Article  PubMed  Google Scholar 

  52. Allison KC, Lundgren JD, O’Reardon JP, et al. The night eating questionnaire (NEQ): psychometric properties of a measure of severity of the Night Eating Syndrome. Eat Behav. 2008;9:62–72.

    Article  PubMed  Google Scholar 

  53. Armstrong T, Bull F. Development of the world health organization global physical activity questionnaire. J Publ Health. 2006;14:66–70.

    Article  Google Scholar 

  54. Bond DS, Thomas JG, Unick JL, et al. Self-reported and objectively measured sedentary behavior in bariatric surgery candidates. Surg Obes Relat Dis. 2013;9:123–8.

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This work was performed at Eastern Michigan University and St. Vincent Bariatric Center of Excellence, USA. Preparation of this manuscript was supported by the Eastern Michigan University Department of Psychology, the EMU Provost’s Office, and St. Vincent Bariatric Center of Excellence. We would like to also thank Drs. Brenda Cacucci, David Diaz, Christopher Evanson, John Huse, Margaret Inman, and Douglas Kaderabek for allowing us access to their patients for recruitment.

Funding

There was no grant support for this research project. Internal funding from EMU was used to provide participant payments.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors have no conflicts of interest to report. No external sources of funding were available for this project.

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Authors and Affiliations

  1. Eastern Michigan University, Ypsilanti, MI, USA

    Brenton R. Yanos & Karen K. Saules

  2. St. Vincent Carmel Bariatric Center of Excellence, Carmel, IN, USA

    Leslie M. Schuh

  3. Massachusetts General Hospital, Boston, MA, USA

    Stephanie Sogg

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  1. Brenton R. Yanos
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  2. Karen K. Saules
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  3. Leslie M. Schuh
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Correspondence to Karen K. Saules.

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Yanos, B.R., Saules, K.K., Schuh, L.M. et al. Predictors of Lowest Weight and Long-Term Weight Regain Among Roux-en-Y Gastric Bypass Patients. OBES SURG 25, 1364–1370 (2015). https://doi.org/10.1007/s11695-014-1536-z

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