Obesity Surgery

, Volume 25, Issue 9, pp 1693–1702 | Cite as

Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance and Attrition

  • Lisa S. Hochberg
  • Kylie D. Murphy
  • Paul E. O’Brien
  • Leah BrennanEmail author
Original Contributions



Regular aftercare attendance following laparoscopic adjustable gastric banding (LAGB) is associated with greater weight loss and fewer post-surgical complications. Despite high reported rates of attrition from LAGB aftercare, the reasons for non-attendance have not been previously explored. The present study aimed to explore patient-reported barriers to LAGB aftercare attendance, and the perceived helpfulness of potential attrition-reducing strategies, in both regular attendees and non-attendees of aftercare.


One hundred and seventy-nine participants (107 regular attendees and 72 non-attendees) completed a semi-structured questionnaire, assessing barriers to attrition (101 items) and usefulness of attrition prevention strategies (14 items).


Findings indicate that both regular attendees and non-attendees experience multiple barriers to aftercare attendance. Non-attendees generally reported that barriers had a greater impact on their aftercare attendance. There was evidence for some level of acceptability for attrition-reducing strategies suggesting that LAGB patients may be receptive to such strategies.


Current findings highlight the importance of assessing barriers to treatment in both attendees and non-attendees. It is proposed that addressing barriers that differentiate non-attendees from attendees may be most effective in reducing attrition from aftercare.


LAGB Aftercare Attrition Perceived barriers Facilitators Strategies Compliance Attendance Complications Follow-up Systematic review 


Conflict of Interest

The Centre for Obesity Research and Education (CORE) receives a grant from Allergan for research support. The grant is not tied to any specified research projects, and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards the educational programmes. Dr Paul O’Brien reported having written a patient information book entitled The LAP-BAND Solution: A Partnership for Weight Loss which was published by Melbourne University Publishing in 2007. Most copies are given to patients without charge, but he reports that he derives a financial benefit from the copies that are sold. He also reports receiving compensation as the national medical director of the American Institute of Gastric Banding, a multicentre facility, based in Dallas, Texas, that treats obesity predominantly by gastric banding. No other authors reported disclosures.


  1. 1.
    O’Brien P, McDonald L, Anderson M, et al. Long term outcomes after bariatric surgery: fifteen-year follow up after gastric banding and a systematic review of the literature. Ann Surg. 2013;257(1):87–94.PubMedCrossRefGoogle Scholar
  2. 2.
    Dixon JB, Laurie CP, Anderson ML, et al. Motivation, readiness to change, and weight loss following adjustable gastric band surgery. Obesity. 2009;17(4):698–705.PubMedCrossRefGoogle Scholar
  3. 3.
    Shen R, Dugay G, Rajaram K, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Poole N. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15(2):261–5.PubMedCrossRefGoogle Scholar
  6. 6.
    te Riele WW. Long-term results of laparoscopic adjustable gastric banding in patients lost to follow-up. Br J Surg. 2010;97(10):1535–40.CrossRefGoogle Scholar
  7. 7.
    Wheeler E, Prettyman A, Lenhard MJ, et al. Adherence to outpatient program postoperative appointments after bariatric surgery. Surg Obes Relat Dis. 2008;4(4):515–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Sivagnanam P, Rhodes M. The importance of follow-up and distance from centre in weight loss after laparoscopic adjustable gastric banding. Surg Endosc. 2010;24(10):2432–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Pontiroli AE, Fossati A, Vedani P, et al. Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients. Obes Surg. 2007;17(11):1492–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Moroshko I, O’Brien P, Brennan L. Patients’ perspectives on laparoscopic adjustable gastric banding (LAGB) aftercare attendance: qualitative assessment. Obes Surg. 2014;24(2):266–75.PubMedCrossRefGoogle Scholar
  11. 11.
    DeNino WF, Osler T, Evans EG, et al. Travel distance as factor in follow-up visit compliance in postlaparoscopic adjustable gastric banding population. Surg Obes Relat Dis. 2010;6(6):597–600.PubMedCrossRefGoogle Scholar
  12. 12.
    Brennan L, Walkley J, Wilks R. Parent-and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention. Obesity. 2012;20(6):1319–24.PubMedCrossRefGoogle Scholar
  13. 13.
    Greenberg I, Stampfer MJ, Schwarzfuchs D, et al. Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial. J Am Coll Nutr. 2009;28(2):159–68.PubMedCrossRefGoogle Scholar
  14. 14.
    Lara MD, Baker MT, Larson CJ, et al. Travel distance, age, and sex as factors in follow-up visit compliance in the post-gastric bypass population. Surg Obes Relat Dis. 2005;1(1):17–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Huisman S, Maes S, De Gucht VJ, et al. Low goal ownership predicts drop-out from a weight intervention study in overweight patients with type 2 diabetes. Int J Behav Med. 2010;17(3):176–81.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Kolotkin RL, Moore JM. Attrition in a behavioral weight-control program: a comparison of dropouts and completers. Int J Eat Disord. 1983;2(3):93–100.CrossRefGoogle Scholar
  17. 17.
    Pekarik G, Blodgett C, Evans RG, et al. Variables related to continuance in a behavioral weight loss program. Addict Behav. 1984;9(4):413–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Teixeira PJ, Going SB, Houtkooper LB, et al. Pretreatment predictors of attrition and successful weight management in women. Int J Obes. 2004;28(9):1124–33.CrossRefGoogle Scholar
  19. 19.
    Clark MM, Niaura R, King TK, et al. Depression, smoking, activity level, and health status: pretreatment predictors of attrition in obesity treatment. Addict Behav. 1996;21(4):509–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Graffagnino CL, Falko JM, La Londe M, et al. Effect of a community-based weight management program on weight loss and cardiovascular disease risk factors. Obesity. 2006;14(2):280–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Packianathan I, Sheikh M, Boniface D, et al. Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements. Diabetes Obes Metab. 2005;7(4):439–47.PubMedCrossRefGoogle Scholar
  22. 22.
    Moroshko I, Brennan L, O’Brien P. Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev. 2011;12(11):912–34.PubMedCrossRefGoogle Scholar
  23. 23.
    Barlow SE, Ohlemeyer CL. Parent reasons for nonreturn to a pediatric weight management program. Clin Pediatr. 2006;45:355–60.CrossRefGoogle Scholar
  24. 24.
    Grossi E, Grave R, Mannucci E, et al. Complexity of attrition in the treatment of obesity: clues from a structured telephone interview. Int J Obes. 2006;30(7):1132–7.CrossRefGoogle Scholar
  25. 25.
    Gross D, Julion W, Fogg L. What motivates participation and dropout among low-income urban families of color in a prevention intervention? Fam Relat. 2001;50(3):246–54.CrossRefGoogle Scholar
  26. 26.
    Kirk E, Jacobsen D, Gibson C, et al. Time course for changes in aerobic capacity and body composition in overweight men and women in response to long-term exercise: the Midwest Exercise Trial (MET). Int J Obes. 2003;27(8):912–9.CrossRefGoogle Scholar
  27. 27.
    McManus K, Antinoro L, Sacks F. A randomized controlled trial of a moderate-fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults. Int J Obes. 2001;25(10):1503–11.CrossRefGoogle Scholar
  28. 28.
    Read A, Ramwell H, Strorer H, et al. A primary care intervention programme for obesity and coronary heart disease risk factor reduction. Br J Gen Pract. 2004;54(501):272–8.PubMedCentralPubMedGoogle Scholar
  29. 29.
    Stahre L, Hallstrom T. A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment. A randomized controlled trial. Eat Weight Disord. 2005;10(1):51–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Harvey-Berino J, Pintauro S, Buzzell P, et al. Effect of internet support on the long-term maintenance of weight loss. Obes Res. 2004;12(2):320–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Lantz H, Peltonen M, Agren L, et al. A dietary and behavioural programme for the treatment of obesity: a 4-year clinical trial and a long-term posttreatment follow-up. J Intern Med. 2003;254(3):272–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Melin I, Karlstrom B, Lappalainen R, et al. A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomised 2-y clinical trial. Int J Obes. 2003;27(9):1127–35.CrossRefGoogle Scholar
  33. 33.
    Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): A randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012;95(2):297–308.Google Scholar
  34. 34.
    Goulis D, Giaglis G, Boren S, et al. Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial. Int J Obes. 2004;28(11):1391.Google Scholar
  35. 35.
    McElroy SL, Frye MA, Altshuler LL, et al. A 24-week, randomized, controlled trial of adjunctive sibutramine versus topiramate in the treatment of weight gain in overweight or obese patients with bipolar disorders. Bipolar Disor. 2007;9(4):426–34.Google Scholar
  36. 36.
    Elder C, Ritenbaugh C, Mist S, et al. Randomized trial of two mind-body interventions for weight-loss maintenance. J Altern Complement Med. 2007;13(1):67–78.PubMedCrossRefGoogle Scholar
  37. 37.
    Jacobsen DJ, Donnelly JE, Snyder-Heelan K, et al. Adherence and attrition with intermittent and continuous exercise in overweight women. Int J Sport Med. 2003;26(4):459–64.Google Scholar
  38. 38.
    Kushner RF, Blatner DJ, Jewell DE, et al. The PPET Study: people and pets exercising together. Obesity. 2006;14(10):1762–70.PubMedCrossRefGoogle Scholar
  39. 39.
    Goldberg JH, Kiernan M. Innovative techniques to address retention in a behavioral weight-loss trial. Health Educ Res. 2005;20(4):439–47. doi: 10.1093/her/cyg139.PubMedCrossRefGoogle Scholar
  40. 40.
    Macleod M, Craigie AM, Barton KL, et al. Recruiting and retaining postpartum women from areas of social disadvantage in a weight-loss trial: an assessment of strategies employed in the WeighWell feasibility study. Matern Child Nutr. 2012;9(3):322–31.PubMedCrossRefGoogle Scholar
  41. 41.
    Perri MG, Martin A, Leermakers EA, et al. Effects of group- versus home-based exercise in the treatment of obesity. J Consult Clin Psychol. 1997;65(2):278–85.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith CH. The effects of telephone prompting and programmed homework in behavioral treatment of the obese. Diss Abstr Int. 1978;39(6):3007–8.Google Scholar
  43. 43.
    Brownell KD, Stunkard AJ, McKeon PE. Weight reduction at the work site: a promise partially fulfilled. Am J Psychiatr. 1985;142(1):47–52.PubMedCrossRefGoogle Scholar
  44. 44.
    Pekarik G. The effects of program duration on continuance in a behavioral weight loss program. Addict Behav. 1987;12(4):381–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Ard JD, Kumanyika S, Stevens VJ, et al. Effect of group racial composition on weight loss in African Americans. Obesity. 2008;16(2):306–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Karanja N, Stevens VJ, Hollis JF, et al. Steps to soulful living (steps): a weight loss program for African-American women. Ethn Dis. 2002;12(3):363–71.PubMedGoogle Scholar
  47. 47.
    Jeffery RW, Sherwood NE, Brelje K, et al. GOOD EMail and phone interventions for weight loss in a managed-care setting: Weigh-To-Be one-year outcomes. Int J Obes. 2003;27(12):1584–92.CrossRefGoogle Scholar
  48. 48.
    Shapiro JR, Bauer S, Hamer RM, et al. Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: a pilot study. J Nut Educ Behav. 2008;40(6):385–91.CrossRefGoogle Scholar
  49. 49.
    Keller CS, Gonzales A, Fleuriet K. Retention of minority participants in clinical research studies. West J Nurs Res. 2005;27(3):292–306.PubMedCrossRefGoogle Scholar
  50. 50.
    Richardson CR, Buis LR, Janney AW, et al. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12(4):e71.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol. 1999;67(1):132–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Minniti A, Bissoli L, Di Francesco V, et al. Individual versus group therapy for obesity: comparison of dropout rate and treatment outcome. Eat Weight Disord. 2007;12(4):161–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Jeffery RW, Forster JL, Snell MK. Promoting weight control at the worksite: a pilot program of self-motivation using payroll-based incentives. Prev Med. 1985;14(2):187–94.PubMedCrossRefGoogle Scholar
  54. 54.
    Lasco RA, Curry RH, Dickson VJ, et al. Participation rates, weight loss, and blood pressure changes among obese women in a nutrition-exercise program. Pubic Health Rep. 1989;104(6):640–6.Google Scholar
  55. 55.
    Parra-Medina D, D’Antonio A, Smith SM, et al. Successful recruitment and retention strategies for a randomized weight management trial for people with diabetes living in rural, medically underserved counties of South Carolina: the POWER study. J Am Diet Assoc. 2004;104(1):70–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Schelling S, Munsch S, Meyer AH, et al. Increasing the motivation for physical activity in obese patients. Int J Eat Disord. 2009;42(2):130–8. doi: 10.1002/eat.20595.PubMedCrossRefGoogle Scholar
  57. 57.
    DiMarco ID, Klein DA, Clark VL, et al. The use of motivational interviewing techniques to enhance the efficacy of guided self-help behavioral weight loss treatment. Eat Behav. 2009;10(2):134–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Smith DE, Heckemeyer CM, Kratt PP, et al. Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM: a pilot study. Diabetes Care. 1997;20(1):52–4.PubMedCrossRefGoogle Scholar
  59. 59.
    VanWormer JJ, Boucher JL. Motivational interviewing and diet modification: a review of the evidence. Diabetes Educ. 2004;30(3):404–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Cowan RJ, Sheridan SM. Investigating the acceptability of behavioral interventions in applied conjoint behavioral consultations: moving from analog conditions to naturalistic settings. Sch Psychol Q. 2003;18(1):1–21.CrossRefGoogle Scholar
  61. 61.
    Kazdin AE. Acceptability of alternative treatments for deviant child behavior. J Appl Behav Anal. 1980;13:259–73.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Kazdin AE. Acceptability of child treatment techniques: the influence of treatment efficacy and adverse side effects. Behav Ther. 1981;12:439–506.Google Scholar
  63. 63.
    Kazdin AE. Perceived barriers to treatment participation and treatment acceptability among antisocial children and their families. J Child Fam Stud. 2000;9(2):157–74.CrossRefGoogle Scholar
  64. 64.
    Nelson TD, Steele RG. Beyond efficacy and effectiveness: a multifaceted approach to treatment evaluation. Prof Psychol Res Prac. 2006;37:389–97.CrossRefGoogle Scholar
  65. 65.
    Sidani S, Miranda J, Epstein DR, et al. Relationships between personal beliefs and treatment acceptability, and preferences for behavioral treatments. Behave Res Ther. 2009;47(10):823–9.CrossRefGoogle Scholar
  66. 66.
    DeVellis RF. Scale development: theory and applications. 2nd ed. Newbury Park: Sage Publications; 2003.Google Scholar
  67. 67.
    Frazer L, Lawley M. Questionnaire design & administration: a practical guide. Milton: John Wiley & Sons Ltd; 2000.Google Scholar
  68. 68.
    Melin I, Reynisdottir S, Berglund L, et al. Conservative treatment of obesity in an academic obesity unit. Long-term outcome and drop-out. Eat Weight Disord. 2006;11(1):22–30.PubMedCrossRefGoogle Scholar
  69. 69.
    Caltabiano ML, Sarafino EP. Health psychology: biopsychosocial interactions. An Australian Perspective. Milton: John Wiley & Sons; 2002.Google Scholar
  70. 70.
    Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.PubMedCrossRefGoogle Scholar
  71. 71.
    Moroshko I, Brennan L, O’Brien P. Predictors of attrition in bariatric aftercare: a systematic review of the literature. Obes Surg. 2012;22(10):1640–7.PubMedCrossRefGoogle Scholar
  72. 72.
    Weingarten SR, Henning JM, Badamgarav E, et al. Interventions used in disease management programmes for patients with chronic illness—which ones work? Meta-analysis of published reports. BMJ. 2002;325(7370):925.PubMedCentralPubMedCrossRefGoogle Scholar
  73. 73.
    Wagner E, Austin B, Von Korff M. Organising care for patients with chronic illness. Millbank Q. 1996;74(4):511–44.CrossRefGoogle Scholar
  74. 74.
    World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. Geneva: World Health Organization; 2002.Google Scholar
  75. 75.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Battersby MW, Kit JA, Prideaux C, et al. Implementing the flinders model of self-management support with aboriginal people who have diabetes: findings from a pilot study. Aust J Prim Health. 2008;14(1):66–74.CrossRefGoogle Scholar
  77. 77.
    Lorig KR, Ritter P, Stewart AL, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39(11):1217–23.PubMedCrossRefGoogle Scholar
  78. 78.
    Zwar NA, Harris M, Griffiths R, et al. A systematic review of chronic disease management. APHCRI: Canberra; 2006.Google Scholar
  79. 79.
    Lorig KR, Sobel DS, Stewart AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14.PubMedCrossRefGoogle Scholar
  80. 80.
    Funnell MM. Empowerment and self-management after weight loss surgery. Obes Surg. 2005;15:417–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lisa S. Hochberg
    • 1
    • 2
  • Kylie D. Murphy
    • 1
    • 3
  • Paul E. O’Brien
    • 1
  • Leah Brennan
    • 1
    • 3
    Email author
  1. 1.Centre for Obesity Research and EducationMonash University, Level 6, The Alfred CentreMelbourneAustralia
  2. 2.School of PsychologyMonash UniversityClaytonAustralia
  3. 3.School of PsychologyAustralian Catholic UniversityMelbourneAustralia

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