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Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial

  • Susanna E. HanvoldEmail author
  • Kathrine J. Vinknes
  • Elin B. Løken
  • Anette Hjartåker
  • Ole Klungsøyr
  • Eline Birkeland
  • Hilde Risstad
  • Hanne L. Gulseth
  • Helga Refsum
  • Anne-Marie Aas
Original Contributions

Abstract

Background

Weight regain after bariatric surgery often starts after 1–2 y, but studies evaluating strategies to prevent weight regain are lacking. The aim of this intervention was to evaluate the efficacy of a 2-y-group-based lifestyle intervention starting approximately 2 y after Roux-en-Y gastric bypass (RYGB) compared with usual care on weight regain and related metabolic risk factors.

Methods

A total of 165 patients with a mean of 21 months (range 14–32) after RYGB were randomized to a lifestyle intervention group (LIG) or a usual care group (UCG). Of the 165 participants 86% completed the study. The LIG was offered 16 group meetings over 2 y with focus on healthy diet, physical activity, and behavioural strategies to prevent weight regain, in addition to usual care.

Results

Mean (SD) total weight loss at study start was 30.1 ± 8.2%, while weight regain during the intervention was 4.9 ± 7.4 and 4.6 ± 9.2% in the LIG and UCG, respectively (P = 0.84). There were no differences in metabolic risk factors between the groups. The LIG participants attended 8 ± 4 group meetings, with no difference in weight regain between participants with high compared to lower participation. In all the participants, a positive association between weight increase from nadir to study start and weight regain during the intervention was found. Participants who reported physical activity ≥ 150 min/wk had smaller % weight regain compared with less active participants (β = − 5.2 [SE 2.0, 95% CI − 9.1 to − 1.4]).

Conclusion

We found no difference in weight regain between LIG and UCG.

Keywords

RYGB Weight regain Randomized clinical trial Lifestyle intervention 

Notes

Acknowledgements

This research was supported by the Norwegian ExtraFoundation for Health and Rehabilitation through the EXTRA funds, the Throne Holst Foundation, and the Norwegian Research Council. We are grateful to the Section of Nutrition and Dietetics, especially Ingunn Bergstad (former chief dietitian), and the Section of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, for contribution in facilitating the project. We also wish to thank the master students in clinical nutrition for data collection, and the staff at the Department of Nutrition, University of Oslo, for their help with analyses of dietary data, the Diabetes Laboratory, and Central Laboratory, Oslo University Hospital, for blood samples and blood analyses, and the Department of Psychology, University of Oslo, Patient Education Resource Centre and Section of Nutrition and Dietetics, Oslo University Hospital, for their contribution to the intervention.

Author Contribution

SEH, HR, and AMA designed the research; SEH conducted the research; SEH, KJV, EBL, OK, HLG, HR, and AMA analyzed data; SEH, KJV, HR, and AMA wrote the paper; and all co-authors reviewed and commented on the manuscript; SEH had the primary responsibility for the final content.

Funding

This study was funded by the Norwegian ExtraFoundation for Health and Rehabilitation through the EXTRA funds, the Throne Holst Foundation, and the Norwegian Research Council.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Regional Committee for Medical and Health Research Ethics. The research was conducted according to the Declaration of Helsinki.

Informed Consent

All subjects signed informed consent before participation in the trial. The study is registered in ClinicalTrials.gov (NCT01270451).

References

  1. 1.
    Scandinavian Obesity Surgery Registry. Annual report SOReg 2016 part 2: follow-up weight changes, change in comorbidity, long-term complications and quality indicators on the clinical level. Internet: http://www.ucr.uu.se/soreg/component/edocman/arsrapport-2016-del-2. Published August 2017 (accessed 10th November 2017).
  2. 2.
    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(1):53–8.  https://doi.org/10.1016/j.nut.2011.01.011.PubMedGoogle Scholar
  3. 3.
    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.  https://doi.org/10.1097/01.sla.0000217592.04061.d5.PubMedGoogle Scholar
  4. 4.
    Kushner RF, Sorensen KW. Prevention of weight regain following bariatric surgery. Curr Obes Rep. 2015;4(2):198–206.  https://doi.org/10.1007/s13679-015-0146-y.PubMedGoogle Scholar
  5. 5.
    Odom J, Zalesin KC, Washington TL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349–56.  https://doi.org/10.1007/s11695-009-9895-6.PubMedGoogle Scholar
  6. 6.
    Livhits M, Mercado C, Yermilov I, et al. Patient behaviors associated with weight regain after laparoscopic gastric bypass. Obes Res Clin Pract. 2011;5(3):e169–266.  https://doi.org/10.1016/j.orcp.2011.03.004.PubMedGoogle Scholar
  7. 7.
    Papalazarou A, Yannakoulia M, Kavouras SA, et al. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18(7):1348–53.  https://doi.org/10.1038/oby.2009.346.PubMedGoogle Scholar
  8. 8.
    Sarwer DB, Moore RH, Spitzer JC, et al. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8(5):561–8.  https://doi.org/10.1016/j.soard.2012.02.010.PubMedGoogle Scholar
  9. 9.
    Kalarchian MA, Marcus MD, Courcoulas AP, et al. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–5.  https://doi.org/10.1016/j.soard.2011.04.231.PubMedGoogle Scholar
  10. 10.
    Nijamkin MP, Campa A, Sosa J, et al. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012;112(3):382–90.  https://doi.org/10.1016/j.jada.2011.10.023.PubMedGoogle Scholar
  11. 11.
    Ogden J, Hollywood A, Pring C. The impact of psychological support on weight loss post weight loss surgery: a randomised control trial. Obesity Surgery. 2015;25(3):500–5.  https://doi.org/10.1007/s11695-014-1428-2.PubMedGoogle Scholar
  12. 12.
    Bradley LE, Forman EM, Kerrigan SG, et al. A pilot study of an acceptance-based behavioral intervention for weight regain after bariatric surgery. Obes Surg. 2016;26(10):2433–41.  https://doi.org/10.1007/s11695-016-2125-0.PubMedGoogle Scholar
  13. 13.
    Bradley LE, Forman EM, Kerrigan SG, et al. Project HELP: a remotely delivered behavioral intervention for weight regain after bariatric surgery. Obes Surg. 2017;27(3):586–98.  https://doi.org/10.1007/s11695-016-2337-3.PubMedGoogle Scholar
  14. 14.
    Faria SL, de Oliveira KE, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20(2):135–9.  https://doi.org/10.1007/s11695-008-9610-z.PubMedGoogle Scholar
  15. 15.
    Himes SM, Grothe KB, Clark MM, et al. Stop regain: a pilot psychological intervention for bariatric patients experiencing weight regain. Obes Surg. 2015;25(5):922–7.  https://doi.org/10.1007/s11695-015-1611-0.PubMedGoogle Scholar
  16. 16.
    Bradley LE, Thomas JG, Hood MM, et al. Remote assessments and behavioral interventions in post-bariatric surgery patients. Surg Obes Relat Dis. 2018;14:1632–44.  https://doi.org/10.1016/j.soard.2018.07.011.PubMedGoogle Scholar
  17. 17.
    Conceicao EM, Machado PP, Vaz AR, et al. APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial. Trials. 2016;17(1):114.  https://doi.org/10.1186/s13063-016-1246-z.PubMedGoogle Scholar
  18. 18.
    Hanvold SE, Loken EB, Paus SF, et al. Great health benefits but no change in employment or psychopharmaceutical drug use 2 years after Roux-en-Y gastric bypass. Obes Surg. 2015;25(9):1672–9.  https://doi.org/10.1007/s11695-015-1583-0.PubMedGoogle Scholar
  19. 19.
    Hanvold SE, Vinknes KJ, Bastani NE, et al. Plasma amino acids, adiposity, and weight change after gastric bypass surgery: are amino acids associated with weight regain? Eur J Nutr. 2017;57:2629–37.  https://doi.org/10.1007/s00394-017-1533-9.PubMedGoogle Scholar
  20. 20.
    Melin I. Obesitas: Handbok för praktisk klinisk behandling av övervikt baserad på beteendemodifikation och konventionell behandling, in Swedish. [Handbook for practical treatmet of obesity and metabolic syndrome based on cognitive behavior modification and conventional treatment] 1995.Google Scholar
  21. 21.
    The Norwegian Directorate of Health. Anbefalinger om kosthold, ernæring og fysisk aktivitet [Recommendations on diet, nutrition and physical activity] 2014. Internet: https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/806/Anbefalinger-om-kosthold-ernering-og-fysisk-aktivitet-IS-2170.pdf (accessed 4th May 2017).
  22. 22.
    The Norwegian Directorate of Health. Keyhole, healthy choices made easy. Internet: https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/1148/Enkelt-a-velge-sunnere-IS-0520E-engelsk.pdf (accessed 9th Oct. 2017).
  23. 23.
    World Health Organization. Global recommendations on physical activity for health. Internet: http://www.who.int/dietphysicalactivity/physical-activity-recommendations-18-64years.pdf?ua=1 (accessed 24th February 2017).
  24. 24.
  25. 25.
    Myhre JB, Johansen AMW, Hjartaker A, et al. Relative validation of a pre-coded food diary in a group of Norwegian adults—comparison of underreporters and acceptable reporters. PLoS One. 2018;13(8):e0202907.  https://doi.org/10.1371/journal.pone.0202907.PubMedGoogle Scholar
  26. 26.
    Rimestad AH, Løken EB, Nordbotten A. Den norske matvaretabellen og beregningsdatabasen ved Institutt for ernæringsforskning, in Norwegian [The Norwegian food composition table and the database for nutrient calculations at the Institute for Nutrition Research]. Nor Epidemiol 2000;10.Google Scholar
  27. 27.
    Solberg M, Anderssen SA. Utarbeidelse av målemetoder for måling av fysisk aktivitet. Utvikling og validering av spørreskjema for ungdom og voksne [Assessment of a method for measuring physical activity. Development and validation of a questionnaire for adolescents and adults], 2002. Internet: http://helsedirektoratet.no/publikasjoner/utarbeidelse-av-malemetoder-for-maling-av-fysisk-aktivitet/Publikasjoner/utarbeidelse-av-malemetoder-for-maling-av-fysisk-aktivitet.pdf (accessed 24th March 2014).
  28. 28.
    Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81.  https://doi.org/10.1249/MSS.0b013e31821ece12.PubMedGoogle Scholar
  29. 29.
    King WC, Hinerman AS, Belle SH, et al. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA. 2018;320(15):1560–9.  https://doi.org/10.1001/jama.2018.14433.PubMedGoogle Scholar
  30. 30.
    da Silva FB, Gomes DL, de Carvalho KM. Poor diet quality and postoperative time are independent risk factors for weight regain after Roux-en-Y gastric bypass. Nutrition. 2016;32(11–12):1250–3.  https://doi.org/10.1016/j.nut.2016.01.018.PubMedGoogle Scholar
  31. 31.
    Stevens J, Truesdale KP, McClain JE, et al. The definition of weight maintenance. Int J Obes. 2006;30(3):391–9.  https://doi.org/10.1038/sj.ijo.0803175.Google Scholar
  32. 32.
    Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: intention-to-treat versus per-protocol analysis. Perspect Clin Res. 2016;7(3):144–6.  https://doi.org/10.4103/2229-3485.184823.PubMedGoogle Scholar
  33. 33.
    Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: executive summary. Crit Pathw Cardiol. 2005;4(4):198–203.PubMedGoogle Scholar
  34. 34.
    Lier HO, Biringer E, Stubhaug B, et al. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42.  https://doi.org/10.1016/j.pec.2011.09.014.PubMedGoogle Scholar
  35. 35.
    Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19(9):1826–34.  https://doi.org/10.1038/oby.2011.172.PubMedGoogle Scholar
  36. 36.
    Kaviani S, Dadgostar H, Mazaherinezhad A, et al. Comparing minimally supervised home-based and closely supervised gym-based exercise programs in weight reduction and insulin resistance after bariatric surgery: a randomized clinical trial. Med J Islam Repub Iran. 2017;31:34.  https://doi.org/10.14196/mjiri.31.34.PubMedGoogle Scholar
  37. 37.
    Stea TH, Andersen LF, Paulsen G, et al. Validation of a pre-coded food diary used among 60–80 year old men: comparison of self-reported energy intake with objectively recorded energy expenditure. PloS One. 2014;9(7):e102029.  https://doi.org/10.1371/journal.pone.0102029.PubMedGoogle Scholar
  38. 38.
    Scagliusi FB, Ferriolli E, Pfrimer K, et al. Characteristics of women who frequently under report their energy intake: a doubly labelled water study. Eur J Clin Nutr. 2009;63(10):1192–9.  https://doi.org/10.1038/ejcn.2009.54.PubMedGoogle Scholar
  39. 39.
    Westerterp KR. Doubly labelled water assessment of energy expenditure: principle, practice, and promise. Eur J Appl Physiol. 2017;117(7):1277–85.  https://doi.org/10.1007/s00421-017-3641-x.PubMedGoogle Scholar
  40. 40.
    Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord. 2000;24(9):1119–30.PubMedGoogle Scholar
  41. 41.
    Bergh I, Kvalem IL, Mala T, et al. Predictors of physical activity after gastric bypass—a prospective study. Obes Surg. 2017;27:2050–7.  https://doi.org/10.1007/s11695-017-2593-x.PubMedGoogle Scholar
  42. 42.
    Bond DS, Jakicic JM, Unick JL, et al. Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity. 2010;18(12):2395–7.  https://doi.org/10.1038/oby.2010.88.PubMedGoogle Scholar
  43. 43.
    Amundsen T, Strommen M, Martins C. Suboptimal weight loss and weight regain after gastric bypass surgery—postoperative status of energy intake, eating behavior, physical activity, and psychometrics. Obes Surg. 2017;27(5):1316–23.  https://doi.org/10.1007/s11695-016-2475-7.PubMedGoogle Scholar
  44. 44.
    Aftab H, Risstad H, Sovik TT, et al. Five-year outcome after gastric bypass for morbid obesity in a Norwegian cohort. Surg Obes Relat Dis. 2014;10(1):71–8.  https://doi.org/10.1016/j.soard.2013.05.003.PubMedGoogle Scholar
  45. 45.
    Elshorbagy AK, Nurk E, Gjesdal CG, et al. Homocysteine, cysteine, and body composition in the Hordaland Homocysteine Study: does cysteine link amino acid and lipid metabolism? Am J Clin Nutr. 2008;88(3):738–46.PubMedGoogle Scholar
  46. 46.
    Elshorbagy AK. Body composition in gene knockouts of sulfur amino acid-metabolizing enzymes. Mamm Genome. 2014;25(9–10):455–63.  https://doi.org/10.1007/s00335-014-9527-x.PubMedGoogle Scholar
  47. 47.
    Elshorbagy AK, Refsum H, Smith AD, et al. The association of plasma cysteine and gamma-glutamyltransferase with BMI and obesity. Obesity. 2009;17(7):1435–40.  https://doi.org/10.1038/oby.2008.671.PubMedGoogle Scholar
  48. 48.
    Aasheim ET, Elshorbagy AK, Diep LM, et al. Effect of bariatric surgery on sulphur amino acids and glutamate. Br J Nutr. 2011;106(3):432–40.  https://doi.org/10.1017/S0007114511000201.PubMedGoogle Scholar
  49. 49.
    Evans RK, Bond DS, Wolfe LG, et al. Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2007;3(5):526–30.  https://doi.org/10.1016/j.soard.2007.06.002.PubMedGoogle Scholar
  50. 50.
    Vatier C, Henegar C, Ciangura C, et al. Dynamic relations between sedentary behavior, physical activity, and body composition after bariatric surgery. Obes Surg. 2012;22(8):1251–6.  https://doi.org/10.1007/s11695-012-0619-y.PubMedGoogle Scholar
  51. 51.
    Peters JC, Beck J, Cardel M, et al. The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: a randomized clinical trial. Obesity. 2016;24(2):297–304.  https://doi.org/10.1002/oby.21327.PubMedGoogle Scholar
  52. 52.
    Levine MD, Kalarchian MA, Courcoulas AP, et al. History of smoking and postcessation weight gain among weight loss surgery candidates. Addict Behav. 2007;32(10):2365–71.  https://doi.org/10.1016/j.addbeh.2007.02.002.PubMedGoogle Scholar
  53. 53.
    Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.  https://doi.org/10.1001/jama.2011.1914.PubMedGoogle Scholar
  54. 54.
    Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87.  https://doi.org/10.1001/jamasurg.2013.3654.PubMedGoogle Scholar
  55. 55.
    Pietilainen KH, Korkeila M, Bogl LH, et al. Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labeled water and co-twin assessments. Int J Obes. 2010;34(3):437–45.  https://doi.org/10.1038/ijo.2009.251.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Susanna E. Hanvold
    • 1
    • 2
    Email author
  • Kathrine J. Vinknes
    • 2
  • Elin B. Løken
    • 2
  • Anette Hjartåker
    • 2
  • Ole Klungsøyr
    • 3
  • Eline Birkeland
    • 1
  • Hilde Risstad
    • 4
  • Hanne L. Gulseth
    • 4
    • 5
  • Helga Refsum
    • 2
    • 6
  • Anne-Marie Aas
    • 1
    • 7
  1. 1.Section of Nutrition and Dietetics, Department of Clinical Service, Division of MedicineOslo University HospitalOsloNorway
  2. 2.Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Oslo Centre for Biostatistics and Epidemiology, Department for Research and Education, Division of Mental Health and AddictionOslo University HospitalOsloNorway
  4. 4.Department of Endocrinology, Morbid Obesity and Preventive Medicine, Division of MedicineOslo University HospitalOsloNorway
  5. 5.Department of Chronic Diseases and AgeingNorwegian Institute of Public HealthOsloNorway
  6. 6.Department of PharmacologyUniversity of OxfordOxfordUK
  7. 7.Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloOsloNorway

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