Associations of dietitian follow-up counselling visits and physical exercise with weight loss one year after sleeve gastrectomy

  • Yafit Kessler
  • Liraz Olmer
  • Asnat Raziel
  • David Goitein
  • Rachel DanknerEmail author
Original Article



To examine associations of patients’ attendance to follow-up meetings with a registered dietitian (RD) and physical exercise practices with weight loss during the 1 year following laparoscopic sleeve gastrectomy (SG).


Of 241 patients with obesity who underwent SG during 2012, 184 (76.3%) participated in a 1-year follow-up telephone interview and had information on number of RD follow-up meetings. Clinical information was available from computerized patient files. Multiple logistic regression analysis, adjusting for propensity score, was computed to reveal factors associated with greater weight loss.


The mean %TWL was 31.4 ± 6.1 and the mean number of reported RD meetings during the year following SG was 4.6. The proportion of physically active patients increased by 15% (from 23 to 42) among those who attended at least 3 RD follow-up meetings (n = 123), and by 5% (from 18 to 23) among those who attended fewer than 3 meetings (n = 61) (p = 0.05). Patients conducting physical exercise reported a lower level of pain/discomfort on the EQ5D quality-of-life questionnaire (p = 0.03). The adjusted regression model revealed no association between the number of RD follow-up meetings and weight-reduction success, but physical exercise during the year following SG conferred a 2.6 times greater odds of belonging to the upper two tertiles of the % excess body weight loss ( 95% CI 1.2–5.3).


Patients with better adherence to RD follow-up meetings were also more physically active. Patients on physical exercise also achieved greater weight reduction following SG, and reported less pain or discomfort. Nutritional counselling and physical exercise are necessary to ensure maximal and sustainable benefits from SG. 

Level of Evidence

Level III, Cohort study.


Sleeve gastrectomy Health-related quality of life Weight loss Bariatric surgery % excess body weight loss % total weight loss Registered dietitian 



This work was performed in partial fulfillment of the requirements for a M.Sc. degree of Ms. Yafir Kessler, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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

The study was approved by the institutional review board of the Maccabi Health Services. All participants were given an explanation about the study at the beginning of the telephone interview, and only those who expressed their verbal consent to participate were included in the study. The study was exempted from a signed informed consent.


  1. 1.
    World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation (WHO Technical Report Series 894. ISBN: 92 4 120894 5Google Scholar
  2. 2.
    Arterburn DE, Courcoulas AP (2014) Bariatric surgery for obesity and metabolic conditions in adults. BMJ 349:g3961. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rexford SA (2011) Digging deeper into obesity. J Clin Invest 121(6):076–2079. CrossRefGoogle Scholar
  4. 4.
    Ribaric G, Buchwald JN, McgLennon TW (2014) Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 24(3):437–455. CrossRefPubMedGoogle Scholar
  5. 5.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM et al (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery Obesity. Endocr Pract 19(2):337–372. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ballantyne GH (2003) Measuring outcomes following bariatric surgery: weight loss parameters, improvement in co-morbid conditions, change in quality of life and patient satisfaction. Obes Surg 13(6):954–964 (Review. PMID:14738691) CrossRefPubMedGoogle Scholar
  7. 7.
    Sjöström L (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med 273(3):219–234. CrossRefPubMedGoogle Scholar
  8. 8.
    Sjöström L, Peltonen M, Jacobson P. Ahlin S, Andersson AJ, Anveden A et al (2014) Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 311(22):2297–2304.
  9. 9.
    Magallares A, Schomerus G (2014) Mental and physical health-related quality of life in obese patients before and after bariatric surgery: A meta-analysis. Psychol Health Med 20(2):165. CrossRefPubMedGoogle Scholar
  10. 10.
    Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK et al (2014) Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol 173(1):20–28. CrossRefPubMedGoogle Scholar
  11. 11.
    Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G et al (2013) Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Kulick D, Hark L, Deen D (2010) The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc 110:593–599. CrossRefPubMedGoogle Scholar
  13. 13.
    Win AZ, Ceresa C, Schafer AL, Mak P, Stewart L (2014) Importance of nutrition visits after gastric bypass surgery for American Veterans, San Francisco, 2004–2010. Prev Chronic Dis 2411:E226. CrossRefGoogle Scholar
  14. 14.
    Stoklossa CJ, Atwal S (2013) Nutrition care for patients with weight regain after bariatric surgery. Gastroenterol Res Pract 2013:256145. CrossRefGoogle Scholar
  15. 15.
    Hindle A, de la Piedad Garcia X, Brennan L (2017) Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 18(3):317–334. Scholar
  16. 16.
    Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C (2010) Endocrine and nutritional management of post bariatric surgery an endocrine society clinical practice guideline. J Clin Endocrinol Metab 95(11):4823–4843. CrossRefPubMedGoogle Scholar
  17. 17.
    Thibault R, Huber O, Azzagury DE, Pichard C (2015) Twelve key nutritional issues in bariatric surgery. Clin Nutr. PubMedCrossRefGoogle Scholar
  18. 18.
    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A et al (2010) Behavioral factors associated with successful weight loss after gastric bypass. Am Surg 76:1139–1142PubMedGoogle Scholar
  19. 19.
    Wilson SJ, Amaral JL, Nonino-Borges CB (2011) Factors related to weight loss up to 4 years after bariatric surgery. Obes Surg 21:1724–1730. CrossRefGoogle Scholar
  20. 20.
    Keren D, Matter I, Rainis T, Lavy A (2011) Getting the most from the sleeve: The importance of post-operative follow-up. Obes Surg 21:1887–1893CrossRefPubMedGoogle Scholar
  21. 21.
    Lombardo M, Bellia A, Mattiuzzo F et al (2015) Frequent follow-up visits reduce weight regain in long-term management after bariatric surgery. Bariatr Surg Pract Patient Care 10(3):119–125. CrossRefGoogle Scholar
  22. 22.
    Kim HJ, Madan A, Fenton-Lee D (2014) Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg 24(4):647–651. CrossRefPubMedGoogle Scholar
  23. 23.
    Endevelt R, Ben-Assuli O, Klain E, Zelber-Sagi S. The role of the dietitian follow-up in the long-term success of bariatric surgery. Surg Obes Relat Dis
  24. 24.
    Peacock JC, Schmidt CE, Barry K (2016 Oct) A qualitative analysis of post-operative nutritional barriers and useful dietary services reported by bariatric surgical patients. Obes Surg 26(10):2331–2339. CrossRefPubMedGoogle Scholar
  25. 25.
    Grundy SM, Barondes JM, Bellegy NJ, Fromm H, Greenaway F, Halsted CH et al (1991) Gastrointestinal surgery for severe obesity: Consensus Development Conference Panel. Ann Intern Med 115:956–961CrossRefGoogle Scholar
  26. 26.
    Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T (2017 Mar) Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr 15(2):382–394. CrossRefGoogle Scholar
  27. 27.
    Horowitz E, Abadi-Korek I, Shani M, Shemer J (2010) EQ-5D as a generic measure of health-related quality of life in Israel: reliability, validity and responsiveness. IMAJ 12:715–720PubMedGoogle Scholar
  28. 28.
    Johnson Stoklossa C, Atwal S (2013) Nutrition care for patients with weight regain after bariatric surgery. Gastroenterol Res Pract 2013:256145CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sarwer DB, Dilks RJ, Smith LW (2011) Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis 7(5):644–651. CrossRefPubMedGoogle Scholar
  30. 30.
    King WC, Hsu JY, Belle SH, Courcoulas AP, Eid GM, Flum DR, Mitchell JE, Pender JR, Smith MD, Steffen KJ, Wolfe BM (2012) Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis 8(5):522–532. CrossRefPubMedGoogle Scholar
  31. 31.
    Amichaud R, Donatini G, Barussaud ML, Charalambous C, Ingrand I, Faure JP (2016) Health-related quality of life after laparoscopic sleeve gastrectomy. A multicentric experience. Minerva Chir 71(4):245–251PubMedGoogle Scholar
  32. 32.
    D’Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F (2011) Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc 25(8):2498–2504. CrossRefPubMedGoogle Scholar
  33. 33.
    Sharma AM (2014) Is it time to lower the bar for bariatric surgery? Obes Surg 24(4):520–521. CrossRefPubMedGoogle Scholar
  34. 34.
    Spivak H, Sakran N, Dicker D, Rubin M, Raz I, Shohat T, Blumenfeld O (2017) Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis. Surg Obes Relat Dis 13(7):1189–1194. CrossRefPubMedGoogle Scholar
  35. 35.
    Welbourn R, Pournaras DJ, Dixon J, Higa K, Kinsman R, Ottosson J, Ramos A, van Wagensveld B, Walton P, Weiner R, Zundel N (2018 Feb) Bariatric surgery worldwide: baseline demographic description and 1-year outcomes from the second IFSO global registry report 2013–2015. Obes Surg 28(2):313–322. CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department for Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Unit for Biostatistics, The Gertner Institute for Epidemiology and Health Policy ResearchSheba Medical CenterRamat GanIsrael
  3. 3.Assia Medical Group, The Israeli Center for Bariatric SurgeryAssuta Medical CenterTel AvivIsrael
  4. 4.Department of Surgery CTel Hashomer Medical CenterRamat GanIsrael
  5. 5.Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy ResearchSheba Medical CenterRamat GanIsrael

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