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Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study

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Abstract

Background

Laparoscopic gastric bypass (LGB) surgery markedly increases percent excess weight loss (%EWL) and obesity-related co-morbidities. However, poor study quality and minimal exploration of clinical, behavioral, and psychosocial mechanisms of weight loss have characterized research to date.

Methods

We conducted a comprehensive assessment of n=100 LGB patients surveyed 2–3 years following surgery using standardized measures.

Results

Mean %EWL at follow-up was 59.1±17.2%. This high level of weight loss was associated with a low rate of metabolic syndrome (10.6%), although medications were commonly used to achieve control. Mean adherence to daily vitamin and mineral supplements important to the management of LGB was only 57.6%, and suboptimal blood chemistry levels were found for ferritin (32% of patients), hematocrit (27%), thiamine (25%), and vitamin D (19%). Aerobic exercise level (R 2=0.08) and pre-surgical weight (R 2=0.04) were significantly associated with %EWL, but recommended eating style, fluid intake, clinic follow-up, and support group attendance were not. Psychosocial adjustment results showed an absence of symptomatic depression (0%), common use of antidepressant medications (32.0%), low emotional distress related to the post-surgical lifestyle (19.8±14.0; scale range 0–100), a high level of perceived benefit from weight loss in terms of functioning and emotional well-being (82.7±17.9; scale range 0–100), and a change in marital status for 26% of patients.

Conclusions

At 2–3 years following LGB surgery aerobic exercise, but not diet, fluid intake, or attendance at clinic visits or support groups, is associated with %EWL. Depression is symptomatically controlled by medications, lifestyle related distress is low, and marital status is significantly impacted.

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Correspondence to Garry Welch.

Appendix: Bariatric Surgery Self-management Questionnaire (BSSQ) Subscales and Item Content

Appendix: Bariatric Surgery Self-management Questionnaire (BSSQ) Subscales and Item Content

Eating behaviors (EB):

  1. 1.

    I ate a minimum of 5 mini meals or snacks during the day

  2. 2.

    I ate slowly, putting my utensils or food down between bites

  3. 3.

    It took about 20-30 minutes for me to eat my meals

  4. 4.

    I chewed my food until it was a pureed consistency like baby food

  5. 5.

    I used a bread and butter plate or dessert plate instead of a regular- sized plate for my meals

  6. 6.

    I checked for feeling of a feeling of fullness after every bite

  7. 7.

    I stopped eating immediately if I had any feelings of fullness or discomfort

  8. 8.

    I used a baby spoon, fork, and knife instead of regular sized ones

Fluid intake (FI):

  1. 9.

    I drank 48 ounces (six 8 oz glasses) or more of fluids during the day

  2. 10.

    I only drank water, sugar-free beverages, skim milk, or 1% milk

  3. 11.

    I sipped drinks slowly putting my drink down between sips

  4. 12.

    I avoided using a straw to drink

  5. 13.

    I carried a suitable drink with me at all times

  6. 14.

    I did not rely on feeling thirsty as a signal to drink

  7. 15.

    I checked my urine through the day to make sure it was pale yellow-to-clear in color showing good fluid intake

  8. 16.

    I drank 30 minutes before my meal and waited until 30 minutes after my meal so that I separated my fluids from my solid foods

Physical activity (PA):

  1. 17.

    I got 30-60 minutes of exercise 5 days or more in the past week (e.g., walking, exercise equipment at home, health club, class, etc)

  2. 18.

    I built some exercise into my daily routines (I took the stairs, walked around the supermarket or mall before shopping, etc.)

  3. 19.

    I built some weight training into my exercise program (hand weights, climbing stairs, weight machines, etc)

Dumping syndrome management (DSM):

  1. 20.

    I read nutrition fact panels on food labels to look for high levels of sugar

  2. 21.

    I avoided foods and beverages with 15 grams (3 tsp) of sugar or more a serving

  3. 22.

    I avoided foods and beverages with sugar listed as one of the first three ingredients (glucose, maltose, dextrose, fructose, honey, molasses, corn syrup, brown sugar, cane sugar, confectionary sugar)

  4. 23.

    I avoided sugar alcohols (mannitol, sorbitol, xylitol, lactitol) by looking at food labels as these cause cramping and diarrhea

Supplement Intake (SI):

  1. 24.

    I took a multi-vitamin with minerals tablet every day

  2. 25.

    I took 1000 to 1500 mg of calcium citrate or calcium carbonate with vitamin D every day

  3. 26.

    I took a B-complex vitamin supplement every day

  4. 27.

    I took my vitamin/calcium pills 4 hours or more apart to maximize absorption

Fruits, vegetables, and whole grain intake (FVW):

  1. 28.

    I ate at least 5 fruits and vegetables every day

  2. 29.

    I mostly chose whole grain breads, cereals, and crackers

  3. 30.

    I mostly chose brightly colored fruits and vegetables (yellow, green, red, orange, blue, purple)

Protein Intake (PI):

  1. 31.

    I ate 60-80 grams (2-3 oz) of protein every day (fish, eggs, chicken, turkey, beef, pork, ham, milk, peanut butter, beans, soy, tofu, lentils, cheese, nuts, yogurt, skim or 1% milk, or low sugar protein bars and shakes)

  2. 32.

    I ate the protein on my plate first during meals and snacks

  3. 33.

    I read food labels and chose the foods highest in protein and lowest in sugar

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Welch, G., Wesolowski, C., Zagarins, S. et al. Evaluation of Clinical Outcomes for Gastric Bypass Surgery: Results from a Comprehensive Follow-up Study. OBES SURG 21, 18–28 (2011). https://doi.org/10.1007/s11695-009-0069-3

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