Obesity Surgery

, Volume 27, Issue 2, pp 416–423 | Cite as

Predictors of Vitamin Adherence After Bariatric Surgery

  • Supreet Sunil
  • Vincent A. Santiago
  • Lorraine Gougeon
  • Katie Warwick
  • Allan Okrainec
  • Raed Hawa
  • Sanjeev SockalingamEmail author
Original Contributions



Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients.


A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis.


Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001).


Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.


Bariatric surgery Obesity Adherence Vitamins 



We would like to thank the patients who participated in this study and our Toronto Western Hospital Bariatric Surgery team members for their support of this research project.

Compliance with Ethical Standards

Ethics 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.


No external sources of funding were used for this study or its publication.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Supreet Sunil
    • 1
  • Vincent A. Santiago
    • 1
  • Lorraine Gougeon
    • 1
  • Katie Warwick
    • 1
  • Allan Okrainec
    • 1
    • 2
  • Raed Hawa
    • 1
    • 3
  • Sanjeev Sockalingam
    • 1
    • 3
    • 4
    Email author
  1. 1.Toronto Western Bariatric Surgery ProgramUniversity Health Network, University of TorontoTorontoCanada
  2. 2.Department of Surgery, Toronto Western HospitalUniversity Health Network, University of TorontoTorontoCanada
  3. 3.Centre for Mental HealthUniversity Health Network, University of TorontoTorontoCanada
  4. 4.Toronto General HospitalUniversity Health NetworkTorontoCanada

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