In the management of bariatric surgery follow-up, a multidisciplinary approach allows to evaluate the weight loss maintenance and the dietary and lifestyle changes adherence. The main aim of this study is to create and to validate a questionnaire (eating behavior after bariatric surgery (EBBS)) to objectivize the compliance to dietary/lifestyle suggestions after bariatric surgery.
Materials and Methods
An observational retrospective monocentric clinical trial was carried out at the Bariatric Surgery Unit of Modena, Italy. All weight-related data of bariatric surgery patients collected during the multidisciplinary post-surgical path were recorded. EBBS questionnaire and three validated psychological tests were administered. EBBS includes 11 questions concerning food (domain A), drinks (B), behaviors (C), and lifestyle (S). All data analyzed in the study were collected during the same visit.
In 41 enrolled patients (52.2 + 11.9 years), the total weight loss after surgery was 44.87 + 18.37 kg (− 35.40 + 11.60%), with a weight loss maintenance of 86.92 + 14.30%. The EBBS questionnaire showed a good internal validity (Cronbach’s alpha 0.743, Hotelling’s T-square test p < 0.001). The S domain was directly related with the percentage of weight loss maintained (p = 0.048), suggesting that the frequent physical activity and the periodic weight self-check are the most predictive behaviors to obtain weight control. None of the psychological questionnaires appeared related to the weight trend.
We validated for the first time a 11-item self-filling questionnaire allowing to quantify the adaption to dietary/lifestyle suggestions provided after bariatric surgery. EBBS questionnaire could be a useful tool both in clinical and research setting to monitor the patient’s adherence to post-surgical indications and to identify predictive factors for bariatric surgery efficacy.
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Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 Suppl):s176–85.
Vecchie A, Dallegri F, Carbone F, et al. Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med. 2018;48:6–17.
Bhaskaran K, Dos-Santos-Silva I, Leon DA, et al. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. The lancet Diabetes & endocrinology. 2018;6(12):944–53.
Di Cesare M, Soric M, Bovet P, et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med. 2019;17(1):212.
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metab Clin Exp. 2019;92:6–10.
Alleva G. La salute degli italiani: aspetti sociali e demografici. In: Italiani CDeSC, editor. Italy: Quaderni; 2017.
Barbieri M, Desesquelles A, Egidi V, et al. Obesity-related mortality in France, Italy, and the United States: a comparison using multiple cause-of-death analysis. Int J Public Health. 2017;62(6):623–9.
Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Jama. 2013;309(1):71–82.
Spelta F, Fratta Pasini AM, Cazzoletti L, et al. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord. 2018;23(1):15–22.
Ladhani M, Craig JC, Irving M, et al. Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant. 2017;32(3):439–49.
Gallagher EJ, LeRoith D. Obesity and diabetes: the increased risk of cancer and cancer-related mortality. Physiol Rev. 2015;95(3):727–48.
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254–66.
Ryan DH, Kahan S. Guideline recommendations for obesity management. The Medical clinics of North America. 2018;102(1):49–63.
Smethers AD, Rolls BJ. Dietary management of obesity: cornerstones of healthy eating patterns. The Medical clinics of North America. 2018;102(1):107–24.
Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065–83.
Baig SJ, Priya P, Mahawar KK, et al. Weight regain after bariatric surgery-a multicentre study of 9617 patients from Indian Bariatric Surgery Outcome Reporting Group. Obes Surg. 2019;29(5):1583–92.
Taylor GJ, Bagby RM, Parker JDA. I disturbi della regolazione affettiva. 2000.
Cavedoni S, Dondi P, Valentini L. Valutazione preliminare e trattamento post-chirurgico rivolti a pazienti sottoposti ad interventi di chirurgia bariatrica. In: Angeli F, editor; 2018.
Fava GA, Kellner R, Perini GI, et al. Italian validation of the symptom rating test (SRT) and symptom questionnaire (SQ). Can J Psychiatr. 1983;28(2):117–23.
Cuzzolaro M, Vetrone G, Marano G, et al. The body uneasiness test (BUT): development and validation of a new body image assessment scale. Eat Weight Disord. 2006;11(1):1–13.
Ruini C, Ottolini F, Rafanelli C, et al. The relationship of psychological well-being to distress and personality. Psychother Psychosom. 2003;72(5):268–75.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometria. 1951;16(3):297–334.
Bland JM, Altman DG. Cronbach's alpha. BMJ (Clinical research ed). 1997;314(7080):572.
Heo M, Kim N, Faith MS. Statistical power as a function of Cronbach alpha of instrument questionnaire items. BMC Med Res Methodol. 2015;15:86.
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. 2011;21(1):18–28.
Yanos BR, Saules KK, Schuh LM, et al. Predictors of lowest weight and long-term weight regain among Roux-en-Y gastric bypass patients. Obes Surg. 2015;25(8):1364–70.
Merillat BD, Gonzalez-Vallejo C. How much sugar is in my frink? The power of visual cues. Nutrients. 2020;12(2)
Pedraza LS, Popkin BM, Batis C, et al. The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico. Int J Behav Nutr Phys Act. 2019;16(1):103.
Avenell A, Robertson C, Skea Z, et al. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess. 2018;22(68):1–246.
Wolnerhanssen BK, Peters T, Kern B, et al. Predictors of outcome in treatment of morbid obesity by laparoscopic adjustable gastric banding: results of a prospective study of 380 patients. Surg Obes Relat Dis. 2008;4(4):500–6.
David LA, Sijercic I, Cassin SE. Preoperative and post-operative psychosocial interventions for bariatric surgery patients: a systematic review. Obes Rev. 2020;21(4):e12926.
Kudel I, Pona A, Cox S, et al. Psychometric properties of NIH PROMIS(R) instruments in bariatric surgery candidates. Health Psychol. 2019;38(5):359–68.
Mohun SH, Spitznagel MB, Gunstad J, et al. Performance on the Montreal Cognitive Assessment (MoCA) in older adults presenting for bariatric surgery. Obes Surg. 2018;28(9):2700–4.
Moscovici M, Wnuk S, Okrainec A, et al. Psychosocial predictors of cognition in bariatric surgery. Psychosomatics. 2019;60(2):164–71.
Pinto-Bastos A, Conceicao E, de Lourdes M, et al. Psychological and behavioral aspects of primary and reoperative surgery: a 6-month longitudinal study. Obes Surg. 2018;28(12):3984–91.
Schafer L, Hubner C, Carus T, et al. Pre- and postbariatric subtypes and their predictive value for health-related outcomes measured 3 years after surgery. Obes Surg. 2019;29(1):230–8.
Lin Z, Qu S. Legend of weight loss: a crosstalk between the bariatric surgery and the brain. Obes Surg. 2020;30:1988–2002.
Spirou D, Raman J, Smith E. Psychological outcomes following surgical and endoscopic bariatric procedures: a systematic review. Obes Rev. 2020;21
Gibson AA, Sainsbury A. Strategies to improve adherence to dietary weight loss interventions in research and real-world settings. Behav Sci (Basel). 2017;7(3)
Yancy Jr WS, Mayer SB, Coffman CJ, et al. Effect of allowing choice of diet on weight loss: a randomized trial. Ann Intern Med. 2015;162(12):805–14.
Conflict of Interest
The authors declare that they have no conflict of interest.
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.
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Spaggiari, G., Santi, D., Budriesi, G. et al. Eating Behavior after Bariatric Surgery (EBBS) Questionnaire: a New Validated Tool to Quantify the Patients’ Compliance to Post-Bariatric Dietary and Lifestyle Suggestions. OBES SURG 30, 3831–3838 (2020). https://doi.org/10.1007/s11695-020-04723-w
- bariatric surgery
- Post-surgical follow-up
- Dietary recommendations
- lifestyle change