Scientists present insights into the standard of lifetime of bariatric surgical procedure sufferers

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In today's issue of Annals of Surgery, University of Pittsburgh epidemiologists published two separate analyzes that could help clinicians and policy makers advise patients undergoing bariatric surgery to improve their quality of life for years to come.

A study led by Gretchen White, Ph.D., Assistant Professor of Medicine, and Clinical and Translational Science at the Pitt Institute for Clinical Research and Education, identified several patient characteristics before and after surgery – such as insufficient social support and unrealistic weight loss expectations – this can predict that you will not be satisfied with Roux-en-Y gastric bypass surgery in the long term.

In a second article, White's colleague Wendy King, Ph.D., Associate Professor of Epidemiology at the Pitt Graduate School of Public Health, found that increased physical activity after bariatric surgery decreased symptoms of depression, and decreased symptoms both mental and physical Improve quality of life. regardless of weight loss.

Every year, tens of thousands of Americans struggling with obesity have gastric bypass surgery to control their body weight and comorbid conditions such as diabetes. However, the Pitt scientists found that while most patients are at least somewhat satisfied with their surgery over the long term, they fell from 85% to 77% three to seven years after surgery. Most patients continue to lead sedentary lives, which contributes to weight gain and has a negative impact on their mental well-being.

Knowing which patients are more likely to be dissatisfied with their surgery can help doctors have a conversation about expectations and maximize the positive effects of the procedure, White said. Similarly, providing quantitative data showing that physical activity has positive effects on a person's wellbeing can help transform a patient's perspective on exercise.

"Our data supports why it is important to counsel patients about their physical activity behavior," said King.

"Although patients generally did not meet post-operative physical activity recommendations, we found a dose-response relationship – the more active the patients, the better their depressive symptoms and health-related quality of life improved. Every little bit matters."

Both studies analyzed data from 1,700 adults who had Roux-en-Y gastric bypass surgery between March 2006 and April 2009 and were followed up for up to seven years.

In a pre-surgery assessment, younger age, lower body mass index (BMI), higher percentage of weight loss required to achieve "dream weight", poorer physical and mental health, and lower social support all independently a higher risk of not being satisfied with surgery. In addition, less weight loss, deterioration in physical and mental health, less social support, and more depressive symptomology after surgery were all associated with dissatisfaction.

"Knowing these traits can be useful for clinicians when talking to patients about how realistic their expectations are after surgery, especially when having conversations about reaching their dream weight," said White. "Changing expectations early on can lead to better satisfaction in the long term."

In a separate study, King found that the improvement in quality of life associated with mental and physical health differed according to physical activity. When analyzing objective measures recorded by wearable activity monitors – step count, time spent sitting, and time spent on moderate to vigorous activity – she found that increased physical activity was related to improvements regardless of weight loss.

In her most recent work, also published in the Annals of Surgery, King showed that higher levels of activity predicted better weight loss and less weight gain – but that study did not look at measures to improve quality of life.

Even after surgery, the average patient undergoing bariatric surgery leads a significantly more sedentary lifestyle than doctors recommend.

King says this could explain why the magnitude of associations between physical activity and health-related quality of life improvements and depressive symptoms were small in their cohort. Nevertheless, the results support the expansion of physical activity enhancement measures in patients undergoing bariatric surgery to influence mental and physical health outcomes.

"Most insurers offer nutritional coverage but do not reimburse costs for hiring a health coach or gym membership," said King. "There needs to be more systemic support to help patients increase their activity levels and maintain an active lifestyle after surgery."

The analysis identifies patients who are at greatest risk of weight gain after bariatric surgery

More information:
Annals of Surgery (2020). DOI: 10.1097 / SLA.0000000000004625

Annals of Surgery (2020). DOI: 10.1097 / SLA.0000000000004652

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University of Pittsburgh

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