Abstract
Bariatric surgery is considered to be an effective treatment for the resolution of severe obesity; however, in more than half of the bariatric surgery patients, weight reacquisition occurs as early as 18 months postsurgery, compromising the surgery's beneficial effects. Maintaining weight loss after surgery poses a great challenge, necessitating the identification of predicting factors. In the present study, we explored the association between weight regain and dietary habits and behavioral lifestyle practices in patients following bariatric surgery. Fifty patients who underwent bariatric surgery with ≥18-month postoperative period of follow-up were included. They were classified into two groups: weight maintainers (n = 29) were patients who regained <15% of their weight, and weight regainers (n = 21) were patients who regained ≥15% of their weight compared to their lowest postoperative weight. The mean age of the study participants was 41.4 ± 8.9 years, and twenty-eight patients (56%) of the total, were females. A detailed analysis of dietary and lifestyle habits was performed by questionnaire-based interviews. Significant weight regain was noted in the regainers compared to the maintainers (19.6 ± 8.4 kg vs. 4.5 ± 3.5 kg, respectively, P ≤ 0.001), which was attributed to their following of unhealthy dietary habits and behavioral lifestyle practices. The dietary and behavioral lifestyle practices adopted by the maintainers were higher fiber consumption and water intake, monitored pace of eating, evasion of emotional binge, and distracted eating and following of self-assessment behaviors. Additionally, regular nutritional follow-ups and compliance with postoperative dietary counseling significantly helped to improve weight maintenance. In conclusion, the effectiveness of weight loss postbariatric surgery was compromised by weight regain due to unhealthy dietary and behavioral lifestyle practices stemming from a lack of nutritional guidance and knowledge. The implementation of comprehensive nutritional counseling and advice on behavioral changes before and after surgery will help achieve optimal weight results.
Highlights
Among the fifty patients studied, 54% were found to follow healthy dietary habits, and 34% followed healthy behavioral lifestyle practices. is finding might indicate the predominance of unhealthy lifestyle behaviors among postbariatric surgery patients collectively compared to unhealthy dietary habits, stressing the fact that the two factors need to be considered as separate and independent causes for weight regain [8, 14]
Upon stratifying the patients into weight regainers and weight maintainers, we found a significant association between adherence to following healthy dietary habits and the maintenance of weight loss. e healthy dietary behaviors that stood out in the maintainers were (1) eating a regular breakfast, (2) having increased intake of water, and (3) eating foods with high dietary fiber content, which included vegetables and fruits
We found that the regainers had a decreased fiber intake characterized by the complete elimination of fruits and vegetables from the daily diet along with low intake of water (Table 2). ese findings illustrate that weight regain is more due to poor selection of healthy foods rather than excessive consumption, and it is mainly attributed to food quality rather than quantity [16]
Summary
Obesity and its associated comorbidities, including metabolic syndrome and type 2 diabetes, continue to represent a major cause of public health burden worldwide, and they are projected to reach approximately 58% of the population worldwide in the upcoming years [1]. e same is true for the Saudi population, where the prevalence rate of obesity has dramatically increased from 22% in 1993 to 36% in 2005 and is projected to rise to 71%, with one of three adults being obese and at least one of ten adults having morbid obesity [2, 3]. e treatment and remission of obesity through lifestyle modifications and pharmacotherapy has largely yielded limited results compared with surgical interventions, especially for morbidly obese patients [4, 5]. E procedures have evolved from invasive, open methods to minimally invasive laparoscopic procedures with mortality rates comparable to those of common general surgical procedures In spite of their proven benefits, their long-term effects on sustaining weight loss have been conflicting, and weight reacquisition is considered a constant threat to the effectiveness of surgery. Ese factors have mainly been attributed to the dietary habits and lifestyle behaviors with the reemergence of presurgery eating disturbances, excessive intake of calories, snacks, and sweets, and the psychological status of patients [8, 9] They are known to play a major role in weight regain and maintenance, their exact contribution to weight regain remains to be further elucidated in patients who underwent bariatric surgery. A comprehensive dietary and behavioral lifestyle assessment was carried out to explore this association and identify potential predictors of weight regain in patients following bariatric surgery. A subanalysis was carried out to evaluate if the gender of the patients influenced the weight regain in the overall group and within the maintainers and regainers groups
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