Abstract
Background:Although bariatric surgery is the most effective treatment for severe obesity, weight regain may still occur. While non-modifiable factors associated with weight regain have been explored, modifiable factors responsible for weight regain are understudied. This scoping review aimed to identify modifiable behaviors associated with weight regain after bariatric surgery. Methods:A systematic search was conducted in Medline, Google Scholar, Cochrane, National Collaborating Centre for Methods and Tools (NCCMT) and Practice-based Evidence in Nutrition (PEN) which included articles published between January 1990 and February 2 2017, for studies examining "weight regain" after bariatric surgery. A total of 293 citations were retrieved. Eligible articles must have examined modifiable factors and addressed weight regain, or a long-term post-operative phase in which weight regain may occur.After removing duplicates, 22 studies were included for thematic analysis. Results:Key modifiable factors associated with weight regain were identified and categorized under the following themes: poor dietary adherence (e.g. excessive calorie, carbohydrate, and alcohol intake), maladaptive eating behaviors (e.g. grazing, binging), lack of on-going follow-up with the bariatric team and insufficient physical activity. Conclusions: Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change.
Highlights
IntroductionSevere obesity, measured by a body mass index (BMI) ≥35 kg/m2, is a complex, multifactorial disease that has been shown to significantly increase the risks of morbidity (e.g. cardiovascular diseases, type 2 diabetes, cancers) and mortality[1]
Severe obesity, measured by a body mass index (BMI) ≥35 kg/m2, is a complex, multifactorial disease that has been shown to significantly increase the risks of morbidity and mortality[1]
Articles were further excluded if they were not relevant to weight regain post-bariatric surgery, involved clinical practice guidelines that did not explicitly examine measurable outcomes, and if they were already mentioned in the included systematic reviews
Summary
Severe obesity, measured by a body mass index (BMI) ≥35 kg/m2, is a complex, multifactorial disease that has been shown to significantly increase the risks of morbidity (e.g. cardiovascular diseases, type 2 diabetes, cancers) and mortality[1]. There are two distinct patient populations observed with people who had bariatric surgery with suboptimal or poor outcomes There are those who do not lose the expected or anticipated average percentage of weight following surgery, while there are others who lose. In the current form, it makes it seem that most of the patients regain weight after surgery, suggesting that surgery is not effective. In a recent study from Kothari and colleagues, reported on 10 year follow-up post bariatric surgery on > 70% of patients 3 They reported a 56% EWL at 10 years post gastric bypass - confirming durability of the results after this operation.”. Conclusions: Health professionals and self-monitoring tools for patients who have undergone bariatric surgery may benefit from these findings to direct their education and interventions to target behavior change
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