A new study shows somewhat murky success rates, that we probably already are aware of — and that problem behaviors are likely to continue.
60% of Bariatric Patients Keep Weight Off.
Nearly 60% of bariatric surgery patients are successful at long-term weight loss according to a new study from Switzerland with an eight-year follow-up.
However, disordered eating behaviors, such as binge eating or night eating lingered for 51% of the 80 women who completed the entire study, says study author Maaike Kruseman, MPH, RD, professor of nutrition and dietetics at the University of Applied Sciences Western Switzerland, Geneva.
The weight loss results, however, were a pleasant finding for researchers and patients, Kruseman says. ''In our center, most patients have a long history of failed diets, so successful weight loss lasting longer than a couple of years was an incredibly good result," Kruseman tells WebMD in an email interview.
Disordered eating after the bariatric or weight loss surgery is not usually documented on a routine basis, she says, but she suspects it is common. "The bypass takes care of one aspect of the patient's problems, but if disordered eating is present before the operation, it will not [usually] disappear by itself, or only rarely," she says.
That finding, she says, points to the need for long-term follow-up of bariatric surgery patients by a team of health care providers that can tend to medical and psychological needs.
The study appears in the Journal of the American Dietetic Association.
At the 8-year mark, 80 participants, all women, were still taking part in the study. Of those, 47, or 59%, had achieved an excess weight loss of 50% or more, considered successful.
At the end of the follow-up, researchers also found:
- Fifty-three patients or 67% had a BMI under 40; 16 or 20% had shifted from the obesity category to overweight. One woman achieved a normal BMI, under 25.
- The average daily calorie intake went from 2,355 at the study start to 1,680 for the 80 participants who finished the study.
Younger women were more likely to maintain the successful weight loss.
Despite the overall success, Kruseman found that 41 women or 51% had binge eating or night eating syndrome. This points to the need for continued follow-up, she says, with attention given to eating behaviors.
''To my patients who ponder the operation, I ask them to think about their expectations," she says. "It is a very invasive intervention and it has apparently good results, but only on weight. There is no guarantee that their whole life will improve after the operation."
Follow-up Care Important
The weight loss results of the new study are in line with other studies, says John Baker, MD, president of the American Society for Metabolic & Bariatric Surgery and director of the medical weight loss program at Baptist Health in Little Rock, Ark., who reviewed the study for WebMD.
"It's not surprising, the fact that patients still had eating disorder issues," he says. "The surgery doesn't correct those things."
"This [study] is emphasizing the importance of aftercare and allowing the patients access to aftercare," he tells WebMD. That care should include dietary instructions and psychological help to deal with any eating issues, he says.
Another expert says the study results confirm the idea that bariatric surgery requires a long-term commitment by the patient and health care providers. ''The consequences of bariatric surgery can change as patients move through active weight loss to some weight gain," says Trina Histon, PHD, director of the Weight Management Initiative at Kaiser Permanente in Oakland, Calif.
''Patients need various check-ins over the years to ensure they are maintaining optimal care," she says. That way, health care providers can pick up on early warning signs of issues that warrant attention, she says.
The study –
Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass
Background and objective
Long-term data on patients with obesity outcome after bariatric surgery are lacking. The goal was to document dietary and anthropometric changes more than 5 years after surgery, as well as patients' eating behavior, psychological state, and quality of life.
A cohort of 80 women (mean age 40±10 years) who underwent a Roux-en-Y gastric bypass between 1997 and 2002 were followed in a Swiss University Hospital for an average of 8±1.2 years. The primary outcome was successful weight loss defined as excess weight loss ≥50%. Body composition was measured by bioelectrical analysis, and diet was assessed via a food diary. Eating disorders, psychological factors, and quality of life were evaluated by questionnaires. Patients' perceptions of difficulties and benefits were explored using semistructured interviewing. Results at baseline and last visit were compared using paired t test. Cofactors' means were compared between successful and unsuccessful patients with Student t tests and logistic regression.
Average weight loss 8 years after surgery was 30.7±13.8 kg. Excess weight loss ≥50% was observed for 47 patients (59%). Between baseline and last visit, relative proportions of fat mass/total body weight decreased, and fat-free mass/total body weight increased. Mean energy intake was 2,355±775 kcal at baseline and 1,680±506 kcal at last visit, with 42% of energy from carbohydrates, 39% of energy from fats, and 19% of energy from protein (0.8 g/kg). At last visit, 41 patients (51%) described episodes of binge eating or night eating syndrome. Factors associated with excess weight loss ≥50% were: younger age at operation, greater number of psychological consultations before the operation, and higher
scores on ineffectiveness and social insecurity scales at baseline.
More than half of the patients achieved successful weight loss, but disordered eating behavior was frequent. Periodic follow-up screenings and interdisciplinary care are advised. The definition of successful outcome should take into account problematic eating behaviors.