Predictors of Lowest Weight and Long-Term Weight Regain
among Weight Loss Surgery Patients
Brenton R.
Background
Even though weight-loss surgery (WLS) is
the most effective weight loss treatment
for the morbidly obese, not all patients
undergoing WLS experience optimal
outcomes. Over time, WLS patients often
regain weight and may experience
associated declines in health-related
quality of life. Consequently,
these
individuals may be burdened by the
recurring costs associated with obesity
and related medical comorbidities.
Unfortunately, variables related to longterm WLS outcomes are poorly
understood.
Successful weight-loss and weight-loss
maintenance may require different diet,
physical activity, cognitive, and tracking
practices due to poor agreement between
the activities associated with both
outcomes (Sciamanna et al., 2011).
One study examining weight regain (WR)
following WLS reported several patient(e.g., poor diet quality, clinical syndromes,
binge eating, grazing behaviors, physical
inactivity) and surgery-related (e.g.,
stoma, pouch, and sleeve dilation)
predictive factors of WR (Karmali et al.,
2013).
We evaluated the relationship of standard
(e.g., health, diet, physical activity) and
novel (addictive elements of food and
substances) variables to lowest post-WLS
weight (nadir) and WR thereafter.
1
Yanos ,
Karen K.
1
Saules ,
Leslie M.
2
Schuh ,
& Stephanie
3
Sogg
1Eastern
Michigan University (Ypsilanti, MI)
2St. Vincent Carmel Bariatric Center of Excellence (Carmel, IN)
3Massachusetts General Hospital (Boston, MA)
Hypothesis
Several eating-related variables (e.g., food
addiction, nocturnal eating), nonadherence
to
recommended
selfmanagement behaviors, and substance
use were hypothesized to negatively
impact outcomes following WLS.
Method
Patients completed an online survey that
assessed a host of variables including
weight history, medical comorbidities,
substance and alcohol use, physical
activity, food addiction, depression, and
other weight-, health-, and eating-related
variables.
Measures:
• Yale Food Addiction Scale
• Global Physical Activity Questionnaire
• Alcohol Use Disorder Identification Test
• Patient Health Questionnaire- Depression
• Bariatric Surgery Self-management Behaviors
• Questionnaire of Eating and Weight Patterns-R
• Nocturnal Eating Scale
Participants
• 101 post-WLS patients
•
•
•
•
•
•
78.2% female; Mean age = 55.85 yrs
96% Roux-en-y gastric bypass
Mean weight pre-WLS = 328.96 lbs
Mean yrs post-WLS = 8.7
42% total weight-loss at nadir
26% WR from nadir
Results
Stepwise regression showed that pre-WLS
substance use and post-WLS medical
comorbidities were the only significant
predictors of nadir weight. However, daily
vitamin intake approached significance and
2
was thus included in the model (R =
.15, F(3, 92) = 5.53, p < .01). Non-adherence
to several behavioral recommendations was
associated with WR. Significant WR (≥ 20%
from nadir) was associated with similar
practices, plus problematic alcohol use and
“food addiction” symptoms. Depression and
poor exercise adherence were associated
with significant WR (R2 = .21, F(2,61) =
7.94, p < .01).
Sig. correlations with WR
Weight Regain
• Problem foods (+)
• Depression (+)
• Food addiction (+)
• Adequate protein intake (-)
• Fluid consumption (-)
• Physical activity (-)
• Avoiding sweets (-)
• Fruits and Vegetables (-)
• Severe alcohol use (+)
• Post-WLS comorbidities (+)
Presented at Obesity Week, 2013, Atlanta, GA
Discussion
In support of the study hypothesis,
many eating-related variables (except
nocturnal eating), non-adherence
behaviors, and substance use were
associated with WR.
Nadir weight is related to pre-WLS
substance use, post-WLS medical
comorbidities, and daily vitamin intake.
However, WR is associated with far
more variables, such as not following
recommended post-WLS behaviors,
depression, post-WLS alcohol abuse,
and additional variables that may
reflect features of food addiction (i.e.,
eating despite knowledge of adverse
consequences, eating larger amounts
with a marked decrease in effect, and
unsuccessful attempts to stop eating).
Results highlight the importance of
preventative post-WLS behaviors to
attenuate long-term WR. Future
research on the relationship between
aspects of food and substance
“addiction” and long-term WLS
outcomes is warranted.
Stepwise regression model predicting Nadir Weight and WR
%TWL
β
.23
-.25
.19
t
2.36*
-2.50*
1.93
Pre-WLS substance use
Post-WLS comorbidities
Vitamin intake
Depression
Physical activity
*p < .05, **p < .01, Vitamin intake p = .057
%WR
β
t
.32
-.25
2.66**
-2.09*