Weight Loss Surgery: Patients Who Regain

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

PURPOSE OF REVIEW

Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.

RECENT FINDINGS

Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.

Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough

Bariatric (weight loss) surgery is the gold standard treatment for severe obesity. Concern exists that patients are regaining weight in the longer term. Success and cost-effectiveness of surgery are threatened due to the re-emergence of related conditions such as diabetes. This exploratory qualitative study investigates patients' expectations and experiences of weight regain (WR) 2 years or more after Roux-en-Y gastric bypass (RYGB). Ten participants (two men and eight women) who experienced WR were interviewed between 2 and 6 years following surgery. Findings highlight that participants reacted to initial weight loss as passive spectators and were unprepared for subsequent WR. Their tolerability of WR reduced as the amount of regain increased, suggesting a 'line of tolerance' for WR. WR was influenced by a new vulnerability arising from weight loss over time, and participants struggled to manage their own weight actively as surgical effects waned. They considered self-management skills, and carer and professional support to be limited at the time when WR was most likely to occur. Degrees of tolerability are noted in individuals regaining weight after RYGB. More studies are needed to further understand these problems. Pre- and post-operative support and teaching patients self-management skills may be helpful to minimize WR.

Understanding Eating and Exercise Behaviors in Post Roux-en-Y Gastric Bypass Patients: A Quantitative and Qualitative Study

BACKGROUND

Weight regain following gastric bypass (GB) surgery continues to plague many individuals across the United States. However, understanding long-term eating and exercise behaviors to promote and sustain a lower weight following GB surgery is limited.

METHOD

The purpose of this study was to explore the perceptions and attitudes of eating and exercise behaviors associated with weight maintenance in post-GB patients (n=24) 2 or more years postsurgery. Demographic, anthropometric, and food record data were collected. Focus groups and personal interviews were used to understand behaviors and support systems associated with weight stabilization. Focus groups were audio-taped, transcribed, and organized into common themes.

RESULTS

All participants were female, with a mean of 6 years postsurgery, and had a mean age of 51.8±10.5 years. The majority were married (71%) and had a college degree (58%). Although the average weight regain postsurgery was estimated at 16.2±12.7 kg, most of the women (75%) had maintained a significant weight loss of at least 50% of their excess body weight. Themes associated with weight regain emerging from the focus groups included variable family support and a return to "old eating habits."

CONCLUSION

Focus group participants identified lack of long-term emotional support from family members and limited community support for weight loss surgery patients.