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BACKGROUND: Disordered eating is a concern for patients seeking metabolic and bariatric surgery (MBS), but little is known about how these behaviors are reflected in typical dietary intake prior to surgery. OBJECTIVES: This study examined the relationships between disordered eating behavior and the content and context of typical dietary intake among patients seeking MBS using an innovative combination of rigorous self-report and interview assessments. SETTING: Participants were recruited from two academic medical centers in the United States. METHODS: Adults were enrolled prior to MBS. Participants completed the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) and then reported details of their dietary intake for three consecutive days using a validated 24-hour dietary recall system. RESULTS: Among the sample (n = 140), objective overeating (OOE) was prevalent and related to greater daily energy and macronutrient intake. Individuals engaging in recurrent OOE were also more likely to consume meals past 8 pm Findings failed to identify significant associations between other disordered eating behaviors, such as objective binge eating (OBE), and contextual factors related to dietary intake. CONCLUSIONS: The timing of eating may play a greater role in recurrent overeating than social and physical aspects of the environment. Individuals reporting frequent OOE before MBS may benefit from targeted education and intervention aimed at reducing OOE and subsequently promoting better adherence to dietary recommendations.
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Objective: Given that low early (4 weeks) weight loss (WL) predicts longer-term WL, the purpose of this study was to identify factors associated with poor early WL. Methods: 438 adults with overweight/obesity participating in an Internet-delivered behavioral WL program provided weights at baseline and 4 weeks. Participants were stratified by percent WL at 4 weeks: LOW: <2% WL, MEDIUM: 2 to <4% WL, HIGH: ≥4% WL and groups were compared on baseline variables (demographics, physical activity, and psychosocial measures) and 4-week intervention adherence. Results: 37.4%, 40.9%, and 21.7% of participants had LOW, MEDIUM, and HIGH early WL respectively. LOW was more likely to be female compared to HIGH and less likely to be non-Hispanic White compared to MEDIUM and HIGH (p's<0.05). After controlling for demographic differences, LOW had lower baseline physical activity compared to HIGH and watched fewer video lessons, self-monitored calorie intake and weight on fewer days, and were less likely to achieve the exercise goal compared to MEDIUM and HIGH (p's<0.05). Conclusion: Findings can inform future adaptive interventions which tailor treatment based upon early WL to improve WL outcomes for more individuals.
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Importance: Weight loss (WL) during the first month of a behavioral program is associated with longer-term WL. Testing of translatable and adaptive obesity programs is needed. Objective: To compare brief, extended, and no telephone coaching for individuals with suboptimal response (ie, 1-month WL <4%) within an online WL program. Design, Setting, and Participants: This randomized clinical trial with enrollment between March 2019 and April 2022 (data collection completed May 2023) was conducted at an academic research center in the US. Eligible participants included adults aged 18 to 70 years with daily access to internet and a body mass index between 25 and 45. Interventions: All participants received an automated online WL program (4 months) and WL maintenance program (8 months), consisting of video lessons, self-monitoring, and personalized feedback. Participants were randomized, such that individuals with suboptimal response received either brief telephone coaching (3 calls during weeks 5-8), extended telephone coaching (12 calls during weeks 5-16), or no coaching (control). Coaching included education, problem solving, and goal setting, and promoted engagement with the online program. Main Outcomes and Measures: The primary outcomes were percent weight change and proportion of participants achieving 5% or greater WL at 4 and 12 months. A priori hypotheses for WL were that WL for extended coaching would be greater than for brief coaching, and both extended and brief coaching would be greater than no coaching (control). A longitudinal mixed-effects model with participant-specific intercept was used to examine intervention effects on percent WL at 4 and 12 months. Secondary analyses focused on program engagement and cost/kilogram of WL. Results: The study included a total of 437 participants who reported WL at 1 month (mean [SD] age, 50.8 [11.4] years; mean [SD] BMI, 34.6 [5.0]; 305 female [69.8%] and 132 male [30.2%]) with 148 randomized to extended coaching, 143 assigned to brief coaching, and 146 assigned to the control group. Of all participants, 346 (79.2%) were considered to have a suboptimal response. WL at 4 months was significantly greater in the extended coaching group (mean [SD] WL, -7.0% [5.1%]) and brief coaching group (mean [SD] WL, -6.2% [4.7%]) vs the control group (mean [SD] WL, -4.5% [4.7%]) (P < .001). Similarly, the proportion of participants achieving 5% or greater WL at 4 months was greater in the extended coaching group (89 participants [65.9%]) and brief coaching group (77 participants [58.5%]) vs control group (46 participants [36.5%]) (P < .001). At 12 months, a similar pattern was observed for achievement of 5% WL or greater (extended coaching, 63 participants [48.1%]; brief coaching, 58 participants [45.9%]; control, 38 participants [32.8%]; P = .03). Percent WL at 12 months was significantly higher in extended coaching vs control (mean [SD] WL for extended coaching, -5.5% [6.7%]; mean [SD] WL for control, -3.9% [7.4%]; P = .03) but not for brief coaching (mean [SD] WL, -4.9% [6.1%]).Both the brief and extended coaching groups watched more lessons and self-monitored on more days compared with the control group. The cost per additional kilogram of WL, beyond that of the control group, was $50.09 for brief coaching and $92.65 for extended coaching. Conclusions and Relevance: In this randomized clinical trial testing an adaptive intervention, the provision of coaching for individuals with suboptimal response improved WL and was cost-effective; further testing in clinical settings (eg, health care systems) is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT03867981.
Subject(s)
Mentoring , Obesity , Telephone , Weight Reduction Programs , Humans , Female , Male , Weight Reduction Programs/methods , Middle Aged , Adult , Mentoring/methods , Obesity/therapy , Weight Loss , AgedABSTRACT
BACKGROUND: Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. METHODS: This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. RESULTS: Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. CONCLUSION: Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.
Subject(s)
Bariatric Surgery , Obesity, Morbid , Telemedicine , Adult , Humans , Feasibility Studies , Pandemics , Retrospective Studies , Obesity, Morbid/surgery , Exercise/psychologyABSTRACT
BACKGROUND: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. OBJECTIVES: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? SETTING: Clinical and academic exercise settings worldwide. METHODS: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. RESULTS: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and postoperative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". CONCLUSIONS: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
Subject(s)
Bariatric Surgery , Exercise , Humans , Exercise/psychology , Bariatric Surgery/methods , Exercise Therapy , Life Style , Physical FitnessABSTRACT
Objective: Greater perceived social support (PSS) is associated with more favorable changes in weight loss, activity behaviors, and eating regulation after metabolic and bariatric surgery (MBS). However, studies have relied on generic, retrospective PSS measures, and stability of PSS levels and relations with weight loss and weight-related behaviors over time is unknown. Using smartphone-based Ecological Momentary Assessment, this study evaluated pre-to 1-year post-MBS changes in daily weight management-focused PSS and associations with weight loss, device-measured activity behaviors, and eating regulation before and during the initial year after MBS. Method: Adult MBS patients (n = 71) received (1) an accelerometer to measure daily moderate-to-vigorous intensity physical activity (MVPA) and sedentary time (ST) minutes/day, and (2) a smartphone to complete morning weight-focused PSS ratings and eating regulation (dietary restraint/disinhibition) ratings at four semi-random times daily for 10 days at pre- and 3, 6, and 12-month postoperative. Generalized linear mixed models analyzed the associations of PSS with total weight loss (%TWL) and activity/eating outcomes. Results: Participants on average reported relatively stable moderate-to-high PSS (3.98 on one to five scale) across assessments. Perceived social support was not related to %TWL, MVPA, or ST. Participants with higher PSS reported lower disinhibition and higher restraint than those with lower PSS (ps < 0.05); however, participants reported higher restraint on days that PSS was lower than their usual levels (p = 0.009). Conclusions: MBS patients on average had stable PSS levels across time. Higher PSS levels were associated with greater resistance to overeating cues (disinhibition) and cognitive control to restrict food intake (restraint) over time. Additionally, participants reported higher restraint when PSS levels were lower than usual. Overall, weight-focused PSS appeared to hold greater importance in relation to regulating eating behavior than engaging in activity behaviors or weight loss among MBS patients during the initial postoperative year. Clinical Trial Registration: NCT02777177.
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BACKGROUND: Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence. OBJECTIVES: To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence. SETTING: University hospital; public practice. METHODS: Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery. RESULTS: A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence. CONCLUSIONS: Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS.
Subject(s)
Bariatric Surgery , Obesity, Morbid , Female , Humans , Male , Obesity, Morbid/surgery , Weight Loss , Diet , ExerciseABSTRACT
Introduction/Purpose: Observational research suggests that consistent exercise timing could be leveraged to promote moderate-to-vigorous physical activity (MVPA) among adults with obesity. However, the feasibility and acceptability of prescribed consistent exercise timing in a free-living setting is unknown. The purpose of this study was to assess the feasibility and acceptability of prescribed consistent exercise timing in a free-living setting among inactive adults with obesity (primary) and to compare MVPA timing prescriptions and characterize exercise barriers/facilitators (secondary). Methods: Using a within-subjects design, inactive adults with obesity (n=15) were randomized in counterbalanced order to three 3-wk exercise timing conditions separated by 2-wk washout periods: 1) consistent morning, 2) consistent evening, and 3) choice timing (control). Feasibility was assessed using prespecified benchmarks. Acceptability and preferred timing were assessed with questionnaires post-intervention. Secondarily, exercise timing and MVPA were assessed via accelerometry and nightly surveys and barriers/facilitators were assessed with nightly surveys. Results: All feasibility benchmarks were achieved (e.g., timing adherence = 69.9% via accelerometry and 87.4% via self-report (target: ≥60%)). Consistent exercise timing was acceptable (mean rating = 3.7 of 5 (target: ≥3.5)). Choice was the most popular prescription. There were medium- to large-sized effects (partial η2 of 0.09-0.16) of condition on MVPA; MVPA was higher during the morning and evening conditions versus choice condition. Facilitators were similar across conditions, while some barriers were time specific. Conclusion: Prescribed exercise timing in a free-living setting appears feasible and acceptable. While choice timing was most preferred, consistent timing appeared most effective for increasing MVPA. Data warrant larger trials to test the efficacy and mechanisms of consistent exercise timing as a translational strategy for promoting MVPA. Pending findings from a fully powered randomized trial, practitioners interested in promoting MVPA among their patients or clients could consider encouraging exercise at a consistent time day-to-day.
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BACKGROUND: Metabolic and bariatric surgery (MBS) is the most effective and durable obesity treatment. However, there is heterogeneity in weight outcomes, which is partially attributed to variability in appetite and eating regulation. Patients with a strong desire to eat in response to the reward of palatable foods are more likely to overeat and experience suboptimal outcomes. This subgroup, classified as at risk, may benefit from repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique that shows promise for reducing cravings and consumption of addictive drugs and food; no study has evaluated how rTMS affects the reinforcing value of food and brain reward processing in the context of MBS. OBJECTIVE: The goal of the Transcranial Magnetic Stimulation to Reduce the Relative Reinforcing Value of Food (RESTRAIN) study is to perform an initial rTMS test on the relative reinforcing value (RRV) of food (the reinforcing value of palatable food compared with money) among adult patients who are pursuing MBS and report high food reinforcement. Using a within-participants sham-controlled crossover design, we will compare the active and sham rTMS conditions on pre- to posttest changes in the RRV of food (primary objective) and the neural modulation of reward, measured via electroencephalography (EEG; secondary objective). We hypothesize that participants will show larger decreases in food reinforcement and increases in brain reward processing after active versus sham rTMS. METHODS: Participants (n=10) will attend 2 study sessions separated by a washout period. They will be randomized to active rTMS on 1 day and sham rTMS on the other day using a counterbalanced schedule. For both sessions, participants will arrive fasted in the morning and consume a standardized breakfast before being assessed on the RRV of food and reward tasks via EEG before and after rTMS of the left dorsolateral prefrontal cortex. RESULTS: Recruitment and data collection began in December 2022. As of October 2023, overall, 52 patients have been screened; 36 (69%) screened eligible, and 17 (47%) were enrolled. Of these 17 patients, 3 (18%) were excluded before rTMS, 5 (29%) withdrew, 4 (24%) are in the process of completing the protocol, and 5 (29%) completed the protocol. CONCLUSIONS: The RESTRAIN study is the first to test whether rTMS can target neural reward circuits to reduce behavioral (RRV) and neural (EEG) measures of food reward in patients who are pursuing MBS. If successful, the results would provide a rationale for a fully powered trial to examine whether rTMS-related changes in food reinforcement translate into healthier eating patterns and improved MBS outcomes. If the results do not support our hypotheses, we will continue this line of research to evaluate whether additional rTMS sessions and pulses as well as different stimulation locations produce clinically meaningful changes in food reinforcement. TRIAL REGISTRATION: ClinicalTrials.gov NCT05522803; https://clinicaltrials.gov/study/NCT05522803. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50714.
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BACKGROUND: The relationship between migraine and blood pressure (BP) is equivocal, warranting exploration of potential moderators. Obesity associates with both migraine and BP in a dose-dependent fashion, although its role as a moderator has not been evaluated. We examined the relation between migraine and BP in women with comorbid migraine and obesity, and whether this relation was influenced by obesity severity. METHODS: Women with migraine and obesity (n = 134) completed a 28-day headache diary before randomization to lifestyle intervention or migraine education. BP (systolic (SBP)/diastolic (DBP)), body mass index (BMI), and waist circumference (WC) were measured before diary completion. Hierarchical linear regression assessed associations between BP and migraine characteristics (headache frequency, duration, and pain intensity), and obesity severity (both total (BMI) and abdominal (WC)) as moderators of these associations. RESULTS: Participants (BMI = 35.4 ± 6.5 kg/m2; WC = 105.4 ± 15.6 cm, SBP = 113.1 ± 12.1/DPB = 68.1 ± 8.0 mmHg) reported 8.4 ± 4.5 migraine days that lasted 20.2 ± 15.9 h with mean pain intensity of 5.9 ± 1.6 on a 10-point scale. DBP inversely related to migraine days in both total (ß = - 0.226, p = .010) and abdominal (ß = 0.214, p = .015) obesity severity models. SBP and obesity severity did not relate to migraine characteristics. Obesity severity did not moderate relations between migraine characteristics and BP (p's > .05). CONCLUSION: Among women with comorbid migraine and obesity, DBP inversely related to migraine frequency; however, obesity severity did not affect the strength of this or other examined associations. Future studies including healthy weight controls and men and women with continuous BP measures are needed to confirm these findings and identify mechanisms and moderators.
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Metabolic and bariatric surgery (MBS) is the most effective long-term treatment for Class III obesity. Reduced dietary intake is considered a behavioral driver of post-surgical weight loss, but limited data have examined this association. Therefore, this study examined prospective, longitudinal relationships between dietary intake and weight loss over 24 months following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. Relationships between weight loss and dietary intake were examined using a validated 24-h dietary recall method. Associations between total energy/macronutrient intake and weight loss outcomes were assessed at 12-, 18-, and 24-months following MBS, defining patients as "responders" and "suboptimal responders". Consistent with previous literature, 12-month responders and suboptimal responders showed significant associations between weight loss and energy (p = 0.018), protein (p = 0.002), and total fat intake (p = 0.005). However, this study also revealed that many of these associations are no longer significant 24 months post-MBS (p > 0.05), despite consistent weight loss trends. This study suggests a short-term signal between these dietary factors and weight loss outcomes 12 months post-MBS; however, this signal does not persist beyond 12 months. These results are essential for interpreting and designing clinical studies measuring long-term post-surgical weight loss outcomes.
Subject(s)
Gastric Bypass , Laparoscopy , Obesity, Morbid , Humans , Gastric Bypass/methods , Obesity, Morbid/surgery , Prospective Studies , Diet , Gastrectomy/methods , Weight Loss , Treatment Outcome , Laparoscopy/methods , Retrospective StudiesABSTRACT
Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting: Clinical and academic exercise settings worldwide. Methods: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
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OBJECTIVE: The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine. METHODS: This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained. RESULTS: The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients' exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions. CONCLUSION: From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients' preferences and psychological considerations, level of physical activity, and possible adverse effects. IMPACT: The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients' psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
Subject(s)
Migraine Disorders , Yoga , Humans , Delphi Technique , Exercise Therapy , ExerciseABSTRACT
INTRODUCTION: Patients who undergo metabolic and bariatric surgery (MBS) are advised to make healthy activity and dietary changes. While previous research has examined post-surgical changes in activity and dietary behaviors separately, no study has assessed whether changes in these behaviors are beneficially associated with each other. We evaluated whether post-surgical improvements in activity behaviors related to favorable changes in dietary behaviors overall and by surgery type (Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]). METHODS: At pre-surgery and 6- and 12-months post-surgery, participants (N = 97; 67 RYGB/30 SG) wore an accelerometer for 7 days and completed 24-h dietary assessments on 3 days. General linear models assessed associations between pre- to post-surgical changes in activity (moderate-to-vigorous physical intensity activity [MVPA], sedentary time [ST]) and dietary (total energy intake [EI; kcal/day], dietary quality [healthy eating index/HEI scores]) behaviors, with surgery type as a moderator. RESULTS: Participants on average: demonstrated small, non-significant post-surgical changes in MVPA and ST minutes/day (ps > .05); and reported significant post-surgical decreases in EI (p < .001), but no changes in HEI scores (ps > .25). Greater 12-month post-surgical increases in MVPA were significantly associated with greater decreases in EI, but only for RYGB participants (p < .001). DISCUSSION: Participants reported large decreases in EI, but made minimal changes in other behaviors after MBS. Results suggest greater increases in MVPA could assist with achieving greater decreases in EI, although this benefit appears to be limited to RYGB patients. Additional research is needed to confirm these findings and determine whether activity-dietary behavior associations differ beyond the immediate post-surgical year.
Subject(s)
Bariatric Surgery , Gastric Bypass , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Bariatric Surgery/methods , Gastric Bypass/methods , Energy Intake , Sedentary Behavior , Gastrectomy/methodsABSTRACT
The rate of hiatal hernia (HH) repair during conversion bariatric surgery is largely unknown. We sought to determine this rate in 12,788 patients undergoing conversion surgery using the 2020 participant use file of the MBSAQIP database. Concurrent HH repair was performed in 24.1% of conversion cases; most commonly during SG to RYGB (33.1%), followed by AGB to SG conversion (20.2%). The remaining conversion pathways had a repair rate around 13%. Only 12.1% of HH repairs were performed using a mesh. GERD was the primary indication for conversion in 65% of the SG to RYGB cases. A much higher proportion of patients with concomitant HH repair reported GERD as the main reason for conversion than those without a HH repair (44.5% vs. 23.7%; p<0.001).
Subject(s)
Bariatric Surgery , Gastroesophageal Reflux , Hernia, Hiatal , Laparoscopy , Obesity, Morbid , Humans , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/surgery , Gastroesophageal Reflux/complications , Hernia, Hiatal/epidemiology , Hernia, Hiatal/surgery , Hernia, Hiatal/complications , Obesity, Morbid/surgery , Incidence , Herniorrhaphy/adverse effects , Treatment Outcome , Laparoscopy/adverse effects , Retrospective Studies , Bariatric Surgery/adverse effectsABSTRACT
Obesity and migraine are often comorbid. Poor sleep quality is also common among individuals with migraine and may be influenced by comorbidities such as obesity. However, understanding of migraine's relationship with sleep and the potential exacerbating effect of obesity remains limited. This study evaluated the associations of migraine characteristics and clinical features with sleep quality among women with comorbid migraine and overweight/obesity and assessed the interplay between obesity severity and migraine characteristics/clinical features in relation to sleep quality. Women seeking treatment for migraine and obesity (n = 127; NCT01197196) completed a validated questionnaire assessing sleep quality (Pittsburgh Sleep Quality Index-PSQI). Migraine headache characteristics and clinical features were assessed using smartphone-based daily diaries. Weight was measured in-clinic, and several potential confounders were assessed using rigorous methods. Nearly 70% of participants endorsed poor sleep quality. Greater monthly migraine days and the presence of phonophobia related to poorer sleep quality, and specifically poorer sleep efficiency, controlling for confounders. Obesity severity was neither independently associated nor interacted with migraine characteristics/features to predict sleep quality. Poor sleep quality is common among women with comorbid migraine and overweight/obesity, although obesity severity does not appear to uniquely relate to or exacerbate the association between migraine and sleep in this population. Results can guide research on mechanisms of the migraine-sleep link and inform clinical care.
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Background--: Most metabolic and bariatric surgery (MBS) patients perform too little moderate-to-vigorous intensity physical activity (MVPA) and too much sedentary time (ST). Identifying factors that influence MVPA and ST in MBS patients is necessary to inform the development of interventions to target these behaviors. Research has focused on individual-level factors and neglected those related to the physical environment (e.g., weather and pollution). These factors may be especially important considering rapid climate change and emerging data that suggest adverse effects of weather and pollution on physical activity are more severe in people with obesity. Objectives--: To examine the associations of weather (maximal, average and Wet Bulb Globe Temperatures), and air pollution indices (air quality index [AQI]) with daily physical activity (PA) of both light (LPA) and MVPA and ST before and after MBS. Methods--: Participants (n=77) wore an accelerometer at pre- and 3, 6, and 12-months post-MBS to assess LPA/MVPA/ST (min/d). These data were combined with participants' local (Boston, MA or Providence, RI, USA) daily weather and AQI data (extracted from federal weather and environmental websites). Results--: Multilevel generalized additive models showed inverted U-shaped associations between weather indices and MVPA (R2≥.63, p<.001), with a marked reduction in MVPA for daily maximal temperatures ≥20°C. Sensitivity analysis showed a less marked decrease of MVPA (min/d) during higher temperatures after versus before MBS. Both MVPA before and after MBS (R2=0.64, p<.001) and ST before MBS (R2=0.395; p≤.05) were negatively impacted by higher AQI levels. Discussion--: This study is the first to show that weather and air pollution indices are related to variability in activity behaviors, particularly MVPA, during pre- and post-MBS. Weather/environmental conditions should be considered in MVPA prescription/strategies for MBS patients, especially in the context of climate change.
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PURPOSE: Postoperative loss of control eating (LOCE) has detrimental associations with weight outcomes and mental health following bariatric surgery. However, little is known regarding LOCE course following surgery and preoperative factors that predict remittance, continuance, or development of LOCE. The present study aimed to characterize LOCE course in the year following surgery by identifying four groups: individuals with (1) postoperative de novo LOCE, (2) maintained LOCE (endorsed at pre- and post-surgery), (3) remitted LOCE (endorsed only at pre-surgery), and (4) those who never endorsed LOCE. Exploratory analyses examined group differences in baseline demographic and psychosocial factors. MATERIALS AND METHODS: A total of 61 adult bariatric surgery patients completed questionnaires and ecological momentary assessment at pre-surgery and 3-, 6-, and 12-month postoperative follow-ups. RESULTS: Results showed that 13 (21.3%) never endorsed LOCE prior to or after surgery, 12 (19.7%) developed LOCE after surgery, 7 (11.5%) evidenced remittance from LOCE after surgery, and 29 (47.5%) maintained LOCE prior to and after surgery. Relative to those who never endorsed LOCE, all groups who evidenced LOCE before and/or after surgery reported greater disinhibition; those who developed LOCE reported less planned eating; and those with maintained LOCE reported less satiety sensitivity and greater hedonic hunger. CONCLUSION: These findings highlight the importance of postoperative LOCE and need for longer-term follow-up studies. Results also suggest a need to examine the longer-term impact of satiety sensitivity and hedonic eating on LOCE maintenance, and the extent to which meal planning may buffer risk for de novo LOCE following surgery.
Subject(s)
Bariatric Surgery , Obesity, Morbid , Adult , Humans , Obesity, Morbid/surgery , Feeding Behavior/psychology , Prognosis , Bariatric Surgery/psychology , Weight Loss/physiologyABSTRACT
OBJECTIVE: Loss-of-control (LOC) eating is common in adults undergoing bariatric surgery. Agreement between real-time and retrospective assessment methods is unclear. METHODS: Adults with severe obesity reported on LOC eating over the preceding 28 days via Eating Disorder Examination-Questionnaire (EDE-Q) items and in near real time over 10 days via ecological momentary assessment (EMA; involving daily repeated surveys delivered via smartphone in the natural environment), with both assessment forms completed before surgery and at 3, 6, and 12 months after surgery. Wilcoxon signed rank tests and generalized linear mixed models were used to compare participants' EDE-Q and EMA reports of subjectively and objectively large LOC episodes across time points. RESULTS: Participants reported subjectively large LOC episodes more frequently via EMA than EDE-Q across time points, although differences did not reach statistical significance (all p > 0.05). Conversely, objectively large LOC episodes were more frequently reported via EDE-Q than EMA, with differences reaching significance at 6 months post surgery only (p = 0.03). CONCLUSIONS: Agreement between real-time and retrospective assessments of LOC eating varied by episode size and time elapsed in the year following surgery. These findings should be considered when designing assessment batteries for bariatric surgery-seeking adults and when extrapolating research findings across studies with diverging methods of real-time versus retrospective self-report assessment of LOC eating in adults undergoing bariatric surgery.
Subject(s)
Bariatric Surgery , Feeding and Eating Disorders , Obesity, Morbid , Humans , Adult , Self Report , Retrospective Studies , Bariatric Surgery/methods , Obesity , Obesity, Morbid/surgeryABSTRACT
Evidence-based online behavioral weight loss (BWL) treatment targets a combination of diet, physical activity, and behavioral skills training. While weight loss outcomes are well documented, little is known about changes in physical activity. This study examined changes in objectively measured physical activity across the energy expenditure spectrum during a fully automated, online BWL program. Adults with overweight or obesity (n = 63) completed a 12-week, online BWL program. Participants wore an accelerometer for 7 days and body weight was measured in-clinic at pre- and post-treatment. At post-treatment, mean daily moderate-to-vigorous physical activity increased by about 4 min (SE = 1.59, p = 0.01). There were no statistically significant changes in light physical activity or time spent sedentary (p's > 0.05). Despite only minimal changes in moderate-to-vigorous physical activity overall, larger increases correlated with greater weight loss (r = - 0.28, p = 0.02), which averaged 6.1% of baseline weight at post-treatment. Though achieving important weight loss outcomes, online programs may fail to produce clinically relevant improvements in physical activity, which can put weight loss maintenance at risk.