Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial

Abstract

Background Weight regain after bariatric surgery often starts after 1-2 y, but studies evaluating strategies to prevent weight regain are lacking. The aim of this intervention was to evaluate the efficacy of a 2-y-group-based lifestyle intervention starting approximately 2 y after Roux-en-Y gastric bypass (RYGB) compared with usual care on weight regain and related metabolic risk factors. Methods A total of 165 patients with a mean of 21 months (range 14-32) after RYGB were randomized to a lifestyle intervention group (LIG) or a usual care group (UCG). Of the 165 participants 86% completed the study. The LIG was offered 16 group meetings over 2 y with focus on healthy diet, physical activity, and behavioural strategies to prevent weight regain, in addition to usual care. Results Mean (SD) total weight loss at study start was 30.1 ± 8.2%, while weight regain during the intervention was 4.9 ± 7.4 and 4.6 ± 9.2% in the LIG and UCG, respectively (P = 0.84). There were no differences in metabolic risk factors between the groups. The LIG participants attended 8 ± 4 group meetings, with no difference in weight regain between participants with high compared to lower participation. In all the participants, a positive association between weight increase from nadir to study start and weight regain during the intervention was found. Participants who reported physical activity ≥ 150 min/wk had smaller % weight regain compared with less active participants (β = − 5.2 [SE 2.0, 95% CI − 9.1 to − 1.4]). Conclusion We found no difference in weight regain between LIG and UCG.

Behavioral weight management interventions in metabolic and bariatric surgery: A systematic review and meta‐analysis investigating optimal delivery timing

“…Weight data were reported in 31 (89%) studies, 41,43,44,46,51,53–59,61–65,67–72,74–81 with 15 (48%) reporting absolute weights 41,44,51,53,57,59,63–65,67,68,70,74,78,79 and 11 (35%) reporting weight changes 43,53,54,56,59,61,69,71,74,77,78 . BMI and/or BMI change was reported in 26 (72%) studies.…”

“…BMI and/or BMI change was reported in 26 (72%) studies. Weight was mostly (56%) measured using digital or calibrated scales 41,43,44,50,51,53–57,59,61,64,67,69,71,74,77,80,81 . The remainder (44%) provided no (17%) 46,49,58,62,68,72 or insufficient information (28%) 52,60,63,65,70,73,75,76,78,79 about methods of assessment for weight and/or BMI.…”

“…As detailed in Data S4, the majority (90%) of experimental interventions lasted ≥3 months (median = 6; range = 1–36). Most (78%) were delivered in person 41,43,44,49–51,53,54,56,58–62,64,65,68,69,71–74,76–81 and either individually (39%), 41,44,49,52,53,55,61,67,68,70,72,73,75,78,81 in a group (24%), 49,51,56,59,65,71,73,76,77,80 or both (5%) 54,58 . Delivery format was not clearly defined for 32% of interventions 43,46,50,51,57,60,62–64,69,74,79 .…”

“…As seen in Figure 2 and detailed in Data S5, at least half of studies had a high risk of selection and/or performance bias . “Random sequence generation” and/or “allocation concealment” domains were judged high risk in 69% of studies due to non‐reporting 41,43,49,50,54,55,59,61–64,67,70,72,74,76,77,81 or use of non‐randomized designs 53,57,58,60,68,71,73 . Double blinding is almost impossible to achieve in behavioral trials, but participants' expectancies can be used to adjust for a lack of blinding, with all studies rated high risk for “blinding” due to lack of blinding/expectation measurement.…”

A place for vitamin supplementation and functional food in bariatric surgery?

“…Some studies have further tested whether dietary interventions associated to BS would decrease weight regain in unselected patients undergoing BS. A recent RCT [66] where patients were randomized post-BS to usual follow-up or to a lifestyle intervention program (i.e. increasing healthy food such as fruits and vegetables and improving food choices and quantities) did not evidence any difference in weight regain between groups.…”