Weight-loss maintenance in successful weight losers: surgical vs non-surgical methods

Abstract

Objective Since large weight losses are rarely achieved through any method except bariatric surgery, there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means. The National Weight Control Registry (NWCR) provides a resource for making such unique comparisons. This study compared amount of weight regain, behaviors, and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight via either bariatric surgery or non-surgical methods. Design Surgical participants (n = 105) were matched with two non-surgical participants (n = 210) on gender, entry weight, maximum weight loss, and weight maintenance duration and compared prospectively over 1 year. Results Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ≥ 13.6 kg off for 5.5 ± 7.1 years. Both groups gained small but significant amounts of weight from registry entry to 1 year (p = 0.034), but did not significantly differ in magnitude of weight regain (1.8 ± 7.5 kg and 1.7 ± 7.0 kg for surgical and non-surgical groups, respectively; p = 0.369). Surgical participants reported less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress at entry and 1 year. Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups. Conclusions Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight loss maintenance comparable to that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts. Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight loss method.

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

“…Indeed, only one study to date has assessed whether aerobic exercise is even a feasible therapeutic option in this patient population (20). Case-controlled studies indicate that bariatric surgery patients have lower levels of physical activity than weight-matched nonsurgery controls (21)(22)(23). A number of retrospective cohort studies report a positive association between physical activity and postsurgery weight loss (24)(25)(26)(27)(28).…”

“…Case-control studies report significantly lower levels of physical activity than weight-matched nonsurgery controls (21)(22)(23). Indeed, it is not clear whether an exercise training intervention is even a feasible therapeutic option in this unique patient population.…”

Managing obesity in adults in primary care

“…Clinicians can promote long-term maintenance of weight loss using the strategies presented in Box 4. [39][40][41][42] To complete this intervention, a sixth "A" should be added to the mnemonic: advocate -that is, to advocate for environmental and policy changes that support healthy eating and physical activity.…”

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

“…These finding are consistent with other WLS studies that report, in most cases of recidivism, weight loss failure is due to dietary noncompliance or an inability to change eating and exercise behaviors. [17][18][19][20][21][22] Findings from the Swedish Obesity Subjects study reported that baseline caloric intake was 2,800 calories. 35 At 6 months postsurgery, the study reported caloric intake at approximately 1,500 calories, and by 10 years postsurgery, the calorie intake had increased to an average of 1,800-2,000 calories per day.…”

“…[13][14][15][16] Many studies show that, in most cases of recidivism, weight loss failure is due to dietary noncompliance or an inability to change eating, social, and exercise behaviors. [17][18][19][20][21][22] Following WLS, individuals must learn to cope with internal and external eating behavior stimuli, including the family environment, food availability, and emotional stress that may lead to weight regain. 23 This represents the complex behavioral and environmental factors associated with weight maintenance and potential weight regain following WLS.…”