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Unexpected benefits

Does bariatric surgery have a “halo effect”?

Families of bariatric patients demonstrate weight loss and lifestyle improvements
Accompanying patients to pre- and post-operative sessions is sufficient to impart health benefits
Bariatric patients encouraged to be "ambassadors of good health"

According to a study by researchers at Stanford University School of Medicine, family members of patients who have undergone bariatric surgery have reported weight loss and improvements in their lifestyles. This so-called ‘halo effect’ is believed to be a results of the family’s close association with the patient.

The findings were published in the October 2011 issue of the Archives of Surgery.

“Family members were able to lose weight comparable to being part of a medically controlled diet simply by accompanying the bariatric surgery patient to their pre- and post-operative visits," said senior author Dr John Morton, Associate Professor of Surgery at Stanford and Director of Bariatric Surgery at Stanford Hospital & Clinics. “Bariatric surgery programs should encourage family involvement in support groups and education sessions to capitalise on these halo effects.”

Although it has been established that bariatric surgery is an effective treatment for morbid obesity, it is increasingly recognized as a familial disease and healthy behaviour transmission could be enhanced by family relationships. Therefore, the researchers decided to investigate whether changes in weight and healthy behaviour in patients who underwent Roux-en-Y gastric bypass surgery had any subsequent impact on their family members.

The study ran from January 2007 to December 2009 and included 85 participants (35 patients, 35 adult family members, and 15 children younger than 18 years). Of the adult family members of the surgery recipients, 60% were obese prior to the procedure, as were 73% of the children of the patients. Surgery was combined with dietary and lifestyle counselling.

Results

After 12 months, the researchers observed a weight loss in adult family members, from a mean of 234lbs to a mean of 226lbs (p=0.01). Children of patients trended toward lower body mass indices, from 31.2 kg/m2 (expected, based on growth projections) to 29.6 kg/m2 observed (p=0.07). The researchers also noted an increase in daily activity levels among adult and child family members, as measured by the Seven-Day Physical Activity Recall questionnaire, from eight to 17 metabolic equivalent task–hours (equivalent to consuming 1 kcal/kg body weight/hour; p= 0.005), and from 13 to 22 metabolic equivalent task–hours (p=0.04), respectively.

Eating habits, which were measured by the Three-Factor Eating Questionnaire, also improved among adult family members, including a reduction in uncontrollable eating (from a score of 35 to 28; p=0.01), a reduction in emotional eating (from 36 to 28; 0=0.04), and a reduction in alcohol consumption (from 11 drinks per month to one drink per month; 0=0.009).

It is important to note that all the study participants accompanied the patients to all of their pre- and post-operative clinical visits, where they received dietary and lifestyle counselling. These sessions would emphasize a high-protein, high-fibre, low-fat and low-sugar diet and small, frequent meals. The sessions also set daily goals for exercise and stressed a good night's sleep, alcohol moderation and less time in front of the television.

“In the US, we do roughly 200 000 bariatric surgery cases a year, and we struggle with how to deal with the obesity epidemic in society. Can you imagine if every one of these bariatric patients were an ambassador for good health?” added Morton. “You would have a huge, grassroots movement with bariatric surgery providing a vehicle for healthy change for patient and family alike. Obesity is a family disease and bariatric surgery sets the table for future, healthy family meals."

The study was funded by the school's Medical Scholars Program.

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