Epidemiologists from the University of Pittsburgh have published two separate analyses in the Annals of Surgery, that could help guide clinicians and policymakers in counselling bariatric surgery patients to improve their quality of life for many years to come.
In the first study, ‘Long-term Satisfaction with Roux-en-Y Gastric Bypass Surgery - Results from a Multicenter Prospective Cohort Study’, led by Dr Gretchen White, assistant professor of medicine and clinical and translational science at Pitt's Institute for Clinical Research and Education, the researchers wanted to know why satisfaction with RYGB surgery changes over time following surgery as the factors associated with not being satisfied are not well understood. They identified several patient characteristics pre- and post-surgery - such as insufficient social support and unrealistic weight loss expectations - that can predict not being satisfied long-term with Roux-en-Y gastric bypass (RYGB) surgery, three to seven years after the procedure.
The study included participants from a multi-centre prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study) of bariatric surgery who were followed annually up to seven years. In total, 1,423 participants of the 1,770 who underwent RYGB had data on satisfaction with surgery (81% female; median age 47 years; median body mass index 46 kg/m2).
The percentage of participants who were not satisfied with RYGB surgery significantly increased from 15.4% three years post-surgery to 23.0% seven years post-surgery (p=0.01). Pre-surgery younger age, lower BMI, higher percent weight loss needed to reach dream weight, lower physical and mental health status and less social support independently predicted higher risk of not being satisfied with surgery.
When examining pre- to post-surgery changes, less post-surgery weight loss, worsening physical and mental health status, less social support and greater depressive symptomology were associated with higher risk of not being satisfied with surgery. The researchers noted that most patients also continue to lead sedentary lives, which contributes to weight regain and negatively affects their mental well-being.
"Knowing these characteristics can be useful for clinicians when talking to patients about how realistic their post-surgery expectations are, particularly when having conversations about achieving their dream weight," said White. "Modifying expectations early may lead to better satisfaction long-term."
Similarly, providing quantitative data that show being more physically active has positive effects on a person's well-being might help shift a patient's perspective on exercise.
"Our data support why it's important to counsel patients regarding their physical activity behaviours," said co-author, Dr Wendy King, associate professor of epidemiology at Pitt's Graduate School of Public Health. "Although patients in general are not meeting physical activity recommendations post-surgery, we found a dose-response relationship - the more active patients were, the better improvement they had in depressive symptoms and health-related quality of life. Every bit matters."
In the second paper, ‘Associations Between Physical Activity and Changes in Depressive Symptoms and Health-Related Quality of Life Across 7 Years Following Roux-en-Y Gastric Bypass Surgery - A Multicenter Prospective Cohort Study’, King and colleagues found that higher physical activity levels after bariatric surgery lessen depressive symptoms and improve mental and physical quality of life, irrespective of weight loss. By analysing objective measures collected from wearable activity monitors - step count, amount of time spent sedentary and amount of time spent doing moderate-to-vigorous activity - they found that higher levels of physical activity related to improvements independent of weight loss.
Adults undergoing RYGB in the LABS-2 study wore an activity monitor and completed the Beck Depression Inventory (BDI) and 36-Item Short Form Health Survey (SF-36) annually ≤7 years. In total, 646 patients were included in the analysis (78% female, median age 47 years, median BMI 46 kg/m2). Linear mixed models estimated associations of quartiles of steps, sedentary behaviour (SB), and moderate-to-vigorous intensity physical activity (MVPA), respectively, with pre-to-post-surgery changes in the BDI and SF-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, respectively, one to seven years post-surgery, with adjustment for sex, age, race, pre-surgery BMI, the respective pre-surgery score, treatment for depression (time-varying) and pre-to-post-surgery weight change (time-varying).
They found that there were dose-response associations between steps, SB (inverse) and MVPA quartiles, respectively, with improvements in each score. Across follow-up, mean improvements in the BDI, MCS and PCS scores, were 1.9 (95%CI, 1.0–2.8), 3.1 (95%CI, 1.5–4.7), and 4.0 (95%CI, 2.7–5.4) points higher, respectively, in the highest versus lowest steps quartile.
King explained that the findings may explain why the magnitude of associations between physical activity level and improvement in health-related quality of life and depressive symptoms in their cohort was small. However, the findings provide support for expanding measures that increase physical activity in bariatric surgery patients to influence mental and physical health outcomes.
"Most insurance providers include coverage for dietary counselling but don't reimburse expenses for hiring a health coach or getting a gym membership," added King. "There needs to be more systemic support to help patients increase their activity level and maintain an active lifestyle post-surgery."