Table 2. Studies Examining Post-Operative Adherence to Recommended Diet, Physical Activity, Medical Visits, and Support Groups (n=27).
Study | Bariatric procedure1 |
Sample2 | Mean follow- up period |
Assessment measures/ methods |
Weight loss at follow-up3 |
Predictors |
---|---|---|---|---|---|---|
Bond et al. 2004 | LAGB | 1585; 1309 women, 276 men, Mage=40.4±10 | 24 mos. | Self-made questionnaires | %EWL=Physical activity: 68.2±17.4 No physical activity: 63.9±19.5 | Self-reported physical activity was associated with greater %EWL at 2 years post-surgery. |
Bond et al. 2009 | RYGBP | 199(293); Mage=43.8±11, dor=32% | 12 mos. | Standardized questionnaires | Inactive/active: WL=52.5 %EWL=71.5 Active/active: WL=50.8 %EWL=69.8 Inactive/inactive: WL=46.4 %EWL=63.1 | Patients who changed from inactive to active (>=200min/week) from pre- to 1 yr post-surgery had greatest weight loss. Those who changed had equal weight loss to those who had been active prior to and after surgery. |
Bueter et al. 2007 | RYGBP, LAGB | 71(85); 69 women, 16 men, Mage=40, dor=16% | 27 mos. | Clinical interview, self-made questionnaire | %EWL=43.2 Success (EWL> 50% and no band removal)= 37% | Post-operative physical activity and absence of sweet eating and stress eating was correlated with successful weight loss (%EWL >50 with no band removal). |
Chevallier et al. 2007 | LAGB | 942(1236); Mage=NR, dor=24% | 24 mos. | Retrospective chart review, standardized questionnaires | %EWL <50%=606 patients %EWL>50%=336 patients | Not changing eating behavior associated with 2.2× higher risk of losing <50% vs>50% EWL 2 years post-surgery. |
Coleman et al. 2010 | RYGBP | 110(172); 95 women, 15 men, Mage=44.4±10.6, dor=36% | 32±12 mos. | Clinical interview, standardized questionnaires, height and weight measurement | ≥70% EWL=75 patients ≥50% EWL=103 patients | Post-operative medication and dietary noncompliance were not associated with weight loss outcomes. Depending on the measure, unsuccessful weight loss was associated with missed appointments and dumping syndrome 6 months post-op and exercise noncompliance 2 years post-op. |
Colles et al. 2008 | LAGB | 129(173); 103 women, 26 men, Mage=45.2±11.5, dor=25% | 12 mos. | Semistructured clinical interview, standardized questionnaires, self-made questionnaire | %WL=20.8±8.5 %EWL=50.0±20.7 | Uncontrolled eating and grazing predicted poorer weight loss post-operatively. |
Dixon et al. 2008 | (A) LAGB (B) Conventional therapy | 55(60); (A) 30; 15 women, 15 men, Mage=46.6±7.4, dor=3% (B) 30; 17 women, 13 men, Mage=47.1±8.7, dor=13% | 24 mos. | Medical assessments | WL=Physically active: 13.9±10.9 Not physically active: 7.8±12.3 | Participants who reported more than 3 periods of physical activity>30 minutes/wk had higher mean weight loss. |
Dixon et al. 2009 | LAGB | 204(227); 177 women, 50 men, Mage=42.9±10.4, dor=10% | 24 mos. | Standardized questionnaire, self-made questionnaire | WL=27.9±16.6 %WL=22.1±11.1, %EWL=52.7±27.6 | Poor attendance at follow-up visits associated with less weight loss 2 years post-surgery. |
Elakkary et al. 2006 | (A) LAGB without support group (B) LAGB support group attenders | 38; (A) 28; 26 women, 2 men, Mage=43.1±12.4 (B) 10; 10 women, Mage=45.5±15.1 | 12 mos. | Retrospective chart review | BMIL= (A) 8.1±2.1 (B) 9.7±1.9 | Patients who attended support groups had greater weight loss/BMIL that those who did not attend support groups. |
Evans et al. 2007 | LAGB comparison of subjects at 3 (A), 6 (B), and 12 (C) mo. follow-up | 515; 422 women, 93 men (A) 178; Mage=42.3±10, (B) 128; Mage=43.5±10.9, (C) 209; Mage=43.1±10.9 | 24 mos. | Standard questionnaires | 6-mos. %EWL=Physical activity: 56±11.5 No physical activity: 50.5±11.612 mos. %EWL=Physical activity: 67.4±14.3 No physical activity: 61.7±17.0 | Patients who engaged in 105 minutes/wkof physical activity showed significantly greater weight loss at 6 and 12 months post-operatively, but not at 3 months. |
Forbush et al. 2011 | RYGBP | 265(805); 229 women, 36 men, Mage=48.2±10.25, dor=67% | 5 yrs. | Standardized questionnaires, weight measurements | %EWL=81.24±24.76 | Patients with more energy expended and more hours in activity had better %EWL; increasing hours in activity improved %EWL maintenance. Self-reported energy consumption was not associated with %EWL or %EWL maintenance. |
Gould et al. 2007 | LAGB | 85(130); 71 women, 14 men, dor=35% (A) Mage=47±10 (B) Mage=43±10 (C) Mage=40±7 | 36-48 mos. | Clinical interview | %EWL= (A) 74±16 (B) 61±15 (C) 56±26 | LAGB patients who attend all scheduled follow-up appointments show increased long-term (2-4 year) weight loss. |
Josbeno et al. 2011 | RYGBP | 42(48); 38 women, 4 men, Mage=50.6±9.8, dor=12% | 2-5 yrs. | Standardized questionnaires, weight measurements, accelerometer arm band | %EWL=62.7 ± 19.7%EWL= (A) ≥150 min physical activity/wk: 68.2 ± 19 (B) <150 min physical activity/wk: 52.5 ± 17.4 | Overall, moderate-to-vigorous physical activity (MVPA) predicted %EWL. Those with ≥150 min/wk of MVPA (A) had greater %EWL than those with <150min/wk (B). |
Kaiser et al. 2011 | LAGB | 102; 89 women, 13 men, Mage=45.6±11.3 | 12 mos. | Retrospective chart review | NR | Support group meeting attendance significantly predicted %EWL, controlling for age and baseline BMI. |
Kruseman et al. 2010 | RYGBP | 80(141); 80 women, Mage=40±10, dor=41% | 8 ±1.2 yrs. | Semi-structured interview, standardized questionnaires, food diary, pedometer, BIA measurements | WL=30.7±13.8 | Energy intake (kcal) at 8-year follow-up (but not at 1-year follow-up) was associated with successful weight loss. Patients reporting total daily steps in the upper quartile were four times more likely to achieve 50% EWL. Macronutrient intake and mean number of steps per day were not associated with successful WL. |
Larsen et al. 2006 | LAGB | 157(196); 144 women, 13 men, Mage=40.0±7.9, dor=20% | 33.9±15.1 mos. | Standardized questionnaires, self-reported weight | Mean Post-Operative BMI: 35.3±6.9 (Mean Pre-operative: 45.5±5.7) | Physical activity was not strongly associated with weight loss at 34 months post-surgery. |
Latner et al. 2004 | LAGB | 65(150); 65 women, Mage=39.5, dor=57% | 16.4 mos. | Semistructured clinical interview, telephone follow-up interviews, standardized questionnaires | %EBMIL=71 | Post-operative exercise predicted greater BMI loss. |
Metcalf et al. 2005 | DS | 100; 86 women, 14 men, Mage=NR | 18 mos. | Height, weight and BIA measurements | %WL= Exercisers: 51 Non-exercisers: 54 | Exercise does not affect total percentage of body weight loss, but positively affected body composition post-operatively. |
Orth et al. 2008 | (A) RYGBP, LAGB, and VBG without support group (B) RYGBP, LAGB, and VBG support group attenders | 46; Mage=NR (A) 28 (B) 18 | 12 mos. | Self-made questionnaires | %BMIL= (A) 32 (B) 42 | For RYGBP patients, support groups attenders had greater %BMIL than non-attenders. |
Pontiroli et al. 2007 | LAGB | 162(172); 138 women, 34 men, Mage=40.7±0.81, dor=6% | 12, 24, 36, and 48 mos. | Interview | BMIL=93.3±0.81 | Greater compliance and % attendance at scheduled visits positively associated with weight loss at 12, 24 and 36 months post-surgery. % attendance at scheduled visits predicted weight-loss at 48 months. |
Rosenberger et al. 2011 | RYGBP | 131; 116 women, 15 men, Mage=42.9±10.3 | 12 mos. | Standardized questionnaires, weight measurements | %BMIL=71.3±18.1 | Frequency of moderate/strenuous activity correlated with %BMIL. Intensity of activity significantly associated with greater %BMIL. |
Sarwer et al. 2008 | RYGBP | 112(200); 164 women, 36 men, Mage=43.2±9.8, dor=44% | 20, 40, 66, and 92 wks. | Standardized questionnaires, self-made questionnaires | %EWL=39.4 | Greater self-reported adherence to post-20 week diet associated more weight loss at post-92 weeks. |
Shen et al. 2004 | (A) LAGB (B) RYGBP | 311(355); (A) 130 women, 56 men, Mage=40.4, dor=14%, (B) 92 women, 33 men, Mage=41.3, dor=17% | 12 mos. | Medical follow-up assessments, weight measurements, self-reported weight | %EWL= (A) 44.5±1.4 (B) 66.3±1.9 | Significant difference in %EWL in LAGB patients who attended <=6 times/year vs 6+ times/year, with greater weight loss for the regular attenders. |
Silver et al. 2006 | RYGBP | 140(212); 124 women, 16 men, Mage=45.2±9.9, dor=44% | 24.2±7.9 mos. | Self-made questionnaire, weight measurements | WL=55.8±15.2 | Physical activity but not number of meals and snacks and number of food groups avoided did not predict weight loss. |
Toussi et al. 2009 | RYGBP | 112(172); 95 women, 17 men, Mage=44.5±10.9, dor=35% | 24 mos. | Structured and semistructured interview, standardized questionnaires, measured height and weight | %EWL=70±17 | Post-operative medication noncompliance was not associated with weight loss outcomes at one year but it was associated with less EWL at 2 years. Adherence to appointment attendance, and diet and exercise plans was not associated with EWL. |
Welch et al. 2008 | RYGBP | 200(201); 169 women, 31 men, Mage=44.9±9.7, dor=0.5% | 14.5±13.9 mos. | Self-made questionnaires, self-reported weight | WL=108.9±68.1 | Post-surgery weight loss associated with adherence to activity regime. |
Wolfe et al. 2006 | RYGBP | 93(194); 170 women, 24 men, Mage=42.1±10.4, dor=52% | 78.4±35.7 wks. | Self-made questionnaire, weight measurements | NR | BMI lost did not differ between exercisers and non-exercisers. Planning and self-monitoring of food intake was not associated with BMI lost. |
LAGB=laparoscopic adjustable gastric banding, RYGBP=Roux-en-Y gastric bypass, DS=duodenal switch, VBG= vertical banded gastroplasty.
Sample presented as: post-operative N (pre-operative N, if relevant). DOR=percent lost to post-operative follow-up (if relevant).
NR=not reported. All weight loss (WL) values in kilograms (kg). (%) EWL=(percent) excess weight lost. (%) EMBIL=(percent) excess body mass index lost. (%) BMIL=(percent) body mass index lost.