April 2010

Posted by: Melissa Schumacher

Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass.

MAAIKE KRUSEMAN, MPH, RD, ANIK LEIMGRUBER, RD, FLAVIA ZUMBACH, RD, ALAIN GOLAY, MD, PHD.

The purpose of this study was to document patients’ dietary and anthropometric changes as well as eating behavior, psychological state, and quality of life more than five years after surgery. The participants in the study consisted of 80 women with a mean age of forty years plus or minus ten years. All of the participants underwent a Roux-en-Y gastric bypass between 1997 and 2002 were followed for an average of eight years.
Before the surgery, each patient met with a dietitian, who explained the post-operation diet as well as helped them prepare for any changes or difficulties with the procedure. In addition, they met with a psychologist for an initial assessment. The patients were followed by the RD and surgeon for at least five years after gastric bypass: four times during the first year, and once or twice a year for the remaining four years. In this study, successful weight loss was defined as an excess weight loss of at least fifty percent. Diet was assessed by using a food diary (RD assisted patients in learning how to keep a food diary), body composition was measured by bioelectrical analysis, and eating disorders, psychological factors, and quality of life were evaluated by questionnaires. Activity was measured using a pedometer.
At the end of the eight year study, the average weight loss was 30.7 kilograms. More than half (forty-seven) of patients achieved excess weight loss of at least fifty percent. Ten patients still had a BMI greater than forty while one patient had a BMI of less than twenty-five. Factors associated with this outcome were younger age at baseline, a leaner body composition one year after surgery, lower energy intake at last visit and higher number of psychological consultations. Although the operation leads to smaller volumes of food being consumed, it does not assist in any problems the patient faces in food choices, texture and timing of intake. The patients in this study tended to have high rates of problematic eating patterns. The study concluded by suggesting that patients should not only receive pre-surgery counseling for eating disorders but also extensive follow-up consultations in an attempt to prevent disordered eating from developing.


Continuing Education Article:

Kruseman, M., Leimgruber, A., Zumbach, F., Golay, A. (2010). Dietary, Weight, and Psychological Changes among Patients with Obesity, 8 Years after Gastric Bypass. Journal of the American Dietetic Association, 10(4): 527-534.

Link: http://download.journals.elsevierhealth.com/pdfs/journals/0002-8223/PIIS0002822309020987.pdf

Supplemental Article:
Gasteyger et al. (2008). Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. American Journal of Clinical Nutrition, 87 (5): 1128.

http://www.ajcn.org/cgi/reprint/87/5/1128