Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery
Open accessAbstract
Background To investigate the relationship between preoperative eating behavior, postoperative dietary adherence and weight loss after gastric bypass surgery in a major, urban medical center with a comprehensive bariatric surgery program. Despite the significant weight loss and dramatic improvements in co-morbidities associated with bariatric surgery, a significant minority of patients appear to experience suboptimal weight loss. The reasons for this are not well understood, but the suboptimal weight loss is often attributed to preoperative psychosocial characteristics and/or eating behaviors, as well as poor adherence to the recommended postoperative diet.Methods A prospective investigation was performed of 200 female and male patients who were studied both preoperatively and 20, 40, 66, and 92 weeks postoperatively. All patients underwent either open or laparoscopic Roux-en-Y gastric bypass surgery. The measures were the percentage of weight loss, macronutrient intake, dietary adherence, and eating behavior.Results Gender, baseline cognitive restraint, and self-reported adherence to the postoperative diet at postoperative week 20 were associated with the percentage of weight loss at postoperative week 92. Those high in dietary adherence had lost 4.5% more weight at postoperative week 92 than those low in dietary adherence.Conclusion Baseline cognitive restraint and adherence to the recommended postoperative diet were associated with the percentage of weight loss after gastric bypass surgery. These results suggest the potential utility of pre- and/or postoperative dietary counseling interventions to improve the postoperative outcomes.
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In a prospective study, higher scores on self-report measures of positive affect and self-esteem were associated with greater improvements in adherence to dietary recommendations from week 20 to week 92 post-surgery.
“In a prospective study, those who had higher scores on self‐report measures of positive affect and self‐esteem also demonstrated greater improvements in their adherence to dietary recommendations from week 20 to week 92 post‐surgery. 29”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Pre-operative depressive symptoms were negatively associated with dietary adherence in two prospective studies.
“In contrast, pre‐operative depressive symptoms were negatively associated with dietary adherence in two prospective studies. 29 , 31”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Pre-operative negative affect predicted less improvement in patients' dietary adherence over time.
“Similarly, pre‐operative negative affect predicted less improvement in patients' dietary adherence over time. 29”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Patients who reported higher levels of eating-related cognitive restraint showed greater improvements in adherence over time.
“those who reported having higher levels of eating‐related cognitive restraint showed greater improvements in adherence over time. 29 , 30”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Patients who, prior to surgery, reported feeling more prepared to limit their food intake demonstrated better adherence after surgery.
“Conversely, patients who, prior to surgery, reported feeling more prepared to limit their food intake demonstrated better adherence after surgery, and those who reported having higher levels of eating‐related cognitive restraint showed greater improvements in adherence over time. 29 , 30”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Pre-operative depression/depressive symptoms were commonly associated with poorer adherence to post-operative instructions, including dietary recommendations, follow-up appointment attendance, and exercise.
“Pre‐operative depression/depressive symptoms were commonly associated with poorer adherence to post‐operative instructions, including dietary recommendations, 29 , 31 follow‐up appointment attendance, 13 , 19 and exercise. 30”
From Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review (2024) · cites this paper as [29]
Cognitive restraint and self-efficacy have been identified as predictors of dietary adherence.
“Cognitive restraint and self-efficacy has been identified as predictors of dietary adherence [10, 11].”
From Preoperative predictors of adherence to dietary and physical activity recommendations and weight loss one year after surgery (2016) · cites this paper as [11]
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- Authors
- Sarwer, D. B., Wadden, T. A., Moore, R. H., Baker, A. W., Gibbons, L. M., Raper, S. E., & Williams, N. N.
- Affiliations
- University of Pennsylvania (US)
- University of Florida Health (US)
- Hospital of the University of Pennsylvania (US)
- Corresponding author
- Sarwer, David B.
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 4
- Issue
- 5
- Pages
- 640-646
- ISSN
- 1550-7289 (ISSN-L)
- PMC
- PMC2610859
- OpenAlex
- W2012180351
- Cited by
- 286
- References
- 30
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 15 · 2023: 11 · 2022: 14 · 2021: 23 · 2020: 14 · 2019: 19 · 2018: 19 · 2017: 14 · 2016: 24 · 2015: 16 · 2014: 30 · 2013: 16 · 2012: 21
- FWCI
- 13.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Surgery for Obesity and Related Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5k24dk065018-10)
- National Institute of Diabetes and Digestive and Kidney Diseases (R03DK067885, K24-DK-065018, K23DK060023, K23 DK 60023)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- Roux-en-Y gastric bypass, bariatric surgery
- MeSH terms
- Adult, Diet, Feeding Behavior, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Compliance, Postoperative Complications, Prospective Studies, Gastric Bypass, Weight Gain, Weight Loss, Treatment Outcome
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