Page 55 - When surgery alone won’t cut it - Valerie Maureen Monpellier

INTRODUCTION
Bariatric surgery has proven to effectively treat morbid obesity and its comorbidities 1,2. However, in 20-30% of the bariatric population insufficient weight loss (< 50% ex- cess weight loss) or substantial weight regain is observed; both can lead to re-emerg- ing of comorbidities and secondary and/or tertiary bariatric procedures 3,4. Behaviour- al factors can be modified and thereby reoperations could be avoided. A recent review focussed on the association between behaviour, mainly physical activity and eating, on weight change after bariatric surgery 5. This review showed that these factors have only been studied sparsely.
Physical activity is considered an important way to achieve weight loss and main- tain a healthy weight 6-8. Therefore, bariatric patients are advised to engage in regular physical activity 8-11. Previous studies indicate that low physical activity after bariatric surgery is related to less weight loss and more weight regain 12-14, though more re- cent studies question whether weight loss is positively influenced by adherence to a healthy lifestyle with regular physical activity 15,16.
Self-reported eating styles, like emotional, restrained or external eating, have not been studied frequently in the bariatric population. Emotional eating, in which patients re- port to eat more in response to emotions, has been linked to less weight loss in two studies 17,18. However, others did not support this association 12,13. Studies on self-re- ported external and restrained eating show the same conflicting results; some sug- gest a negative effect on weight change, while other studies show no effect 12,13,17,19. In addition to these conflicting results, most of the previous studies, assessing the physical activity and eating style, include small populations and relatively short fol- low-ups 12,13,17,18. A longer follow up is of interest since weight loss plateaus around 18 months after surgery 20.
In the present study, the relationship between weight change and self-reported phys- ical activity and eating style was examined in a large bariatric population (primary RYGB) with a longer follow-up (15, 24, 36 and 48 months). It was hypothesized that patients with better physical activity and better eating styles have higher weight loss and less weight regain.
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