Page 65 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Preoperative screening of eligible patients is standard part of bariatric treatment. Ac- cording to the IFSO criteria, motivation to follow-up and adherence to, non-specified, behavioural changes is part of the pre-operative assessment 26. Thus, preoperative behaviour of the patients is, at least partly, used to decide whether a patient is suit- able for bariatric surgery. Thereby, it is assumed that current preoperative behaviours influence behaviour and weight change after surgery. This has been questioned be- fore 27. The results of the current study show that preoperative physical activity and self-reported eating style are not related to weight loss or weight regain at any of the follow-up moments. This indicates that questionnaires evaluating physical activity and eating style do not provide information that should be used to decide whether a patient is suitable for bariatric surgery. Preoperative scores did influence the associa- tion between changes in physical activity / eating styles and weight loss after surgery and changing of physical activity and eating style should thus be focus of post-oper- ative care.
Like in the non-bariatric population, regular physical activity is advised to all bariatric patients 8-11. In previous publications higher physical activity after surgery was related to better weight loss 28-34. In our population, patients who became increasingly active showed higher weight loss at almost all follow-up moments. This has been shown before, even when looking at preoperative change in physical activity 22,35.
Emotional eating is thought to negatively influence weight loss results, after non-sur- gical and surgical weight loss treatments 18,36,37. There was a decrease in emotional eating after surgery, this decrease was mostly observed between baseline and 15 months; after that, emotional eating scores gradually increased. The mixed model showed that patients who experienced more emotional eating after surgery had lower weight loss. In addition, at 48- month follow-up, reporting more emotional eating was related to more weight regain. These data do not permit conclusions about causality: self-reported emotional eating might be a factor that contributes to weight regain though it is also possible that people who regain weight increase eating in response to emotions, and even other factors might play a role.
For external and restrained eating, studies assessing the effect on weight loss in bar- iatric patients are scarce and show conflicting results 12,13,17,19. In the large population of the current study, an increase in self-reported restrained eating at 15, 24 and 36 months after RYGB was related with a less weight loss. Higher restrained eating was also related to more weight regain 36 months after surgery. It was interesting that, like emotional and external eating, restrained eating scores decreased after surgery and that higher restrained had a negative relationship with weight loss. These results again show that self-reported restrained eating seems to reflect intentions to restrain intake instead of actual restrained eating 38. For external eating there was only a significant
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