title: Behavioral predictors of weight regain after bariatric surgery.
abstract: BACKGROUND
  After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared.
  
  
  RESULTS
  Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p < 0.0001. The mean follow-up after bariatric surgery was 28.1 +/- 18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p = 0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of > or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model.
  
  
  CONCLUSIONS
  Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.
authors: Department of Medicine, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, 4949 Coolidge, Royal Oak, MI 48073, USA.
authors: Jacqueline
authors: J
authors: Odom
authors: Kerstyn C
authors: KC
authors: Zalesin
authors: Tamika L
authors: TL
authors: Washington
authors: Wendy W
authors: WW
authors: Miller
authors: Basil
authors: B
authors: Hakmeh
authors: Danielle L
authors: DL
authors: Zaremba
authors: Mohamed
authors: M
authors: Altattan
authors: Mamtha
authors: M
authors: Balasubramaniam
authors: Deborah S
authors: DS
authors: Gibbs
authors: Kevin R
authors: KR
authors: Krause
authors: David L
authors: DL
authors: Chengelis
authors: Barry A
authors: BA
authors: Franklin
authors: Peter A
authors: PA
authors: McCullough
mesh_terms: D050110:Bariatric Surgery; D016739:Behavior, Addictive / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000517:prevention & control / Q000523:psychology / Q000601:surgery*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain