Next in bariatric surgery : the role of lifestyle and adequate information to improve patients’ quality of life and health

Aim: The overall aim of this doctoral thesis is to increase the knowledge about how behavioral modification and information can improve the individual results following bariatric surgery or conventional weight loss treatment.

Background: Obesity is a growing health issue often affecting quality of life and morbidity. Bariatric surgery is since many years acknowledged to lead to successful long-term weight loss. Its effect on weight loss is more pronounced in the beginning post-surgery and thereafter some weight regain is to be expected. To counteract this, it is of importance to explore possible ways to support lifestyle changes among patients who choose to undergo bariatric surgery. Digital solutions may be useful in supporting lifestyle changes pre- or post-surgery, but they have to be scientifically evaluated.

Methods and materials: In Paper I, 250 women with obesity from Finland, Norway, Germany, Sweden and the Netherlands were asked about their main reasons to seek surgery and their expectation on post-surgery weight loss result. In Paper II, at 1-year post-surgery the Swedish participants from paper I (n=50) were asked which issue they felt most satisfied with post-surgery, and if they were satisfied with their post-surgery weight loss. In Paper III, a cohort of 23,233 persons were recruited within a Web-based weight loss program (viktklubb.se) and the participants eating behavior were measured with TFEQ-R18 at baseline, 3- and 6-months. In Paper IV, 146 out of 201 patients accepted for bariatric surgery were randomized either to standard care or to standard care plus a 3-month-smartphone app intervention to increase their level of moderate-to-vigorous physical activity post-surgery.

Results: The main reason to seek bariatric surgery was weight loss. The odds ratio for certain reasons like less co-morbidity, less medication, and longevity was dependent on if the participants had co-morbidities. The participants expected to lose almost 80% of their excessive weight post-surgery. The issue of most satisfaction 1-year post-surgery was improved selfesteem. Only those with a weight loss of more than 80% of their excessive weight were satisfied with their post-surgery weight loss. A change in eating behavior was associated with a greater weight loss in the Web-based weight loss program. The uncontrolled eating score decreased and the cognitive restrained eating score increased in both men and women, whereas a reduction in the emotional eating score only was seen among men. A smartphone app intervention led to a significant increase in minutes/day of moderate-to-vigorous physical activity in the intervention group, compared to the control group receiving standard care postsurgery.

Conclusions: To address patient expectations before bariatric surgery may improve postsurgery satisfaction. Individualized pre-surgery information and post-surgery care could be of importance for the lifestyle changes required after bariatric surgery. Technology like Webbased or app-based programs may serve as interactive solutions to support lifestyle changes and the need for individualized information.

List of scientific papers

I. Women’s reasons to seek bariatric surgery and their expectations on the surgery outcome - A multicenter study from five European countries. Mari Hult, Stephanie E. Bonn, Wouter te Riele, Lars Fischer, Signe Röstad, Kai Orava, Timo Heikkinen, Rune Sandbu and Anne Juuti. [Submitted]

II. Women’s Satisfaction with and Reasons to Seek Bariatric Surgery—a Prospective Study in Sweden with 1-Year Follow-up. Mari Hult, Stephanie E. Bonn, Lena Brandt, Mikael Wirén, Ylva Trolle Lagerros. Obesity Surgery. 2019.
https://doi.org/10.1007/s11695-019-03834-3

III. The Change in Eating Behaviors in a Web-Based Weight Loss Program: A Longitudinal Analysis of Study Completers. Madeleine Svensson, Mari Hult, Marianne van der Mark, Alessandra Grotta, Josefine Jonasson, Yvonne von Hausswolff-Juhlin, Stephan Rössner, Ylva Trolle Lagerros. Journal of Medical Internet Research. 2014;16(11):e234).
https://doi.org/10.2196/jmir.3131

IV. Can app technology increase physical activity after bariatric surgery? Results from the PromMera study, a randomized controlled trial. Mari Hult, Stephanie E. Bonn, Kristina Spetz, Helén Eke, Ellen Andersson, Mikael Wirén, Marie Löf, Ylva Trolle Lagerros. [Submitted]