Bariatric Surgery

Predictors of weight loss after bariatric surgery—a cross-disciplinary approach combining physiological, social, and psychological measures

Abstract

Background

Bariatric surgery leads to a substantial weight loss (WL), however, a subset of patients undergoing surgery fails to achieve adequate WL. The reason for the individual variation in WL remains unexplained. Using an exploratory cross-disciplinary approach, we aimed to identify preoperative and early postoperative factors explaining the variation in WL after bariatric surgery.

Methods

Sixty-one subjects were recruited. Eighteen subjects did not receive surgery and three subjects dropped out, leaving a total sample of 40 subjects. Physiological, social, and psychological data were collected before and 6 months after surgery. All variables were analyzed in combination using a least absolute shrinkage and selection operator (LASSO) regression to explain the variation in WL 18 months after Roux-en-Y gastric bypass (n = 30) and sleeve gastrectomy (n = 10).

Results

Mean WL was 31% (range: 10–52%). The following preoperative factors predicted 59% of the variation in WL: type of surgery (14%), diabetes status (12%), economic resources (9%), sex (7%), binge eating disorder (7%), degree of depression (5%), household type (3%), and physical activity (1%). Including information on early responses after surgery increased the ability to predict WL to 78% and was explained by early WL (47%), changes in energy density of food consumed from a buffet meal (9%), changes in glicentin (5%), degree of depression (5%), sex (5%), type of surgery (2%), economic resources (2%), and changes in drive for thinness (1%).

Conclusions

Using a cross-disciplinary approach, a substantial part of the individual variation in WL was explained by a combination of basic patient characteristics, psychological profile, and social conditions as well as physiological, psychological and behavioral responses to surgery. These results suggest that patient characteristics collected in a cross-disciplinary approach may help determine predictors for less successful WL after bariatric surgery. If verified in larger cohorts this may form the basis for individualized postoperative support to optimize WL outcome.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Overview of the study design.
Fig. 2: Weight loss 18 months after bariatric surgery.

References

  1. 1.

    Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143–55.

    PubMed  PubMed Central  Article  Google Scholar 

  2. 2.

    Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity. JAMA. 2018;319:255.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Lutfi R, Torquati A, Sekhar N, Richards WO. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc. 2006;20:864–7.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Melton GB, Steele KE, Schweitzer MA, Lidor AO, Magnuson TH. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg. 2008;12:250–5.

    PubMed  Article  Google Scholar 

  5. 5.

    Corcelles R, Boules M, Froylich D, Hag A, Daigle CR, Aminian A, et al. Total weight loss as the outcome measure of choice after roux-en-Y gastric bypass. Obes Surg. 2016;26:1794–8.

    PubMed  Article  Google Scholar 

  6. 6.

    Campos GM, Rabl C, Mulligan K, Posselt A, Rogers SJ, Westphalen AC, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Manning S, Pucci A, Carter NC, Elkalaawy M, Querci G, Magno S, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29:1484–91.

    PubMed  Article  Google Scholar 

  8. 8.

    Josbeno DA, Kalarchian M, Sparto PJ, Otto AD, Jakicic JM. Physical activity and physical function in individuals post-bariatric surgery. Obes Surg. 2011;21:1243–9.

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Nielsen MS, Rasmussen S, Just Christensen B, Ritz C, le Roux CW, Berg Schmidt J, et al. Bariatric surgery does not affect food preferences, but individual changes in food preferences may predict weight loss. Obesity. 2018;26:1879–87.

    Article  CAS  Google Scholar 

  10. 10.

    Kanerva N, Larsson I, Peltonen M, Lindroos A-K, Carlsson LM. Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study. Am J Clin Nutr. 2017;106:136–45.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Dirksen C, Jørgensen NB, Bojsen-Møller KN, Kielgast U, Jacobsen SH, Clausen TR, et al. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass. Int J Obes. 2013;37:1452–9.

    CAS  Article  Google Scholar 

  12. 12.

    le Roux CW, Welbourn R, Werling M, Osborne A, Kokkinos A, Laurenius A, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246:780–5.

    PubMed  Article  Google Scholar 

  13. 13.

    Hatoum IJ, Greenawalt DM, Cotsapas C, Reitman ML, Daly MJ, Kaplan LM. Heritability of the weight loss response to gastric bypass surgery. J Clin Endocrinol Metab. 2011;96:E1630–3.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6:67–85.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obes Rev. 2014;15:769–79.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Khorgami Z, Arheart KL, Zhang C, Messiah SE, de la Cruz-Muñoz N. Effect of ethnicity on weight loss after bariatric surgery. Obes Surg. 2015;25:769–76.

    PubMed  Article  Google Scholar 

  17. 17.

    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev. 2011;12:142–8.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Ter Braak UBJM, Hinnen C, de Jong MMC, van de Laar A. Perceived postoperative support differentiates responders from non-responders 3 years after laparoscopic roux-En-Y gastric bypass. Obes Surg. 2018;28:415–20.

    PubMed  Article  Google Scholar 

  19. 19.

    Liebl L, Barnason S, Brage Hudson D. Awakening: a qualitative study on maintaining weight loss after bariatric surgery. J Clin Nurs. 2016;25:951–61.

    PubMed  Article  Google Scholar 

  20. 20.

    Geraci AA, Brunt AR, Marihart CL. Social support systems: a qualitative analysis of female bariatric patients after the first two years postoperative. Bariat Surg Pr Patient Care. 2014;9:66–71.

    Article  Google Scholar 

  21. 21.

    Clark SM, Saules KK, Schuh LM, Stote J, Creel DB. Associations between relationship stability, relationship quality, and weight loss outcomes among bariatric surgery patients. Eat Behav. 2014;15:670–2.

    PubMed  Article  Google Scholar 

  22. 22.

    Sutton DH, Murphy N, Raines DA. Transformation: the “life-changing” experience of women who undergo a surgical weight loss intervention. Bariatr Nurs Surg Patient Care. 2009;4:299–306.

    Article  Google Scholar 

  23. 23.

    Coulman KD, MacKichan F, Blazeby JM, Owen-Smith A. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev. 2017;18:547–59.

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Sogg S, Gorman MJ. Interpersonal changes and challenges after weight-loss surgery. Prim Psychiatry. 2008;15:61–6.

    Google Scholar 

  25. 25.

    Bylund A, Benzein E, Sandgren A. Stabilizing family life after gastric bypass surgery. Int J Qual Stud Health Well-being. 2017;12:1325674.

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    Christensen BJ, Hillersdal L. The taste of intervention: tasting, eating and feeding after weight loss surgery. In: Counihan C, Højlund S, editors. Making taste public. Bloomsbury; London, 2018.

  27. 27.

    Fabricatore AN, Wadden TA. Psychological aspects of obesity. Clin Dermatol. 2004;22:332–7.

    PubMed  Article  Google Scholar 

  28. 28.

    Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.

    PubMed  Article  Google Scholar 

  29. 29.

    Malik S, Mitchell JE, Engel S, Crosby R, Wonderlich S. Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews. Compr Psychiatry. 2014;55:248–59.

    PubMed  Article  Google Scholar 

  30. 30.

    Adami GF, Gandolfo P, Bauer B, Scopinaro N. Binge eating in massively obese patients undergoing bariatric surgery. Int J Eat Disord. 1995;17:45–50.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obe Res. 2004;12:1554–69.

    CAS  Article  Google Scholar 

  32. 32.

    Kinzl JF, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg. 2006;16:1609–14.

    PubMed  Article  Google Scholar 

  33. 33.

    de Zwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM, et al. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relate Dis. 2010;6:79–85.

    Article  Google Scholar 

  34. 34.

    Lunn S, Poulsen S, Daniel SIF. Subtypes in bulimia nervosa: the role of eating disorder symptomatology, negative affect, and interpersonal functioning. Compr Psychiatry. 2012;53:1078–87.

    PubMed  Article  Google Scholar 

  35. 35.

    Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relate Dis. 2019;15:650–5.

    Article  Google Scholar 

  36. 36.

    Christensen BJ, Schmidt JB, Nielsen MS, Tækker L, Holm L, Lunn S, et al. Patient profiling for success after weight loss surgery (GO Bypass study): an interdisciplinary study protocol. Contemp Clin Trials Commun. 2018;10:121–30.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Hatoum IJ, Kaplan LM. Advantages of percent weight loss as a method of reporting weight loss after Roux-en-Y gastric bypass. Obesity. 2013;21:1519–25.

    PubMed  Article  Google Scholar 

  38. 38.

    Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518:197–206.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  39. 39.

    Nielsen MS, Christensen BJ, Ritz C, Rasmussen S, Hansen TT, Bredie WLP, et al. Roux-En-Y gastric bypass and sleeve gastrectomy does not affect food preferences when assessed by an ad libitum buffet meal. Obes Surg. 2017;27:2599–605.

    PubMed  Article  Google Scholar 

  40. 40.

    Christensen BJ, Iepsen EW, Lundgren J, Holm L, Madsbad S, Holst JJ, et al. Instrumentalization of eating improves weight loss maintenance in obesity. Obes Facts. 2017;10:633–47.

    PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Derogatis LR. Symptom Checklist-90-r Dansk Version (Danish Version). Vejledning til Administration og Scoring (Manual for Administration and Scoring). Pearson; Copenhagen, 2009.

  42. 42.

    Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Publishing; 2013.

  43. 43.

    Garner DM. Eating disorder inventory -3. Professional manual. Psychological Assessment Resources, Inc.; Lutz, FL, 2004.

  44. 44.

    Garner DM. Eating disorder inventory -2. Professional manual. Psychological Assessment Resources, Inc.; Odessa, FL, 1991.

  45. 45.

    Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54.

    Article  Google Scholar 

  46. 46.

    Beck A, Steer R, Brown G. Becks depression inventory manual. The Psychological Corporation, San Antonio, 2nd ed., 1996.

  47. 47.

    Little, RJA. Regression with missing X’s: A review. J Am Stat Assoc. 1992,87:1227–37.

  48. 48.

    Hastie T, Tibshirani R, Friedman JH. The elements of statistical learning: data mining, inference, and prediction. Springer, Heidelberg, 2nd ed. 2009.

  49. 49.

    Clausen L, Rosenvinge JH, Friborg O, Rokkedal K. Validating the Eating Disorder Inventory-3 (EDI-3): a comparison between 561 female eating disorders patients and 878 females from the general population. J Psychopathol Behav Assess. 2011;33:101–10.

    PubMed  Article  Google Scholar 

  50. 50.

    DeVault ML. Feeding the Family: the social organization of caring as gendered work. University of Chicago Press; Chicago, 1991.

  51. 51.

    Hjorth MF, Chaput J-P, Ritz C, Dalskov S-M, Andersen R, Astrup A, et al. Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8- to 11-year-old children. Int J Obes. 2014;38:959–65. 2014.

    CAS  Article  Google Scholar 

  52. 52.

    Magnusson M, Sørensen TIA, Olafsdottir S, Lehtinen-Jacks S, Holmen TL, Heitmann BL, et al. Social inequalities in obesity persist in the nordic region despite its relative affluence and equity. Curr Obes Rep. 2014;3:1–15.

    PubMed  PubMed Central  Article  Google Scholar 

  53. 53.

    Newton S, Braithwaite D, Akinyemiju TF. Socio-economic status over the life course and obesity: systematic review and meta-analysis. PLoS ONE. 2017;12:e0177151.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  54. 54.

    Mitchell JE, Lancaster KL, Burgard MA, Howell LM, Krahn DD, Crosby RD, et al. Long-term follow-up of patients’ status after gastric bypass. Obes Surg. 2001;11:464–8.

    CAS  PubMed  Article  Google Scholar 

  55. 55.

    Fairburn CG, Brownell KD. Eating disorders and obesity: a comprehensive handbook. Guilford Press; New York/London, 2002.

  56. 56.

    Tækker L, Christensen BJ, Lunn S. From bingeing to cutting: the substitution of a mal-adaptive coping strategy after bariatric surgery. J Eat Disord. 2018;6:24.

    PubMed  PubMed Central  Article  Google Scholar 

  57. 57.

    Svane MS, Jørgensen NB, Bojsen-Møller KN, Dirksen C, Nielsen S, Kristiansen VB, et al. Peptide YY and glucagon-like peptide-1 contribute to decreased food intake after Roux-en-Y gastric bypass surgery. Int J Obes. 2016;40:1699–706.

    CAS  Article  Google Scholar 

  58. 58.

    Wewer Albrechtsen NJ, Hornburg D, Albrechtsen R, Svendsen B, Toräng S, Jepsen SL, et al. Oxyntomodulin identified as a marker of type 2 diabetes and gastric bypass surgery by mass-spectrometry based profiling of human plasma. EBioMedicine. 2016;7:112–20.

    PubMed  PubMed Central  Article  Google Scholar 

  59. 59.

    Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiolog Rev. 2018;98:1113–41.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We wish to thank the staff at Bariatric Clinic, Køge Hospital, Denmark, the kitchen and laboratory staff and master’s students at the Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark, and Eva Pacini at the Department of Psychology, University of Copenhagen, Denmark, for helping with recruitment and data collection. Furthermore, we wish to thank Lene Stevner at the Department of Nutrition, Exercise and Sports, University of Copenhagen, for support with the protocol. A special thanks to all the participants in the GO Bypass study.

Funding

This study was carried out as part of the research program “Governing Obesity” funded by the University of Copenhagen Excellence Programme for Interdisciplinary Research (www.go.ku.dk). Additional funding was obtained from the Danish Diabetes Academy supported by the Novo Nordisk Foundation, the Lundbeck Foundation, and the Aase and Ejnar Danielsens Foundation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anders Sjödin.

Ethics declarations

Conflict of interest

CWlR is supported by grants from Science Foundation Ireland (ref. 12/YI/B2480), Health Research Board (USIRL-2016–2), and the Irish Research Council during the conduct of the study. Furthermore, CWlR reported being on the advisory boards for Novo Nordisk and GI Dynamics, receiving a research grant from AnaBio, receiving honoraria for lectures and advisory work from Eli Lily, Johnson and Johnson, Sanofi Aventis, Astra Zeneca, Janssen, Bristol-Myers Squibb, and Boehringer-Ingelheim, and reported shares in Keyron. The other authors have declared that no conflict of interest exists.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nielsen, M.S., Christensen, B.J., Schmidt, J.B. et al. Predictors of weight loss after bariatric surgery—a cross-disciplinary approach combining physiological, social, and psychological measures. Int J Obes (2020). https://doi.org/10.1038/s41366-020-0576-9

Download citation