title: A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Effect of a randomised 12-week resistance training programme on muscular strength, cross-sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial. Intervention-related Increases in Preoperative Physical Activity are Maintained 6-months after Bariatric Surgery: Results from the Bari-Active Trial Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies Effects of a Pre-surgery Supervised Exercise Training 1 Year After Bariatric Surgery: a Randomized Controlled Study Effects of gastric bypass surgery followed by supervised physical training on inflammation and endothelial function: A randomized controlled trial. Changes in enjoyment, self-efficacy, and motivation during a randomized trial to promote habitual physical activity adoption in bariatric surgery patients. Randomized Pilot Trial of Bariatric Surgery Versus Intensive Medical Weight Management on Diabetes Remission in Type 2 Diabetic Patients Who Do NOT Meet NIH Criteria for Surgery and the Role of Soluble RAGE as a Novel Biomarker of Success Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study Long-term Weight Regain after Gastric Bypass: A 5-year Prospective Study Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial Effects of gastric bypass followed by a randomized study of physical training on markers of coagulation activation, fibrin clot properties, and fibrinolysis. The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol Preoperative Lifestyle Intervention in Bariatric Surgery: Initial Results from a Randomized, Controlled Trial A randomised control trial assessing the impact of an investment based intervention on weight-loss, beliefs and behaviour after bariatric surgery: study protocol Exercise and Weight Loss Improve Muscle Mitochondrial Respiration, Lipid Partitioning, and Insulin Sensitivity After Gastric Bypass Surgery Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial. Dose-Response of Exercise Training following Roux-en-Y gastric bypass surgery: A randomized trial Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial. Impact of Aerobic Exercise Training on Heart Rate Variability and Functional Capacity in Obese Women After Gastric Bypass Surgery The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients. Effects of 6 months supervised physical training on muscle strength and aerobic capacity in patients undergoing Roux‐en‐Y gastric bypass surgery: a randomized controlled trial Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial.
abstract: BACKGROUND Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery ABSTRACT The purpose of this study was to examine the effect of a 12-week resistance training programme on fat-free mass ( FFM ) , muscle cross-sectional area , muscular strength and muscle quality in women who underwent Roux-en-Y gastric bypass surgery . Participants were 16 women ( mean age = 44.9 ± 10.2 years ) from bariatric surgical groups who were r and omly assigned into either a  control or an intervention group  . Air displacement plethysmography measured FFM and magnetic resonance imaging measured quadriceps muscle cross-sectional area and whole thigh muscle cross-sectional area . Muscular strength and quality was assessed using an estimated 1-Repetition Maximum assessment . All measurements were collected twice , at baseline and at a 12-week follow-up . There were significantly greater improvements in leg press strength ( mean differences = 55.4 % , P < 0.001 , Cohen ’s d = 2.4 ) , leg extension strength ( mean differences = 18.0 % , P = 0.014 , Cohen ’s d = 0.86 ) and leg press muscle quality ( mean differences = 54.5 % , P < 0.001 , Cohen ’s d = 1.9 ) in the intervention group compared to the control group following the resistance training programme . The resistance training intervention significantly improved muscular strength and quality ; however , it did not illicit changes in FFM or muscle cross-sectional area in women who underwent Roux-en-Y gastric bypass surgery OBJECTIVE Bariatric surgery results in significant weight loss and reduces cardiovascular morbidity . However , a large variation in postsurgery weight loss is seen . Physical activity promotes weight loss in nonsurgically treated subjects with obesity . The aim of this study was to investigate the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery ( RYGB ) on body weight and cardiovascular risk markers . METHODS Sixty participants eligible for RYGB were included . Six months post surgery , the participants were r and omly assigned to either twice-weekly supervised physical training sessions in a fitness center ( INT ) or a control group ( CON ) for 26 weeks . Before surgery and 6 , 12 , and 24 months after surgery , the participants underwent an examination program that included  anthropometric measurements , blood pressure , heart rate , blood sample s  , and an  abdominal computed tomography scan .  RESULTS RYGB significantly reduced body weight and improved cardiovascular risk markers ( all P < 0.01 ) . The supervised physical training intervention result ed in a 4.2-kg ( CI : -0.2 to -8.3 kg ) lower body weight in INT compared with CON at the study end ( P = 0.042 ) . The high-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention , but this was not maintained at the 24-months examination . CONCLUSIONS Physical training following RYGB improves weight loss and cardiovascular health Higher preoperative physical activity ( PA ) strongly predicts higher post-operative PA in bariatric surgery ( BS ) patients , providing rationale for preoperative PA interventions ( PAIs ) . However , whether PAI-related increases can be maintained post-operatively has not been examined . This study compared PA changes across pre- ( baseline , post-intervention ) and post-operative ( 6-month follow up ) periods in participants r and omized to 6 weeks of preoperative PAI or st and ard care control ( SC ) . Of 75 participants initially r and omized , 36 ( PAI n=22 ; SC n=14 ) underwent BS .  Changes in daily bout-related ( ⩾10-min bouts ) moderate-to-vigorous PA ( MVPA ) and steps were assessed via the SenseWear Armb and monitor . PAI received weekly counseling to increase walking exercise . Retention ( 86 % ) at post-operative follow up was similar between groups . Intent-to-treat analyses showed that PAI vs SC had greater increases across time ( baseline , post-intervention , follow up ) in bout-related MVPA minutes/day ( 4.3±5.1 , 26.3±21.3 , 28.7±26.3 vs 10.4±22.9 , 11.4±16.0 , 18.5±28.2 ; P=0.013 ) and steps/day ( 5163±2901 , 7950±3286 , 7870±3936 vs 5163±2901 , 5601±3368 , 5087±2603 ; P<0.001 ) . PAI differed from SC on bout-related MVPA at post-intervention ( P=0.016 ; d=0.91 ) , but not follow up ( P=0.15 ; d=0.41 ) , and steps at post-intervention ( P=0.031 ; d=0.78 ) and follow up ( P=0.024 ; d=0.84 ) . PAI participants maintained preoperative PA increases post-operatively . Findings support preoperative PAIs and research to test whether PA changes can be sustained and influence surgical outcomes beyond the initial post-operative period Importance Bariatric surgery is a life-changing treatment for patients with severe obesity , but little is known about its association with interpersonal relationships . Objectives To investigate if relationship status is altered after bariatric surgery . Design , Setting , and Participants Changes in relationship status after bariatric surgery were examined in 2 cohorts : ( 1 ) the prospect i ve Swedish Obese Subjects ( SOS ) study , which recruited patients undergoing bariatric surgery from September 1 , 1987 , to January 31 , 2001 , and compared their care with usual nonsurgical care in matched obese control participants ; and ( 2 ) participants from the Sc and inavian Obesity Surgery Registry ( SOReg ) , a prospect i ve , electronically captured register that recruited patients from January 2007 through December 2012 and selected comparator participants from the general population matched on age , sex , and place of residence . Data was collected in surgical departments and primary health care centers in Sweden . The current analysis includes data collected up until July 2015 ( SOS ) and December 2012 ( SOReg ) . Data analysis was completed from June 2016 to December 2017 . Main Outcomes and Measures In the SOS study , information on relationship status was obtained from question naires . In the SOReg and general population cohort , information on marriage and divorce was obtained from the Swedish Total Population Registry . Results The SOS study included 1958 patients who had bariatric surgery ( of whom 1389 [ 70.9 % ] were female ) and 1912 matched obese controls ( of whom 1354 [ 70.8 % ] were female ) and had a median ( range ) follow-up of 10 ( 0.5 - 20 ) years . The SOReg cohort included 29 234 patients who had gastric bypass surgery ( of whom 22 131 [ 75.6 % ] were female ) and 283 748 comparators from the general population ( of whom 214 342 [ 75.5 % ] were female ) , and had a median ( range ) follow-up of 2.9 ( 0.003 - 7.0 ) years . In the SOS study , the surgical patients received gastric b and ing ( n = 368 ; 18.8 % ) , vertical b and ed gastroplasty ( n = 1331 ; 68.0 % ) , or gastric bypass ( n = 259 ; 13.2 % ) ; controls received usual obesity care . In SOReg , all 29 234 surgical participants received gastric bypass surgery . In the SOS study , bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship ( adjusted hazard ratio [ aHR ] = 1.28 ; 95 % CI , 1.03 - 1.60 ; P = .03 ) and increased incidence of marriage or new relationship ( aHR = 2.03 ; 95 % CI , 1.52 - 2.71 ; P < .001 ) in those who were unmarried or single at baseline . In the SOReg and general population cohort , gastric bypass was associated with increased incidence of divorce compared with married control participants ( aHR = 1.41 ; 95 % CI , 1.33 - 1.49 ; P < .001 ) and increased incidence of marriage in those who were unmarried at baseline ( aHR = 1.35 ; 95 % CI , 1.28 - 1.42 ; P < .001 ) . Within the surgery groups , changes in relationship status were more common in those with larger weight loss . Conclusions and Relevance In addition to its association with obesity comorbidities , bariatric surgery – induced weight loss is also associated with changes in relationship status Background We have previously reported on the benefits of Pre-Surgical Exercise Training ( PreSET ) on physical fitness and social interactions in subjects awaiting bariatric surgery ( BS ) . However , data are needed to know whether these benefits are maintained post-BS . Objectives The purpose of this paper was to evaluate the effect of PreSET on physical activity ( PA ) level , physical fitness , PA barriers , and quality of life ( QoL ) 1 year ( 1-Y ) after BS . Methods Of the 30 participants r and omized into two groups ( PreSET and usual care ) , 25 were included in the final analysis . One year after BS , time spent in different PA intensities and number of steps were assessed with an accelerometer . Before BS and until 1-Y after BS , physical fitness was assessed with  symptom-limited cardiac exercise test , 6-min walk test ( 6MWT ) , and sit-to-st and , half-squat , and arm curl tests . QoL , PA barriers , and PA level were evaluated with question naires . Results The number of steps ( 7460 vs 4287 ) and time spent in light ( 3.2 vs 2.2 h/day ) and moderate ( 0.6 vs 0.3 h/day ) PA were higher in the PreSET group 1-Y after BS . The changes in 6MWT heart cost ( 1.3 vs 0.6 m/beats/min ) , half-squat test ( 38.8 vs 10.3 s ) , and BMI ( − 16.8 vs − 13.5 kg/m2 ) were significantly greater in the PreSET group compared to those in the usual care group . No other significant difference between groups was observed . Conclusion The addition of the PreSET to individual lifestyle counseling seems effective to improve PA level and submaximal physical fitness 1-Y after BS . Studies with larger cohorts are now required to confirm these results .The trial was registered at clinical trials.gov ( NCT01452230 ) BACKGROUND AND AIMS Obesity and physical inactivity are both associated with low- grade inflammation and endothelial dysfunction .  Bariatric surgery improves markers of inflammation and endothelial function , but it is unknown if physical training after bariatric surgery can improve these markers even further . Therefore , we aim ed to investigate the effects of Roux-en-Y gastric bypass ( RYGB ) followed by physical training on markers of low- grade inflammation and endothelial function . METHODS Sixty patients approved for RYGB underwent examinations pre-surgery , 6 , 12 , and 24 months post-surgery . Six months post-surgery , they were r and omized 1:1 to an intervention group or a control group . The interventions consisted of two weekly sessions of supervised moderate intensity physical training for a period of 26 weeks . Fasting blood sample s were analyzed for concentrations of interleukin 6 ( IL-6 ) , C-reactive protein ( CRP ) , intercellular adhesion molecule 1 ( ICAM-1 ) , tissue-type plasminogen activator antigen ( t-PA : Ag ) and von Willebr and factor ( vWF ) . RESULTS RYGB markedly improved markers of inflammation ( IL-6 , CRP ) ( p < 0.001 ) and endothelial function ( ICAM-1 , t-PA : Ag , vWF ) ( p < 0.05 ) , and the improvements were sustained 24 months post-surgery ( p < 0.01 ) , except for the effects on vWF . We found no correlations between the changes in weight or BMI and the changes in markers of inflammation and endothelial function , except that the change in vWF was found to be inversely correlated with the changes in weight and BMI . We observed no effects of supervised physical training on markers on inflammation or endothelial function ( p>0.1 for all ) . CONCLUSIONS RYGB causes substantial and sustained favorable effects on markers of inflammation and endothelial function .  Supervised physical training after RYGB did not cause additional improvements BACKGROUND The Bari-Active trial found that a physical activity ( PA ) intervention ( PAI ) , versus st and ard presurgical care control ( SC ) , produced significant increases in daily bout-related moderate-to-vigorous PA ( MVPA , in≥10-min bouts ) preoperatively . The present study examined whether PAI also produces superior improvements in psychological and /or motivational processes that may be important for PA adoption . OBJECTIVES Compare PAI and SC on baseline to postintervention changes in PA-related enjoyment , self-efficacy , and motivations , and examine whether greater bout-related MVPA changes are associated with greater improvements in these variables . SETTING University hospital , United States . METHODS Participants ( 87 % female ; body mass index = 45.0±6.5 kg/m(2 ) ) were r and omly assigned to 6 weeks of PAI ( n = 40 ) or SC ( n = 35 ) . PAI received weekly counseling sessions to increase daily walking exercise . At baseline and postintervention , both groups completed 7-day objective PA monitoring and question naires to evaluate changes in bout-related MVPA and PA enjoyment , self-efficacy , and motivation . RESULTS Retention was 84 % at postintervention . Intent-to-treat analyses showed that PAI on average reported more favorable changes than SC in PA enjoyment , self-efficacy , amotivation ( i.e. , lack of PA motivation ) , and identified and intrinsic regulations ( i.e. , more autonomous PA motivations ; P<.01 ) . In PAI completers ( n = 33 ) , changes in bout-related MVPA and psychological/motivational variables were unrelated . CONCLUSION PAI produced greater improvements in PA-related enjoyment , self-efficacy , and motivations  than SC . The lack of association between objective ly measured PA changes and psychological/motivational processes highlights the need for future research to identify which processes are most important for PA adoption and maintenance in bariatric surgery patients , and to determine whether the method used to measure PA affects the pattern of association Objective : To compare bariatric surgery versus intensive medical weight management ( MWM ) in patients with type 2 diabetes mellitus ( T2DM ) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products ( sRAGE ) is a biomarker to identify patients most likely to benefit from surgery . Background : There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35 . Methods : Fifty-seven patients with T2DM and BMI 30 to 35 , who otherwise met the criteria for bariatric surgery were r and omized to MWM versus surgery ( bypass , sleeve or b and , based on patient preference ) . The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance ( HOMA-IR ) and diabetes remission . Secondary outcomes included changes in HbA1c , weight , and sRAGE . Results : The surgery group had improved HOMA-IR ( −4.6 vs + 1.6 ; P = 0.0004 ) and higher diabetes remission ( 65 % vs 0 % , P < 0.0001 ) than the MWM group at 6 months . Compared to MWM , the surgery group had lower HbA1c ( 6.2 vs 7.8 , P = 0.002 ) , lower fasting glucose ( 99.5 vs 157 ; P = 0.0068 ) , and fewer T2DM medication requirements ( 20 % vs 88 % ; P < 0.0001 ) at 6 months . The surgery group lost more weight ( 7 . vs 1.0 BMI decrease , P < 0.0001 ) . Higher baseline sRAGE was associated with better weight loss outcomes ( r = −0.641 ; P = 0.046 ) . There were no mortalities . Conclusions : Surgery was very effective short-term in patients with T2DM and BMI 30 to 35 . Baseline sRAGE may predict patients most likely to benefit from surgery . These findings need to be confirmed with larger studies . Clinical Trials.gov ID : Background Many insurance payors m and ate that bariatric surgery c and i date s undergo a medically supervised weight management ( MSWM ) program as a prerequisite for surgery . However , there is little evidence to support this requirement . We evaluated in a r and omized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric b and ing ( LAGB ) in a publicly insured population . Methods This pilot r and omized trial was conducted in a large academic urban public hospital . Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a m and atory 6-month MSWM program  were r and omized to a MSWM program with monthly visits over 6 months ( individual or group ) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively . Demographics , weight , and patient behavior scores , including patient adherence , eating behavior , patient activation , and physical activity , were collected at baseline and at 6 months ( immediately preoperatively and postoperatively ) . Results A total of 55 patients were enrolled in the study with complete follow-up on 23 patients . Participants r and omized to a MSWM program attended an average of 2 sessions preoperatively . The majority of participants were female and non-Caucasian , mean age was 46 years , average income was less than $ 20,000/year , and most had Medicaid as their primary insurer , consistent with the demographics of the hospital ’s bariatric surgery program . Data analysis included both intention-to-treat and completers ’ analyses . No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively , suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB . Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively . Conclusion MSWM does not appear to confer additional benefit as compared to the st and ard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population Background A certain weight gain occurs after obesity surgery compared to the lower weight usually observed between 18 and 24 months postsurgery . The objective of this study was to evaluate weight regain in patients su bmi tted to gastric bypass  over a 5-year follow-up period . Material s and Methods A longitudinal prospect i ve study was conducted on 782 obese patients of both genders . Only patients with at least 2 years of surgery were included . The percentage of excess body mass index ( BMI ) loss at 24 , 36 , 48 , and 60 months postsurgery was compared to the measurements obtained at 18 months after surgery . Surgical therapeutic failure was also evaluated . Results Percent excess BMI loss was significant up to 18 months postsurgery ( p < 0.001 ) , with a mean difference in BMI of 1.06 kg/m2 compared to 12 months postsurgery . Percent BMI loss was no longer significant after 24 months , and weight regain became significant within 48 months after surgery ( p < 0.01 ) . Among the patients who presented weight regain , a mean 8 % increase was observed within 60 months compared to the lowest weight obtained at 18 months after surgery . The percentage of surgical failure was higher in the superobese group at all times studied , reaching 18.8 % at 48 months after surgery . Conclusion Weight regain was observed within 24 months after surgery in approximately 50 % of patients . Both weight regain and surgical failure were higher in the superobese group . Studies in regard to metabolic and hormonal mechanisms underlying weight regain might eluci date the causes of this finding Objective . To examine whether cognitive behavioral therapy ( CBT ) alleviates dysfunctional eating ( DE ) patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery . Design and Methods . A total of 98 ( 68 females ) patients with a mean ( SD ) age of 43 ( 10 ) years and BMI 43.5 ( 4.9 ) kg/m2 were r and omly assigned to a CBT-group or a control group receiving usual care ( i.e. , nutritional support and education ) . The CBT-group received ten weekly intervention sessions . DE , anxiety , and depression were assessed by the TFEQ R-21 and HADS , respectively . Results . Compared with controls , the CBT- patients showed significantly less DE , affective symptoms , and a larger weight loss at follow-up . The effect sizes were large ( DE-cognitive restraint , g = −.92 , P ≤ .001 ; DE-uncontrolled eating , g = −.90 , P ≤ .001 ) , moderate ( HADS-depression , g = −.73 , P ≤ .001 ; DE-emotional eating , g = −.67 , P ≤ .001 ; HADS-anxiety , g = −.62 , P = .003 ) , and low ( BMI , g = −.24 , P = .004 ) . Conclusion . This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health . This clinical trial is registered with NCT01403558 BACKGROUND The risk of cardiovascular disease is reduced by bariatric surgery , but it is unknown if exercise after bariatric surgery reduces this risk even further . OBJECTIVE To investigate if Roux-en-Y-gastric bypass ( RYGB ) and supervised physical training after RYGB improve cardiovascular disease risk markers within coagulation activation , fibrin clot properties , and fibrinolysis . SETTING Bariatric center , Hospital of Southwest Jutl and , Denmark . METHODS Sixty obese patients underwent RYGB and 6 months after RYGB were r and omized to 26 weeks of physical training or  a control group .  Biomarkers within coagulation activation , fibrin clot properties , and fibrinolysis were measured presurgery , and 6 , 12 , and 24 months postsurgery . RESULTS Six months after RYGB , the endogenous thrombin potential decreased from 1744 ( 1603 - 2003 ) to 1416 ( 1276 - 1582 ) nM × min ( P<.001 ) . Alterations in fibrin clot properties result ed in an increased clot lysis from 23.8 % ( 16.1%-38.9 % ) to 40.3 % ( 28.5%-59.35 ; P<.0001 ) . Furthermore , fibrinogen was reduced from 12.6 ( 11.1 - 14.7 ) to 11.5 ( 9.90 - 13.3 ) µM ( P<.001 ) , and plasminogen activator inhibitor antigen was reduced from 40.5 ( 28.4 - 49.4 ) to 24.4 ( 15.4 - 32.7 ) ng/mL ( P<.0001 ) . Physical training after RYGB increased fibrinolytic activity from 58.0 ( 36.0 - 75.5 ) to 88.0 ( 66.0 - 132.0 ) IU/mL compared with 52.5 ( 30.0 - 80.0 ) to 64.0 ( 49.0 - 100.0 ) IU/mL in controls ( P<.01 ) and reduced plasminogen activator inhibitor antigen from 23.5 ( 16.7 - 35.4 ) to 18.1 ( 14.3 - 25.4 ) ng/mL compared with 24.4 ( 13.9 - 28.7 ) to 24.2 ( 14.1 - 29.6 ) ng/mL in controls ( P<.05 ) . No effects of physical training were observed on markers of coagulation activation and fibrin clot properties . CONCLUSION We observed favorable long-term reductions in markers of thrombin generation , improved fibrin clot properties , and increases in fibrinolysis after RYGB . Supervised physical training after RYGB further increased fibrinolysis Background The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service ( BRS ) on  patient weight loss following bariatric surgery  at 1 year . Methods A single-site open-r and omised parallel group control trial based at St. Richard ’s Hospital in Chichester in the UK . Patients ( n = 162 ) were recruited immediately prior to Roux-en-Y gastric bypass  and r and omly allocated to receive either treatment as usual ( n = 80 ) or the BRS ( n = 82 ) . The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information , support and mentoring pre and post surgery addressing psychological issues such as dietary control , self esteem , coping and emotional eating . Weight loss was assessed at 1 year . The key outcome variable was BMI and change in BMI . Results Follow-up weight was available for 145 patients . Intention-to-treat analysis ( n = 162 ) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49 . There was no significant difference between the two groups ( control group = −16.37 , 95 % CI = 15.15–17.57 ; intervention = −16.6 , 95 % CI = 15.42–17.81 ; ηp2 = 0.001 ) . Similarly , explanatory analysis ( n = 145 ) showed a mean change in BMI of −17.17 . The difference between the two groups was not significant ( control group = −16.9 , 95 % CI = 15.78–18.18 ; intervention = −17.35 , 95 % CI = 18.5–16.16 ; ηp2 = 0.001 ) . Conclusions Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year . It is argued that psychological support should be targeted to patients who start to demonstrate  weight regain at a later stage . Trial registration : Clinical Trials.gov NCT01264120 Background To examine whether a preoperative cognitive behavioural therapy ( CBT ) intervention exceeds usual care in the improvements of dysfunctional eating behaviours , mood , affective symptoms and body weight 1 year after bariatric surgery . Methods This is a 1-year follow-up of a single centre parallel-group r and omised controlled trial ( http:// clinical trials.gov/ct2/show/NCT01403558 ) . A total of 80 ( 55 females ) patients mean ( SD ) age 44 ( 10 ) years were included . The intervention group received 10 weeks of CBT prior to bariatric surgery , and the control group received nutritional support and education . Both groups were assessed at baseline ( T0 ) , post CBT intervention/preoperatively ( T1 ) , and 1 year postoperatively ( T2 ) . Using a mixed modelling statistical approach , we examined if the CBT group improved more across time than the control group . Results Our hypothesis was not supported as both groups had comparable improvements in all outcomes except for anxiety symptoms . Body weight declined by 30.2 % ( 37.3 kg ) in the CBT group and by 31.2 % ( 40.0 kg ) in the control group from baseline to follow-up , p = 0.82.There were statistically significant reductions in anxiety and depression symptoms in the CBT group between T0 and T1 and between T1 and T2 for depression only . However , in the control group , the anxiety score did not change significantly . The CBT group showed an earlier onset of improvements in all eating behaviours and affective symptoms than the control group . Conclusion The 10-week CBT intervention showed beneficial effects preoperatively , but the non-significant group differences postoperatively indicate a genuine effect of surgery Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 ( or 35 with co morbidities ) . A minority of patients , however , either do not show the desired loss of excess weight or show weight regain by follow up . Research highlights some of the reasons for this variability , most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body , psychological issues relating to dietary control , self esteem , coping and emotional eating remain neglected . The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service ( BRS ) on patient health outcomes . The bariatric rehabilitation service will provide information , support and mentoring pre and post surgery and will address psychological issues such as dietary control , self esteem , coping and emotional eating . The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes . Methods / Design The study is a r and omised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery . Follow up measures of weight loss and psychological issues will be taken at baseline ( 2 weeks preoperatively ) , 3 , 6 and 12 months postoperatively . The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups ( BOSPA & WLSinfo ) . This study will take place in St Richard 's Hospital in Chichester in the UK . Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life , dietary control , self esteem , coping and emotional eating . This also has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term . Trial registration Clinical Trials.gov NCT01264120 OBJECTIVE To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual ( insurance-m and ated physician supervised diet ) . DESIGN AND METHODS After completing a baseline assessment , c and i date s for surgery were r and omized to a 6-month , evidence -informed , manualized lifestyle intervention ( LIFESTYLE , n = 121 ) or to preoperative care as usual ( USUAL CARE , n = 119 ) . At 6 months , 187 participants remained c and i date s for bariatric surgery and were included in the analyses . RESULTS LIFESTYLE participants  lost significantly more weight than those receiving USUAL CARE [ 8.3 ± 7.8 kg vs. 3.3 ± 5.5 kg , F(1,183 ) = 23.6 , P < 0.0001 ] , with an effect size of 0.72 . Additionally , logistic regression modeling indicated that LIFESTYLE patients were significantly more likely to lose at least 5 % of initial body weight than those in USUAL CARE [ OR ( 95 % CI ) = 2.94 ( 1.253 , 6.903 ) ] , as were participants who were heavier [ OR ( 95 % CI ) = 1.07 ( 1.001 - 1.14 ) for each unit increase in BMI ] or with larger improvements in eating behaviors [ OR ( 95 % CI ) = 1.1 ( 1.049 , 1.145 ) for each unit increase on the Eating Behavior Inventory ) . CONCLUSIONS A behavioral lifestyle intervention for severely overweight individuals leads to clinical ly significant weight loss prior to bariatric surgery . Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes Background Although obesity surgery is currently the most effective method for achieving weight loss , not all patients lose the desired amount of weight and some show weight regain . Previous research shows that successful weight loss may be associated with the amount of investment the patient feels that they have made in their operation . For example , those who feel that it has taken more time and effort to organise , has cost more money , has been more disruptive to their lives and has caused pain are more likely to lose weight after their operation . Therefore , it seems as if the greater the sense of investment , the greater the motivation to make the operation a success . The present study aims to build on these findings by encouraging weight loss surgery patients to focus on the investment they have made , thus making their investment more salient to them and a means to improve weight loss outcomes . Methods The study involves an open r and omised parallel group control trial with patients allocated either to the control or investment intervention group . Using third party blinded r and omization , half the patients will be asked to rate and describe the investment they have made in their operation just before surgery then 3 and 6 months after surgery . All patients will record their weight , beliefs about food , intentions to change and actual eating and exercise behaviour at baseline then 3 , 6 and 12 months follow up . Patients will be recruited from the bariatric surgery pre- assessment clinic at University College Hospital , London . The primary outcome is to explore the impact of the investment based intervention on patient ’s weight and BMI , with secondary outcomes of patients ’ beliefs about foods , behavioural intentions and diet and exercise behaviours . Discussion It is predicted that the investment intervention will improve excess weight loss post-surgery , together with beliefs about food , intentions to change and actual change in diet and exercise behaviour . This has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term and this simple , easy to administer and low cost intervention could become routine practice for bariatric patients .Trial registration Clinical Trials.gov identifier NCT02045628 ; December 2 , 2013 Both Roux-en-Y gastric bypass ( RYGB ) surgery and exercise can improve insulin sensitivity in individuals with severe obesity . However , the impact of RYGB with or without exercise on skeletal muscle mitochondria , intramyocellular lipids , and insulin sensitivity index ( SI ) is unknown . We conducted a r and omized exercise trial in patients ( n = 101 ) who underwent RYGB surgery  and completed either a 6-month moderate exercise ( EX ) or a health education control ( CON ) intervention . SI was determined by intravenous glucose tolerance test . Mitochondrial respiration and intramyocellular triglyceride , sphingolipid , and diacylglycerol content were measured in vastus lateralis biopsy specimens . We found that EX provided additional improvements in SI and that only EX improved cardiorespiratory fitness , mitochondrial respiration and enzyme activities , and cardiolipin profile with no change in mitochondrial content . Muscle triglycerides were reduced in type I fibers in CON , and sphingolipids decreased in both groups , with EX showing a further reduction in a number of ceramide species . In conclusion , exercise superimposed on bariatric surgery – induced weight loss enhances mitochondrial respiration , induces cardiolipin remodeling , reduces specific sphingolipids , and provides additional improvements in insulin sensitivity BACKGROUND Preoperative bariatric patients can follow very low calorie diets ( VLCD ) , reducing surgical risks . However , possible advantages of a liquid diet over one of normal consistency are controversial . This study investigated the effect of a liquid VLCD compared with one of normal consistency considering visceral fat ( VF ) loss and metabolic profile in preoperative clinical ly severe obese patients . METHODS This was a r and omized , open-labeled , controlled clinical trial . Patients were divided into 2 groups : liquid diet and normal diet . Data were collected at baseline and 7 and 14 days after intervention . Information gathered was analyzed for loss of weight and VF , biochemical data , anthropometric data , and energy intake . RESULTS Fifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet . The liquid diet group lost significantly more weight ( P<.0290 ) and VF ( P<.0410 ) than the normal diet group . An inverse correlation occurred between VF loss and surgical time among the liquid diet group ( r2=-.1302 , P=.001 ) . Additionally , there was a positive correlation between the percentage of excess weight loss and ketonuria ( P=.0070 ) . No between-group difference occurred regarding calorie intake . CONCLUSION Patients that consumed a liquid diet presented a positive effect on reducing VF and greater weight loss than the normal diet group . Both VLCDs presented benefits offering a protective effect during the preoperative stage Objective Roux-en-Y gastric bypass(RYGB ) can cause profound weight loss and improve overall cardiometabolic risk factors . Exercise ( EX ) training following RYGB can provide additional improvements in insulin sensitivity(SI ) and cardiorespiratory fitness . However , it remains unknown if a specific amount of EX post-RYGB is required to achieve additional benefits . Methods We performed a post-hoc analysis of participants who were r and omized into either a 6-month structured EX program or a health education control ( CON ) . EX(N=56 ) were divided into tertiles according to the amount of weekly exercise performed , compared to CON(N=42 ) : Low-EX=54±8 ; Middle-EX=129±4 ; High-EX=286±40 minutes per week . Results The High-EX lost a significantly greater amount of body weight , total fat mass and abdominal deep subcutaneous abdominal fat compared to CON(p<0.005 ) . SI improved to a greater extent in both the Middle-EX and High-EX compared to CON(p<0.04 ) . Physical fitness ( VO2max ) significantly improved in the High-EX(+9.3±4.2 % ) compared to CON(−6.0±2.4%)(p < 0.001 ) . Skeletal muscle mitochondrial state 4(p<0.002 ) and 3(p<0.04 ) respiration was significantly higher in the High-EX compared to CON . Conclusion A modest volume of structured exercise provides additional improvements in insulin sensitivity following RYGB , but higher volumes of exercise are required to induce additional weight loss , changes in body composition and improvements in cardiorespiratory fitness and skeletal muscle mitochondrial capacity OBJECTIVE To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity . DESIGN / SETTING Prospect i ve r and omized , controlled trial conducted in a laparoscopic institution . PARTICIPANTS / INTERVENTIONS During the Phase 1 clinical trial ( from preoperative evaluation to 6 months after surgery ) , all participants received st and ard care . During Phase 2 ( 6 - 12 months after surgery ) , participants were r and omly assigned to receive either st and ard care ( n = 72 ) or comprehensive support ( n = 72 ) . Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling . MAIN OUTCOME MEASURES Depression scores and weight change over time . ANALYSIS Independent sample s t tests and regression analysis assessed relationships among depression scores and excess weight loss . RESULTS Participants receiving behavioral-motivational intervention scored significantly lower on Beck 's Depression Inventory question naire scores than those receiving st and ard care . For those with depressive symptoms at r and omization , 24 % of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery , compared with 6 % of those who received st and ard care ( P < .001 ) . Patients ' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions ( P < .001 ) . CONCLUSIONS AND IMPLICATION S Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss BACKGROUND Prior evidence indicates that predictors of weight loss outcomes after  gastric bypass surgery  fall within 5 domains : 1 ) presurgical factors , 2 ) postsurgical psychosocial variables ( e.g. , support group attendance ) , 3 ) postsurgical eating patterns , 4 ) postsurgical physical activity , and 5 ) follow-up at postsurgical clinic . However , little data exist on which specific behavioral predictors are most associated with successful outcomes ( e.g.,≥ 50 % excess weight loss ) when considering the 5 domains simultaneously . The objective of this study was to specify the behavioral variables , and their respective cutoff points , most associated with successful weight loss outcomes . METHODS Signal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables ( within the 5 domains ) and successful weight loss at ≥ 1 year in 274 postgastric bypass surgery patients .  RESULTS Successful weight loss was highest ( 92.6 % ) among those reporting dietary adherence of>3 on a 9-point scale ( median = 5 ) who grazed no more than once-per-day . Among participants reporting dietary adherence<3 and grazing daily or less , success rates more than doubled when highest lifetime body mass index was<53.7 kg/m(2 ) . Success rates also doubled for participants with dietary adherence = 3 if attending support groups . No variables from the physical activity or postsurgical follow-up domains were significant , nor were years since surgery . The overall model 's sensitivity = .62 , specificity = .92 . CONCLUSIONS To our knowledge , this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss . Such data may inform prospect i ve study design s and postsurgical interventions BACKGROUND Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed . OBJECTIVE To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period . SETTING Bariatric Center of Excellence at a large , urban medical center . METHODS C and i date s for bariatric surgery were r and omized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care . The lifestyle intervention consisted of 8 weekly face-to-face sessions , followed by 16 weeks of face-to-face and telephone sessions before surgery ; the intervention also included 3 monthly telephone contacts after surgery . Assessment s were conducted 6 , 12 , and 24 months after surgery . RESULTS Participants who underwent surgery ( n = 143 ) were 90.2 % female and 86.7 % White . Average age was 44.9 years , and average body mass index was 47.5 kg/m(2 ) at study enrollment . At follow-up , 131 ( 91.6 % ) , 126 ( 88.1 % ) , 117 ( 81.8 % ) patients participated in the 6- , 12- , and 24-month assessment s , respectively . Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups , but at 24 months after surgery , the lifestyle group had significantly smaller percent weight loss compared with the usual care group ( 26.5 % versus 29.5 % , respectively , P = .02 ) . CONCLUSIONS Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery . The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients Background Obesity is a major public health concern on a global scale . Bariatric surgery is among the treatment options , result ing in significant and sustainable weight loss as well as amelioration of comorbidities . The purpose of this study was to evaluate whether a 12-week aerobic exercise program positively impacts heart rate variability ( HRV ) and functional capacity after gastric  bypass surgery ( GBS ) in a female cohort . Methods Of the 52 patients initially recruited , 21 were r and omized to a training group ( TG ) or control group and successfully completed the study . Patients were tested on two occasions : 1 week before GBS and 4 months after GBS . Anthropometric variables , body composition , record of heart rate and R-R intervals , and 6-min walk test ( 6MWT ) were assessed at both time points . The TG underwent an aerobic exercise training program on a treadmill ( 1-h session , totaling 36 sessions over 12 weeks ) . Results The main findings from this study were : ( 1 ) only the TG demonstrated a significant increase ( p < 0.05 ) in all indexes of heart rate variability ( HRV ) after 12 weeks of aerobic exercise training and ( 2 ) only the TG demonstrated a significant increase ( p < 0.05 ) in 6MWT distance and decrease in diastolic blood pressure after aerobic exercise training . Conclusions We conclude that 12 weeks of aerobic exercise training improves cardiac autonomic modulation and functional capacity 4 months after GBS OBJECTIVE To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery . METHODS One-hundred-forty-one patients were included in the study . Sixty-nine percent chose to participate in the counseling groups . They were r and omized to a Treatment group and a Control group . Thirty-one percent chose not to participate in the counseling . However , they gave their consent to assessment before and after surgery ( Reference group ) . RESULTS One year after bariatric surgery , 88 % had a weight loss of ≥ 50 % EWL , 37 % reported more than 30 min of physical activity daily , 74 % had 5 - 7 meals daily , and 87 % took recommended vitamins . There were no differences in weight loss , eating habits , or physical exercise between the Treatment group , the Control group and the Reference group one year after surgery . CONCLUSION Preoperative group counseling did not increase treatment adherence to recommended life-style changes . PRACTICE IMPLICATION S In accordance with findings in the present study , it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery . Further research should focus on developing and evaluating programs for postsurgical follow-up , and identifying patients that are in need for more comprehensive treatment programs OBJECTIVE To test the effectiveness of two levels of physical activity interventions before and up to 6½ months after bariatric surgery . METHODS Before surgery , individuals completed submaximal exercise testing on a treadmill . After r and om assignment to st and ard care , pedometer use , or exercise counseling plus pedometer , participants wore an accelerometer for approximately 2 weeks and returned it to the bariatric center before surgery and 2 , 4 , and 6 months postoperatively . RESULTS Individuals in exercise counseling plus pedometer had higher steps per day and bout minutes of exercise per week than st and ard care and pedometer use over the course of the study . There were no group differences related to exercise tolerance ; however , all groups made significant improvement . There was no statistically significant change in sedentary or light activity nor was there a difference between groups . CONCLUSIONS Exercise counseling using pedometers increases physical activity from the perioperative period to 6½ months after surgery , but providing pedometers without professional feedback may not be more effective than st and ard bariatric surgery treatments . Rapid weight loss increases exercise tolerance and may mask the fitness improvements achieved through a modest physical activity intervention during the first 6 months after bariatric surgery OBJECTIVE To examine the impact of a pre-bariatric surgery physical activity intervention ( PAI ) , design ed to increase bout-related ( ≥10 min ) moderate to vigorous PA ( MVPA ) , on health-related quality of life ( HRQoL ) . METHODS Analyses included 75 adult participants ( 86.7 % female ; BMI = 45.0 ± 6.5 kg m(-2 ) ) who were r and omly assigned to 6 weeks of PAI ( n = 40 ) or st and ard pre-surgical care ( SC ; n = 35 ) .  PAI received 6 individual weekly counseling sessions to increase walking exercise . Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey  at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes , respectively . RESULTS PAI increased bout-related MVPA from baseline to post-intervention ( 4.4 ± 5.5 to 21.0 ± 21.4 min day(-1 ) ) versus no change ( 7.9 ± 16.6 to 7.6 ± 11.5 min day(-1 ) ) for SC ( P = 0.001 ) . PAI reported greater improvements than SC on all SF-36 physical and mental scales ( P < 0.05 ) , except role-emotional . In PAI , better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases ( P < 0.05 ) , and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function , bodily pain , and general health scales ( P < 0.05 ) . CONCLUSIONS Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery c and i date s. Future studies should examine whether this effect improves surgical safety , weight loss outcomes , and postoperative BACKGROUND This study examines whether performance of bout-related physical activity ( PA ) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery ( BS ) patients . METHODS Participants with severe obesity ( n = 33 ; mean age = 45.6 ± 9.6 years ; BMI = 45.7 ± 7.0 kg/m2 ) seeking BS were r and omized to and completed 6 weeks of preoperative PA counseling ( retention = 82.5 % ) . Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit . Timing and amount of bout-related moderate-to-vigorous PA ( MVPA )  was assessed via objective monitor at pre- and postintervention . RESULTS Greater proportion of bout-related MVPA performed during morning hours ( 4:00 AM-12:00 PM ) at postintervention was associated with larger total increases in bout-related MVPA minutes/day ( β = .40 , P = .03 ) . At postintervention , a greater proportion of participants whose longest MVPA bouts occurred during morning hours ( n = 11 ) achieved the public health guideline ( ie , ≥150 bout-related MVPA minutes/week ) versus those whose longest MVPA bouts occurred during nonmorning hours ( n = 19 ; 63.6 % vs. 26.3 % , P = .04 ) . CONCLUSIONS Intervention-related increases in PA  tended to be greatest when PA was performed in the morning . Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients Obesity and physical inactivity are major health problems .  Roux‐en‐Y gastric bypass ( RYGB ) surgery  results in significant weight loss and reduces obesity‐related morbidity and mortality . Physical activity lowers the risk of cardiovascular disease and premature death . The aims of this study were to eluci date the effects of RYGB followed by 6 months of supervised physical training on physical capacity . In a r and omized controlled trial , 60 participants eligible for RYGB were r and omized 6 months post‐surgery to either two weekly physical training sessions for 26 weeks ( INT ) or a control group ( CON ) . Aerobic capacity ( VO2max ) , muscle strength ( MS ) of the shoulder and hip and physical function were measured pre‐surgery and 6 , 12 and 24 months post‐surgery . RYGB per se decreased MS in all tested muscle groups , had no effects on VO2max but improved physical function . After the intervention , INT had a significant 0.33 L min−1 increase in VO2max compared to CON ( 95 % CI : 0.07–0.57 , P = 0.013 ) . Furthermore , MS in the hip adductor increased significantly with 13 N ( 95 % CI : 3.6–22.4 , P = 0.007 ) and a between‐group difference was found in the Stair Climb Test ( 0.46 repetitions [ 95 % CI : 0.02–0.91 , P = 0.042 ] ) . The effects were not maintained at follow‐up . Supervised physical training following RYGB improved VO2max , hip MS and physical function , but the positive effects were not maintained at follow‐up . While activities of daily life may become easier as a result of RYGB , the observed extensive post‐operative loss of MS requires more attention to increase the patient 's physical capacity prospect ively BACKGROUND As morbid obesity increasingly affects Hispanic Americans , the incidence of bariatric procedures among this population is rising . Despite this , prospect i ve research on the effects of comprehensive postoperative education-centered interventions on weight loss and physical activity focused on Hispanic Americans is lacking . OBJECTIVE To examine whether a comprehensive nutrition education and behavior modification intervention improves weight loss and physical activity in Hispanic Americans with obesity following Roux-en-Y gastric bypass surgery ( RYGB ) . METHODS A prospect i ve r and omized-controlled trial was conducted between November 2008 and April 2010 . At 6 months following RYGB , 144 Hispanic Americans with obesity were r and omly assigned to a comprehensive nutrition and lifestyle educational intervention ( n=72 ) or a noncomprehensive approach ( comparison group n=72 ) . Those in the comprehensive group received education sessions every other week for 6 weeks in small groups and frequent contact with a registered dietitian . Those in the comparison group received brief , printed healthy lifestyle guidelines . Patients were reassessed at 12 months following surgery . Main outcome measures were excess weight loss and physical activity changes over time . Statistical analyses used t test , ? ( 2 ) test , Wilcoxon signed rank , Mann-Whitney U test , and intent-to-treat analysis , significance P<0.05 . RESULTS Participants ( mean age 44.5 ± 13.5 years ) were mainly Cuban-born women ( 83.3 % ) .  Mean preoperative excess weight and body mass index ( calculated as kg/m(2 ) ) were 72.20 ± 27.81 kg and 49.26 ± 9.06 , respectively . At 12 months following surgery , both groups lost weight significantly , but comprehensive group participants experienced greater excess weight loss ( 80 % vs 64 % from preoperative excess weight ; P<0.001 ) and greater body mass index reduction ( 6.48 ± 4.37 vs 3.63 ± 3.41 ; P<0.001 ) than comparison group participants . Comprehensive group participants were significantly more involved in physical activity ( + 14 min/wk vs ? 4 min/wk ; P<0.001 ) than comparison group participants . Mean protein intake was significantly lower in the comparison group than that in the comprehensive group ( P<0.024 ) . CONCLUSIONS Findings support the importance of comprehensive nutrition education for achieving more effective weight reduction in Hispanic Americans following RYGB
target: Preoperative and post-operative intensive interventions improved symptoms of depression and anxiety , quality of life , diastolic blood pressure , and resting heart rate but not lipids or glycaemic measures .
background: This systematic review and meta- analysis of intervention studies aims to evaluate the effect of preoperative and /or post-operative support for adults who elect bariatric surgery delivered by a multidisciplinary team ( MDT )  on post-operative body composition , mental health , co-morbidities , quality of life , and side effects .