title: A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Long-term Weight Regain after Gastric Bypass: A 5-year Prospective Study Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. The Impact of Psychological Support on Weight Loss Post Weight Loss Surgery: a Randomised Control Trial The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Health benefits of gastric bypass surgery after 6 years. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Road Running After Gastric Bypass for Morbid Obesity: Rationale and Results of a New Protocol Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Optimizing long-term weight control after bariatric surgery: a pilot study. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study.
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 BACKGROUND Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment . However , it is unknown whether these interventions are best delivered pre- or postoperatively . The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention , before or after surgery . METHODS A total of 32 pre- and postoperative patients were referred to a 10-week intervention design ed to reduce eating behaviors associated with postoperative weight gain ( e.g. ,  loss  of control while eating , grazing )  . The sample was 78.1 % female and 84.4 % white , with an average age of 49.43 + /- 9.13 years and a body mass index of 44.22 + /- 6.48 kg/m(2 ) . Of the 32 patients , 21 were referred preoperatively and 11 were referred postoperatively ( 5.63 + /- 2.91 months after surgery ) . These patients were tracked prospect ively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention . RESULTS Compared with the preoperative patients , the postoperative patients were more likely to follow-up with their referral and initiate treatment [ chi(2)(1 ) = 10.06 , P = .002 ] . Of the postoperative patients , 100 % attended the first intervention session  compared with only 43 % of preoperative patients . The postoperative patients also attended more intervention sessions [ t(18 ) = 2.51 , P = .02 ] and were more likely to complete the intervention [ chi(2)(1 ) = 7.21 , P = .007 ] . Only 14 % of the preoperative referral patients completed the program compared with 91 % of the postoperative patients . CONCLUSION Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery 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 Roux-en-Y gastric bypass surgery is the leading surgical treatment of morbid obesity in the United States . The role of preoperative weight loss in gastric bypass surgery remains controversial . We performed a prospect i ve r and omized trial to determine whether preoperative weight loss results in better outcomes after laparoscopic gastric bypass . METHODS A total of 100 patients undergoing laparoscopic gastric bypass surgery from May 2004 to October 2005 were r and omized preoperatively to either a weight loss group with a 10 % weight loss requirement or a group that had no weight loss requirements . The patients were followed prospect ively . The variables analyzed included perioperative complications , operative time , postoperative weight loss , and resolution of co-morbidities . RESULTS Data were available for 26 patients in the weight loss group and 35 in the nonweight loss group . The 2 groups had similar preoperative characteristics , conversion and complication rates , and resolution of co-morbidities . The initial body mass index was 48.7 kg/m(2 ) and 49.3 kg/m(2 ) for the weight loss group and nonweight loss group , respectively ( P = NS ) . The preoperative body mass index was 44.5 kg/m(2 ) and 50.7 kg/m(2 ) for the weight loss group and nonweight loss group , respectively ( P = 0.0027 ) . The operative time was 220.2 and 257.6 minutes for the 2 groups ( P = 0.0084 ) . The percentage of excess weight loss at 3 and 6 months for the weight loss group and nonweight loss group was 44.1 % and 33.1 % ( P = 0.0267 ) and 53.9 % and 50.9 % ( P = NS ) , respectively . The interval to surgery from the initial consultation was 5.4 months and 5.2 months for the 2 groups ( P = NS ) . CONCLUSIONS Preoperative weight loss before laparoscopic Roux-en-Y gastric bypass was associated with a decrease in the operating room time and an improved percentage of excess weight loss in the short term . Preoperative weight loss , however , did not affect the major complication or conversion rates , and its long-term effects were not apparent through this study . Also , preoperative weight loss did not have any bearing on the resolution of co-morbidities 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 BACKGROUND Roux-en-Y gastric bypass ( RYGB ) surgery causes profound weight loss and improves insulin sensitivity ( S(I ) ) in obese patients .  Regular exercise can also improve S(I ) in obese individuals ; however , it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S(I ) and other cardiometabolic factors . METHODS We conducted a single-blind , prospect i ve , r and omized trial with 128 men and women who recently underwent RYGB surgery ( within 1 - 3 months ) . Participants were r and omized to either a 6-month semi-supervised moderate exercise protocol ( EX , n = 66 ) or a health education control ( CON ; n = 62 ) intervention . Main outcomes measured included S(I ) and glucose effectiveness ( S(G ) ) , which were determined from an intravenous glucose tolerance test and minimal modeling . Secondary outcomes measured were cardiorespiratory fitness ( VO2 peak ) and body composition . Data were analyzed using an intention-to-treat ( ITT ) and per- protocol ( PP ) approach to assess the efficacy of the exercise intervention ( > 120 min of exercise/week ) . RESULTS 119 ( 93 % ) participants completed the interventions , 95 % for CON and 91 % for EX . There was a significant decrease in body weight and fat mass for both groups ( P < 0.001 for time effect ) . S(I ) improved in both groups following the intervention ( ITT : CON vs. EX ; + 1.64 vs. + 2.24 min⁻¹/μU/ml , P = 0.18 for Δ , P < 0.001 for time effect ) . A PP analysis revealed that exercise produced an additive S(I ) improvement ( PP : CON vs. EX ; + 1.57 vs. + 2.69 min⁻¹/μU/ml , P = 0.019 ) above that of surgery . Exercise also improved S(G ) ( ITT : CON vs. EX ; + 0.0023 vs. + 0.0063 min⁻¹ , P = 0.009 ) compared with the CON group . Exercise improved cardiorespiratory fitness ( VO2 peak ) compared with the CON group . CONCLUSION Moderate exercise following RYGB surgery provides additional improvements in S(I ) , S(G ) , and cardiorespiratory fitness compared with a sedentary lifestyle during similar weight loss . TRIAL REGISTRATION clinical trials.gov identifier : NCT00692367 . FUNDING This study was funded by the NIH/National Institute of Diabetes and Digestive and Kidney Diseases ( R01 DK078192 ) and an NIH/National Center for Research Re sources / Clinical and Translational Science Award ( UL1 RR024153 ) IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes . The long-term outcomes for remission and diabetes-related complications are not known . OBJECTIVES To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) is a prospect i ve matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden . Of patients recruited between September 1 , 1987 , and January 31 , 2001 , 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline . For the current analysis , diabetes status was determined at SOS health examinations until May 22 , 2013 . Information on diabetes complications was obtained from national health registers until December 31 , 2012 . Participation rates at the 2- , 10- , and 15-year examinations were 81 % , 58 % , and 41 % in the control group and 90 % , 76 % , and 47 % in the surgery group . For diabetes assessment , the median follow-up time was 10 years ( interquartile range [ IQR ] , 2 - 15 ) and 10 years ( IQR , 10 - 15 ) in the control and surgery groups , respectively . For diabetes complications , the median follow-up time was 17.6 years ( IQR , 14.2 - 19.8 ) and 18.1 years ( IQR , 15.2 - 21.1 ) in the control and surgery groups , respectively . INTERVENTIONS Adjustable or nonadjustable b and ing ( n = 61 ) , vertical b and ed gastroplasty ( n = 227 ) , or gastric bypass ( n = 55 ) procedures were performed in the surgery group , and usual obesity and diabetes care was provided to the control group . MAIN OUTCOMES AND MEASURES Diabetes remission , relapse , and diabetes complications . Remission was defined as blood glucose < 110 mg/dL and no diabetes medication . RESULTS The diabetes remission rate 2 years after surgery was 16.4 % ( 95 % CI , 11.7%-22.2 % ; 34/207 ) for control patients and 72.3 % ( 95 % CI , 66.9%-77.2 % ; 219/303 ) for bariatric surgery  patients ( odds ratio [ OR ] , 13.3 ; 95 % CI , 8.5 - 20.7 ; P < .001 ) . At 15 years , the diabetes remission rates decreased to 6.5 % ( 4/62 ) for control patients and to 30.4 % ( 35/115 ) for bariatric surgery patients ( OR , 6.3 ; 95 % CI , 2.1 - 18.9 ; P < .001 ) . With long-term follow-up , the cumulative incidence of microvascular complications was 41.8 per 1000 person-years ( 95 % CI , 35.3 - 49.5 ) for control patients and 20.6 per 1000 person-years ( 95 % CI , 17.0 - 24.9 ) in the surgery group ( hazard ratio [ HR ] , 0.44 ; 95 % CI , 0.34 - 0.56 ; P < .001 ) . Macrovascular complications were observed in 44.2 per 1000 person-years ( 95 % CI , 37.5 - 52.1 ) in control patients and 31.7 per 1000 person-years ( 95 % CI , 27.0 - 37.2 ) for the surgical group ( HR , 0.68 ; 95 % CI , 0.54 - 0.85 ; P = .001 ) . CONCLUSIONS AND RELEVANCE In this very long-term follow-up observational study of obese patients with type 2 diabetes , bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care . These findings require confirmation in r and omized trials . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01479452 The present study was design ed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance , dietary , and physical activity habits and eating behavior of patients following vertical b and ed gastroplasty ( VBG ) . Thirty severely obese female volunteers were included in the study and they were r and omly assigned to one of two intervention groups : usual care ( UC ) or lifestyle intervention ( LS ) group . Patients were followed for 3 years postoperatively . Outcome measures included weight loss , dietary habits , physical activity level ( PAL ) , and eating behavior changes . Weight was significantly lower in the LS group after 12 months ( 84.4 + /- 3.9 kg vs. 98.4 + /- 4.4 kg , P < 0.05 ) , 24 months ( 83.0 + /- 3.3 vs. 101.9 + /- 5.3 kg , P < 0.05 ) , and 36 months following surgery ( 84.2 + /- 3.3 vs. 102.5 + /- 3.5 kg , P < 0.05 ) . Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing . With regard to eating behavior , the LS group scored significantly better in total Dutch Eating Behavior Question naire ( DEBQ ) , Restraint Eating and External Eating scales at all postoperative time points . Similarly , significant differences were found between the two groups in dietary intake . These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery . The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity 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 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 BACKGROUND Laparoscopic gastric bypass has become the st and ard surgical treatment for severe obesity in the United States . Less clear is what diet should be followed by these patients after surgery to maximize their weight loss . METHODS Patients undergoing laparoscopic gastric bypass procedures for morbid obesity were r and omly assigned to either a low-fat control diet based on American Heart Association recommendations or a low-carbohydrate , high-protein diet based on the South Beach Diet . One-on-one diet counseling with a bariatric nutritionist was provided preoperatively , postoperatively while in the hospital , and at postoperative clinic visits during the 12-month follow-up period . Investigators were blinded to diet assignment . Body composition including Body Mass Index ( BMI ) was recorded preoperatively and during postoperative visits at 3 , 6 , and 12 months . RESULTS Thirty-two patients were included in the analysis with 13 control and 19 low-carbohydrate , high-protein subjects . No demographic or clinical preoperative variables , including preoperative BMI , showed statistical differences between the two groups . Both groups demonstrated significant yet similar weight loss both by reduction in BMI ( at 12 months , low fat diet , -14.0 + /- 5.5 % versus low carbohydrate , -17.0 + /- 4.5 % ; P = 0.15 ) and excess body weight lost ( at 12 months , low-fat diet , -60.3 + /- 15.3 % versus low carbohydrate , -59.6 + /- 13.0 % ; P = 0.96 ) . CONCLUSIONS Based on this limited prospect i ve study , no weight loss advantage is observed in substituting a low-carbohydrate , high-protein diet in place of a st and ard low-fat diet in patients who have undergone laparoscopic gastric bypass surgery 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 Weight regain is a problem among many bariatric surgery patients . Whether a high-volume exercise program ( HVEP ) , a strategy to limit weight regain , is feasible in these patients is unknown . The feasibility of an HVEP in obese post-bariatric-surgery patients was determined by r and omizing 33 Roux-en-Y gastric bypass ( RYGB ) and gastric b and ing ( GB ) surgery patients with a mean BMI of 41 ± 6 kg/m2 to an HVEP or control group for 12 weeks . The HVEP group was instructed to expend ≥ 2,000 kcal/week in moderate-intensity exercise . All patients were counseled to limit energy intake . Treatment effect was assessed by repeated measures analysis . During the last 4 weeks of the study , 53 % of the HVEP group expended ≥ 2,000 kcal/week and 82 % expended ≥ 1,500 kcal/week . Step count , reported time spent and energy expended during moderate physical activity , maximal oxygen consumption relative to weight , and incremental area under the postpr and ial blood glucose curve were significantly improved over 12 weeks in the HVEP group compared to controls ( group-by-week effect : P = 0.009 - 0.03 ) . Both groups reported significant improvement in some quality -of-life scales . Changes in weight , energy and macronutrient intake , resting energy expenditure ( REE ) , fasting lipids and glucose , and fasting and postpr and ial insulin concentrations were not different between the two groups . HVEP is feasible in about 50 % of the patients and enhances physical fitness and reduces postpr and ial blood glucose in bariatric surgery patients CONTEXT Extreme obesity is associated with health and cardiovascular disease risks . Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term , long-term outcomes are uncertain . OBJECTIVE To examine the association of  Roux-en-Y gastric bypass ( RYGB ) surgery  with weight loss , diabetes mellitus , and other health risks 6 years after surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese ( body mass index [ BMI ] ≥ 35 ) participants aged 18 to 72 years ( 82 % women ; mean BMI , 45.9 ; 95 % CI , 31.2 - 60.6 ) who sought and received RYGB surgery ( n = 418 ) , sought but did not have surgery ( n = 417 ; control group 1 ) , or who were r and omly selected from a population -based sample not seeking weight loss surgery ( n = 321 ; control group 2 ) . MAIN OUTCOME MEASURES Weight loss , diabetes , hypertension , dyslipidemia , and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment . RESULTS Six years after surgery , patients who received RYGB surgery ( with 92.6 % follow-up ) lost 27.7 % ( 95 % CI , 26.6%-28.9 % ) of their initial body weight compared with 0.2 % ( 95 % CI , -1.1 % to 1.4 % ) gain in control group 1 and 0 % ( 95 % CI , -1.2 % to 1.2 % ) in control group 2 . Weight loss maintenance was superior in patients who received RYGB surgery , with 94 % ( 95 % CI , 92%-96 % ) and 76 % ( 95 % CI , 72%-81 % ) of patients receiving RYGB surgery maintaining at least 20 % weight loss 2 and 6 years after surgery , respectively . Diabetes remission rates 6 years after surgery were 62 % ( 95 % CI , 49%-75 % ) in the RYGB surgery group , 8 % ( 95 % CI , 0%-16 % ) in control group 1 , and 6 % ( 95 % CI , 0%-13 % ) in control group 2 , with remission odds ratios ( ORs ) of 16.5 ( 95 % CI , 4.7 - 57.6 ; P < .001 ) vs control group 1 and 21.5 ( 95 % CI , 5.4 - 85.6 ; P < .001 ) vs control group 2 . The incidence of diabetes throughout the course of the study was reduced after RYGB surgery ( 2 % ; 95 % CI , 0%-4 % ; vs 17 % ; 95 % CI , 10%-24 % ; OR , 0.11 ; 95 % CI , 0.04 - 0.34 compared with control group 1 and 15 % ; 95 % CI , 9%-21 % ; OR , 0.21 ; 95 % CI , 0.06 - 0.67 compared with control group 2 ; both P < .001 ) . The numbers of participants with bariatric surgery-related hospitalizations were 33 ( 7.9 % ) , 13 ( 3.9 % ) , and 6 ( 2.0 % ) for the RYGB surgery group and 2 control groups , respectively . CONCLUSION Among severely obese patients , compared with nonsurgical control patients , the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline 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 Background In recent years , the p and emic explosion of obesity has led to the definition of a pre-eminent therapeutic role for bariatric surgery , confining physical activity to a success parameter of surgery rather than a primary prevention measure . The aim of this study is to evaluate the role for aerobic physical activity ( road running ) in strengthening the metabolic and psychosocial effects of bariatric surgery . Methods Ten patients who underwent gastric bypass for morbid obesity were su bmi tted to an intensive program of road running training , aim ed at completing a 10.5-km competition in September 2013 . Inclusion criteria included age ( < 50 ) , BMI ( < 35 ) , suitability for sport activity , and good compliance . A cohort of 10 patients excluded for logistical issues were enrolled as a  control group . During the training period , patients were su bmi tted to biometrical , sport performance , cardiopulmonary , metabolic , and psychiatric evaluations . Results Protocol adherence was 70 % ; no physical injury was registered among participants . More than weight loss ( BMI 29.3 to 27.1 ) , the runners experienced a redistribution of body mass with significant differences in fat percentage and waist/hip ratio . Participants had a significant running performance improvement and , differently from the controls , a significant amelioration of echocardiographic and cardiopulmonary parameters , predicting a reduction in cardiovascular risk . Psychiatric evaluation underlined a tendency to a reduction in anxiety , depression , and general psychopathology symptoms . Conclusions Road running seems to have an important supporting role in boosting bariatric surgery results . The utilization of monitored and regulated training programs represents a fundamental prerequisite to achieving satisfactory results and patient compliance 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 Although bariatric surgery is associated with significant overall weight loss , many patients experience suboptimal outcomes . Our objective was to document the preliminary efficacy of a behavioral intervention for bariatric surgery patients with relatively poor long-term weight loss and to explore the factors related to outcome at an academic medical center in the United States . METHODS Patients with a body mass index ( BMI ) ≥ 30 kg/m(2 ) who had undergone bariatric surgery ≥ 3 years before study entry and had < 50 % excess weight loss were enrolled . The participants were r and omly assigned to a 6-month behavioral intervention or wait list control group . The assessment s were conducted at baseline ( before intervention ) and 6 months ( after intervention ) and 12 months ( 6-mo follow-up ) . RESULTS On average , the participants ( n = 36 ) had undergone surgery 6.6 years before study entry . The average age was 52.5 ± 7.1 years , and the BMI was 43.1 ± 6.2 kg/m(2 ) ; most participants were women ( 75 % ) and white ( 88.9 % ) . The intervention patients had a greater percentage of excess weight loss than did the wait list control group at 6 ( 6.6 % ± 3.4 % versus 1.6 % ± 3.1 % ) and 12 ( 5.8 % ± 3.5 % versus .9 % ± 3.2 % ) months . However , the differences were not significant and the results varied . The intervention patients with more depressive symptoms ( P = .005 ) and less weight regain before study entry ( P = .05 ) experienced a greater percentage of excess weight loss . CONCLUSION Behavioral intervention holds promise in optimizing long-term weight control after bariatric surgery . More research is needed on when to initiate the intervention and to identify which patients will benefit from this type of approach 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 BACKGROUND Historically , preoperative weight loss has been encouraged for patients undergoing gastric bypass surgery  to decrease liver mass , technically facilitating the procedure . In an earlier prospect i ve r and omized trial investigating effects of preoperative weight loss on patients ' clinical outcomes , we reported no differences in postoperative complications or weight-loss profiles at 6-month followup . This article demonstrates results of the same study , with 1-year followup . STUDY DESIGN One hundred consecutive patients in an 18-month period preparing to undergo gastric bypass surgery at Stanford University Medical Center were selected . Fifty patients were r and omly assigned to lose 10 % or more of their excess body weight preoperatively , and 50 patients were assigned to no preoperative weight-loss requirements . After 1 year , patient demographics and data on postoperative complications , cure or improvement of comorbidities , and differences in weight-loss profiles were collected . RESULTS At 1 year , the 2 groups had similar preoperative demographics and body mass indexes ( BMI s ) . Patients in the weight-loss group , on average , lost 8.2 % of their excess body weight preoperatively compared with the nonweight-loss group , which gained 1.1 % ( p = 0.007 ) . After a year , the patients in both arms of the study showed no difference in weight , BMI , excess weight-loss , and number of remaining comorbidites . But when patients were divided according to those who had lost at least 5 % of their excess body weight preoperatively , the 1-year results for excess weight-loss , weight , and BMI were much lower for the weight-loss group . CONCLUSIONS Preoperative weight loss in patients undergoing gastric bypass surgery  is safe and feasible . It should be encouraged , because it will markedly improve longterm weight loss Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity
target: Behavioural interventions appear to improve weight loss at 12 months after bariatric surgery .
background: Background Significant , sustained weight loss through conventional , non-surgical interventions is often unattainable for people with severe obesity ( e.g. BMI ≥40 or ≥35 kg/m2 with co-morbidities ) .
  Bariatric surgery is effective in treating severe obesity , but surgery alone without additional behaviour change management may not result in optimum long-term weight loss and maintenance .
  This systematic review and meta- analysis of r and omised controlled trials evaluated the effectiveness of lifestyle interventions before and /or after bariatric surgery .