Bariatric surgery is the most effective long-term treatment for severe obesity [
1], however despite excellent results being obtained at the group level, the response and durability of weight loss after surgery is heterogeneous and a proportion of patients may experience suboptimal weight loss (SWL) [
2]. The mechanisms underlying SWL are poorly understood but may be linked to eating behaviours [
2].
The aim of this work was to identify if early changes in energy intake (EI) and eating behaviours at 1-year are associated with long-term weight outcomes 5-years post-surgery. Twenty-two patients, after gastric bypass (gender: 18 F, 82.0%, 46.2 ± 1.6kg/m2, 46.1 ± 2.6 years), attended residential research appointments pre-surgery (−1 month) and at 12- and 60-months post-surgery. At each time point, EI (MJ) and eating behaviours (dietary energy density, eating speed, and number, size and duration of eating occasions) were determined over a 24-h period using the covert weighing of food and validated via closed circuit television. Body composition was measured using dual-energy X-ray absorptiometry and the percentage of total weight loss (%TWL) used to distinguish between patients who had suboptimal (<15% TWL) and patients with optimal weight loss (15–25%, or, >25% TWL) at 5 years post-surgery.
Briefly, 5 patients experienced SWL (−9.2 ± 1.8%), while 7 patients experienced 15–25% TWL (−21.9 ± 1.4%), and 10 patients experienced >25% TWL (−35.0 ± 1.8%). There were no differences in EI or dietary energy density between the three groups at baseline, or percentage changes at 1-year post-surgery (ANOVA; p > 0.54 and p > 0.48, respectively). Those experiencing SWL did not change their eating speed post-surgery, whilst those with optimal weight loss (>25%) reduced their eating speed (+7.2 ± 0.53, +133.8 ± 0.53%, −18.9 ± 21.2%, for SWL [<15%], 15–25% and >25% TWL; p= 0.01). Those with optimal weight loss also decreased their EI per eating occasion at 1 year (−53.2 ± 2.8%, +88.9 ± 105.0%, −57.8 ± 6.9%, for SWL [<15%], 15–25% and >25% for TWL; p = 0.01). These findings indicate that targeting interventions to the stratum of patients with such eating behaviours could enhance weight loss. Further work is required to verify findings and identify other modifiable eating behaviours in those most at risk of SWL.
Author Contributions
Conceptualization, R.K.P., M.B.E.L., C.L.R. and A.S.; Formal analysis, H.S.; investigation, H.S., A.M., J.S., C.L.R., A.S., M.A.K., C.I.R.G., M.B.E.L. and R.K.P.; writing—original draft preparation, H.S.; writing—review and editing, H.S., A.M., J.S., C.L.R., A.S., M.A.K., C.I.R.G. and R.K.P.; visualization, A.M., J.S., C.L.R., A.S., M.A.K., C.I.R.G., M.B.E.L., R.K.P., Z.B., D.D.K. and D.J.P.; supervision, A.M., J.S., C.L.R., M.A.K., C.I.R.G. and R.K.P.; funding acquisition, R.K.P., C.L.R. and A.S. All authors have read and agreed to the published version of the manuscript.
Funding
US-Ireland Research and Development Partnership program, Grant/Award Number: R01-DK106112-01A1; National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, Grant/Award Number: R01DK106112; Health Research Board of the Republic of Ireland, Grant/Award Number: USIRL-2006; Medical Research Council, UK, Grant/Award Number: MC_PC_16017; Health and Social Care R&D Division of Northern Ireland, Grant/Award Number: STL/5062/14. This trial was registered as clinicaltrials.gov as NCT03113305.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Research Ethics Committee 3, West of Scotland (16/WS/0056, date of approval: 04/03/2016).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Data described in the abstract will be made available upon request pending application and approval.
Conflicts of Interest
The authors declare no conflict of interest.
References
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