Self-reported causes of weight gain among prebariatric surgery patients.
Obesity is defined as a body mass index (BMI) of more than 30 kg/[m.sup.2], and has been described as a global epidemic (1-4). Currently, bariatric surgery is reported extensively as the most successful means of weight loss in extremely obese adults (BMI [greater than or equal to] 40 kg/[m.sup.2]) (5-8). However, weight regain after surgery is still reported (9,10).
A limited number of studies have been published on causes of weight gain specifically in prebariatric surgery patients. Some causes that have been discussed are emotional eating, multiple dieting attempts, and smoking cessation (11-14). However, in overweight and obese populations, weight gain appears to be multifactorial (15,16). A better understanding of issues related to weight gain before bariatric surgery therefore may be useful.
The most commonly reported causes of weight gain were examined among prebariatric surgery patients. As an important part of the multidisciplinary bariatric surgery team, registered dietitians (RDs) use their knowledge to help patients ensure appropriate dietary intake both before and after surgery (17,18). By exploring the multiple factors contributing to obesity from the patient's perspective, the RD may be able to tailor perioperative care to each patient's specific needs.
This was a retrospective chart review study of 160 patients (129 women and 31 men), which was approved by the University Health Network Research Ethics Board. From August 16, 2010, to August 30, 2011, an RD at the Toronto Western Hospital (TWH) arm of the University of Toronto Collaborative Bariatric Surgery Program used a revised form to complete assessments for participants. Inclusion criteria for Roux-En-Y bariatric surgery were applied to this study population and consisted of BMI [greater than or equal to] 40 or BMI [greater than or equal to] 35 with one obesity-related morbidity, including diabetes, hypertension, nonalcoholic steatohepatitis, arthritis, or severe sleep apnea. Exclusion criteria were smoking, significant alcohol use, uncontrolled mood, anxiety or psychotic disorder, lack of support, or poor compliance with the program.
Data were collected from the nutrition assessment form in each subject's medical chart (Figure 1). The nutrition assessment form was modelled after the Boston interview and adapted for use by the bariatric health team at TWH, on the basis of clinical practice (19). Patients were able to select as many causes of weight gain as were applicable. Data were analyzed using SPSS (version 20, IBM Corp., Armonk, NY, 2011). Descriptive statistics present the mean plus/minus standard deviation for age and BMI, as well as the percentage for each sex. Frequency distribution analysis was performed to determine the percent occurrence of causes selected by participants. A chi-square test was performed to determine if significant correlations existed between selected causes of weight gain and age, sex, and BMI.
Of 222 participants assessed, 160 (129 women and 31 men) were included in the study. Sixty-two participants who were inadvertently assessed with an older version of the assessment form were excluded. Participants' mean age was 46.1 [+ or -] 10.8 years (range, 21 to 70). The mean BMI was 49.8 [+ or -] 8.9 kg/[m.sup.2] (range, 35 to 80). Mean age and BMI were similar for women and men.
Table 1 lists the frequency of causes of weight gain, which participants selected on the assessment form. Stress and dieting were the top two causes selected by all participants. Significant differences were found between the sexes in the selection of dieting and change in the living environment (62% of women versus 32% of men [P<0.004] and 35% of women versus 42% of men [P<0.026], respectively). No other significant differences between the sexes were found for the remaining causes of weight gain. Correlations between age and BMI were not found.
Stress and weight gain
Stress was the most commonly reported cause of weight gain, selected by 63% (n=101) of participants. A similar percentage was reported in a study showing that eating when stressed is a significant contributor to weight gain in female prebariatric surgery patients (11). However, as stress is a broad category, further research may be useful for the identification of specific factors leading to stress in the prebariatric surgery population. Our findings suggest that stress management may be indicated as part of perioperative care for bariatric surgery patients.
Dieting and weight gain
Fifty-six percent of study participants selected dieting as a cause of weight gain. The existing literature supports this finding, as prebariatric surgery patients commonly report numerous dieting attempts (12,13). The literature suggests that dieting is associated with greater weight gain, particularly in females--a result similar to ours (20). This finding indicates a need for RDs to deconstruct and rebuild patients' perceptions of healthy eating before surgery. Intensified intervention may also be appropriate with female patients.
Living environment and weight gain
A significant difference was also found between the sexes in the selection of a change in living environment as a factor influencing weight gain. This is of interest because currently no literature supports this finding. Research is needed to explore this factor further.
Other causes of weight gain
The remaining causes listed on the nutrition assessment form were also selected. This finding is consistent with the literature, which illustrates that weight gain is multifactorial (15,16).
Limitations include response bias, as self-reported data were used (21,22). In addition, data were collected by a retrospective chart review, which means other demographic information that could potentially affect weight gain was not recorded. Because the category of stress did not include subcategories, participants may have chosen stress more often than would have been the case otherwise. Possibly this skewed the results. Last, the assessment form used was not validated, and therefore further modification and validation may be indicated.
Stress and dieting were the most commonly reported causes of weight gain in this study population. Further research on self-reported causes of weight gain in this population is needed to strengthen these findings and improve RDs' perioperative care of prebariatric surgery patients.
RELEVANCE TO PRACTICE
Tailored care may be useful for patients undergoing bariatric surgery. Our findings support others' finding that weight gain is a multifactorial problem, which requires interdisciplinary care. Because a large proportion of participants selected dieting as a cause of weight gain, RDs can play an important role in dispelling myths perpetuated by the weight loss industry and re-educating patients about the truths of healthy eating. The fact that stress was the most commonly selected cause of weight gain may indicate that patients need enhanced stress management support.
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SARAH FERGUSON, BASc, HonBSc, RD, LAYLA AL-REHANY, BASc, RD, CATHY TANG, BASc, RD, LORRAINE GOUGEON, BA, RD, KATIE WARWICK, BSc, RD, JANET MADILL, PhD, RD, Department of Allied Health, University Health Network, Toronto, ON
Table 1 Causes of weight gain, indicated by participants on the nutrition assessment form Female Male Cause of weight gain (n=129) (a) (n=31) (a) Stress 64% (n=82) 61% (n=19) Dieting 62% (n=80) (b) 32% (n=10) (b) Medical condition 40% (n=52) 45% (n=15) Change in job/career 36% (n=46) 58% (n=18) Quitting smoking 38% (n=49) 32% (n=10) Change in living environment 35% (n=45) (b) 42% (n=13) (b) Financial problems 33% (n=43) 45% (n=14) Chronic pain 33% (n=43) 23% (n=7) Injury (affecting mobility) 27% (n=35) 45% (n=14) Death of loved ones 30% (n=39) 16% (n=5) Puberty 28% (n=36) 16% (n=5) Divorce/end of relationship 26% (n=33) 26% (n=8) Others' influence over diet 21% (n=27) 16% (n=5) Mental health condition 16% (n=21) 26% (n=8) Abuse 16% (n=20) 20% (n=6) Surgery 15% (n=19) 13% (n=4) Other 12% (n=16) 10% (n=3) Drug or alcohol use 8% (n=10) 16% (n=5) Pregnancy 60% (n=77) N/A Menopause 21% (n=27) N/A Total participants Cause of weight gain (n=160) (a) Stress 63% (n=101) Dieting 56% (n=90) Medical condition 41% (n=66) Change in job/career 40% (n=64) Quitting smoking 37% (n=59) Change in living environment 36% (n=58) Financial problems 36% (n=57) Chronic pain 31% (n=50) Injury (affecting mobility) 31% (n=49) Death of loved ones 28% (n=44) Puberty 26% (n=41) Divorce/end of relationship 26% (n=41) Others' influence over diet 20% (n=32) Mental health condition 18% (n=29) Abuse 16% (n=26) Surgery 14% (n=23) Other 12% (n=19) Drug or alcohol use 9% (n=15) Pregnancy 60% (c) (n=77) Menopause 21% (c) (n=27) N/A = not applicable (a) Percentages have been rounded to the nearest whole number. (b) Significant differences were found between the sexes (p<0.05). (c) These values are based on total responses from women.
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|Author:||Ferguson, Sarah; Rehany, Layla Al-; Tang, Cathy; Gougeon, Lorraine; Warwick, Katie; Madill, Janet|
|Publication:||Canadian Journal of Dietetic Practice and Research|
|Date:||Jan 1, 2013|
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