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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).

Study limitations

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.


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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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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Title Annotation:Report/Rapport
Author:Ferguson, Sarah; Rehany, Layla Al-; Tang, Cathy; Gougeon, Lorraine; Warwick, Katie; Madill, Janet
Publication:Canadian Journal of Dietetic Practice and Research
Article Type:Report
Geographic Code:1CANA
Date:Jan 1, 2013
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