Background: Patient adherence to recommended eating and physical activity behaviors is considered important to weight loss outcomes following gastric bypass surgery, but there has been little systematic research in this area to investigate behavioral predictors of weight loss.
Method: We developed a measure of postsurgical behaviors, the bariatric surgery self-management questionnaire (BSSQ). A survey was conducted of 200 patients attending postsurgical support groups (mean time since surgery 14 months, mean age 40 years, 85% female, presurgical weight 150 kg). Patients completed the BSSQ and measures of treatment regimen distress, perceived benefits of weight loss, and weight-related physical symptoms.
Results: Mean BSSQ adherence was in the 70% range, with subscale scores varying considerably. Distress levels associated with the new lifestyle were consistently low (approximately equal to 20%) and perceived benefits of weight loss were high early on and maintained consistently (70-90%). A final predictive model showed premorbid weight, time since surgery, and BSSQ physical activity subscale were significant predictors of weight loss, accounting for 73% of variance.
Conclusions: Physical activity adherence was the sole significant behavioral predictor of weight loss, although maladaptive dietary habits and patient selection issues were identified for future research. It will be important to replicate the current study in prospective, longitudinal studies with representative patient cohorts. A challenge for researchers will be to develop novel, intensive recruiting and retention strategies to allow closer examination of these issues.