Search

Purpose There is a critical need to explore bariatric patients’ perceptions of existing neighborhood and built environment resources and supports to assist with postoperative behavior change and weight loss maintenance. The objective of this study was to survey postoperative patients to determine neighborhood food retail, fitness facility, and options for outdoor activity access, utilization, satisfaction, and perceptions of resources. Materials and Methods A convenience sample of postoperative patients from a single academic surgical center in the USA (N = 44) completed an online survey about access, utilization, satisfaction, and safety for food retail, fitness facility, and outdoor activity options in their neighborhoods. Analysis included descriptives (frequency, percent, Chi-square), and independent samples t tests and ANOVA determined differences based on race, insurance status, geographic location, and receipt of governmental assistance programs. Open-ended questions were analyzed using summative content analysis. Results Patients reported the highest access to lower-cost national food retailers and fitness facilities. The most prevalent challenge in finding food products to meet patients’ goals was financial (39%). Patients’ top suggestions for fitness facilities included training staff/facilities (59%) and trainers (35%) in postoperative patient care and exercise. The highest access for outdoor activity options was for walking/running trails, city/metro parks, and sidewalks. Significant differences in access, utilization, and safety were found based on geographic location, receipt of at least one assistant program, and race. Conclusion The development of targeted resources may benefit patients in non-suburban areas and who receive governmental assistant programs to increase safety of outdoor options and access to lower-cost food retailers and to increase utilization of lower-cost fitness facilities. Graphical abstract

Little is known about associations between preoperative psychiatric, disordered eating, and substance use diagnoses with the clinical decision to require follow-up after the preoperative psychological evaluation. To determine the proportion of patients who require follow-up (no required follow-up (NFU), required follow-up (RFU), placed on hold (POH)) from the preoperative psychological evaluation, associations with diagnoses, and noted reasons for follow-up.The sample included 508 patients (77.6% female; 64.4% White) pursuing bariatric metabolic surgery with completed psychological evaluations between August 2019 and December 2020 at a Midwest medical center. Patient demographics, psychological evaluation outcome and corresponding reasoning, and psychiatric, disordered eating, and substance use diagnoses were extracted from the health record. Descriptive and bivariate analyses determined associations between demographics and diagnoses with psychological evaluation outcomes and corresponding reasoning.The breakdown of psychological evaluation outcomes was 60.6% (n = 308) NFU, 38.4% (n = 195) RFU, and 1.0% (n = 5) POH. Demographic correlates of RFU included higher BMI, being single, lower educational attainment, unemployment, public/no insurance, and receiving multiple or any psychiatric diagnosis (all p-values 0.05). Diagnostic correlates of RFU included anxiety, depression, not having a current trauma or stressor-related disorder, disordered eating, and substance use diagnoses (all p-values 0.001). RFU/POH was primarily due to psychiatric (61%) reasons.Higher rates of RFU were observed for patients with higher economic need and with psychiatric, disordered eating, or substance use diagnoses. Future work should establish preoperative programming to assist patients with addressing ongoing psychiatric concerns prior to bariatric metabolic surgery.

To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients’ weight loss and physical activity levels and family members’ weight control practices. As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1 month pre-surgery, T3 = 2 weeks post-surgery, T4 = 2 months post-surgery). Assessments of patients’ percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members’ weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1–T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate. There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4. Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.

Children witness parental weight loss from bariatric surgery; however, little is understood about parental engagement and communication with children about weight loss. The purpose of this study is to explore parental engagement in activities and communication about weight loss with children during the bariatric surgery process. Seventy-two pre- or post-surgery parents, living with a child 2-25- years- old, were surveyed using a questionnaire to assess engagement in social and physical activities and communication with children about weight loss, and the Social Support for Exercise and Eating Habits Survey. Multivariate logistic regression determined correlates of engagement and communication, with covariates: child age and perceived weight status, surgery status, and social support. Family discouragement for making eating habit change was associated with an increased odds [OR = 1.21 (CI 1.03, 1.41)] of parents endorsing their weight held them back from social activities. Parents with older children [OR = .88 (CI .78, 1.00)] and children perceived to have overweight/obesity [OR = .18 (CI .03, .96)], and who were post-surgery [OR = 4.78 (CI 1.05, 21.88)] had increased odds of discussing losing weight with their child. The results of this study suggest parents are communicating with their children about weight loss, though more often with older and overweight/obese children.

Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient’s postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL). An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates. Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009). Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient's postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL).An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates.Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009).Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients' weight loss and physical activity levels and family members' weight control practices.As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1 month pre-surgery, T3 = 2 weeks post-surgery, T4 = 2 months post-surgery). Assessments of patients' percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members' weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1-T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate.There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4.Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.

The aim was to assess the romantic and peer relationships of bariatric surgery candidates and associations with health behaviors. Adults seeking bariatric surgery (N = 120) completed surveys addressing health behaviors and social relationships at information sessions. Analysis was done to compare male/female differences in peer and romantic relationships and associations with health behaviors. Previously published reference (REF) data on the Relationship Structures questionnaire was used for comparison, and to split our sample into those ≤ or > REF mean for relationship anxiety and avoidance. Our sample reported higher avoidance and lower anxiety in their close friendships and romantic relationships compared to the REF sample. Men in our sample had higher peer and romantic relationships avoidance compared to the REF sample and had significantly higher close friendship avoidance than women in our sample. Participants with lower anxiety in their romantic relationships (≤ REF) had higher uncontrolled eating and physical activity; those with more anxiety in their romantic relationships (> REF) had a higher BMI. Our findings highlight the potential influence that social relationships may have on health behaviors within the bariatric surgery population. Further investigation is warranted to explore male bariatric surgery candidates’ relationships to inform understanding and intervention development.

Long-term weight maintenance following weight loss surgery (WLS) may be challenging for patients without supportive spouses. The health behaviors and relationship quality of spouses pre- and post-WLS have rarely been explored, leaving providers with little guidance on how to engage spouses in treatment. The purpose of this review is to synthesize the empirical research on relationship factors and WLS among married couples. The identified articles (N = 13) reported that the amount of weight lost post-WLS tended to be lower for married patients, couples' relationship quality tended to decline from pre- to post-WLS, and sexual contact increased post-WLS. Future research should explore how the relationship factors and quality of couples may influence patients' WLS outcomes over time to identify ways that interventions can enhance the couple's relationship and health.