Obesity is increasingly common and has devastating effects on society.  When an individual is obese, they are more likely to have heart disease, lung disease, diabetes and cancer.  Furthermore, obese people have less quality of life and die younger than their non-obese peers.  While there is no cure for obesity, weight-loss surgery has been proven to be safe and gives good, long-lasting weight loss results.

Fig. 1. Patient-reported factors causing weight regain. Patient reported behaviours resulting in poor diet (poor food choices, portion size, snacking) and not enough exercise as the reasons for weight regain. These factors were themselves influenced by patient health, psychological problems, cost and lack of support.

Sleeve gastrectomy is one type of weight-loss surgery.  It involves removing the majority of the stomach to leave only a narrow tube in its place.  After a sleeve gastrectomy patients are unable to eat the amounts of food they once were.  Patients lose weight rapidly and tend to achieve their lowest weight about 18 months after the surgery.  After that though, there seems to be a trend towards weight regain.  To understand more about this problem, we conducted seven group interviews with 38 patients who had undergone a sleeve gastrectomy and experienced weight regain.  Discussions with patients were recorded, transcribed and thematically analysed.

When asked about weight regain, patients clearly recognised that healthy eating and regular effective exercise were the cornerstone to sustaining weight loss.  In addition, they identified four factors which influenced their ability to maintain healthy lifestyle behaviours (Fig. 1):

1. Psychological factors such as stress, eating disorders and emotional eating
2. Health factors such as pregnancy, injuries, poor dentition and joint problems
3. The financial burden of good food and, to a lesser extent, access to exercise facilities
4. The available support to assist with ongoing information and motivation.

Fig. 2. Want patients would like to have for follow-up care.

Given that patients identified a lack of support as a potential contributing factor to weight regain, we asked patients what they thought ideal follow-up care might be.  The most important theme here was that patients just wanted more support or follow-up care, particularly in regards to providing good information and psychological support.  Furthermore, they identified that ideal care would be delivered within the overarching principles of providing individualised, specialised care by providers that maintain good rapport and assist in maintaining motivation (Fig. 2).  Participants also described a variety of ways in which increased support could be delivered.  These included a buddy system, internet support, group support and text message support.  This was an important finding as one-on-one follow-up in the long term is unsustainable in most public health settings.

This study provides important information about what patients think contribute to weight regain after weight-loss surgery.  They identified a lack of follow-up care as a possible contributing factor and also described how they would like their follow-up care delivered.  This information should be considered when services are developing follow-up protocols for their weight-loss surgery patients.

Melanie Lauti, Samantha Stevenson, Andrew G Hill, Andrew D MacCormick
Department of Surgery, University of Auckland, South Auckland Clinical Campus, Middlemore Hospital,
New Zealand

Publication

Patient Perspectives About Follow-Up Care and Weight Regain Following Sleeve Gastrectomy.
Lauti M, Stevenson S, Hill AG, MacCormick AD
Obes Surg. 2016 Apr 19

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