Department of Medicine, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, 4949 Coolidge, Royal Oak, MI 48073, USA.
Obes Surg. 2010 Mar;20(3):349-56. doi: 10.1007/s11695-009-9895-6. Epub 2009 Jun 25.
After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB).
In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared.
Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p < 0.0001. The mean follow-up after bariatric surgery was 28.1 +/- 18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p = 0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of > or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model.
Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.
减重手术后，体重反弹的终身威胁依然存在。行为影响被认为在这个问题中起到了调节作用。因此，我们试图在接受 Roux-en-Y 胃旁路术（RYGB）的极度肥胖患者中确定这些预测因素。
在一家拥有成熟减重项目的大型三级医院中，包括一个专门从事减重医学的多学科门诊中心，有两位减重外科医生，我们向 1117 名 RYGB 后的患者邮寄了一份调查问卷。其中，203 份（24.8%）完成并返回，适合进行分析。如果患者接受 RYGB 不到 1 年，则将其排除在外。从患者的病历中提取基线人口统计学病史、术前贝克抑郁量表（BDI）和简明症状量表-18 评分；比较术前和术后的幸福感评分。
研究人群的平均年龄为 50.6±9.8 岁，147 名（85%）为女性，42 名（18%）为男性。女性术前体重为 134.1±23.6kg（295±52lb），男性术前体重为 170.0±29.1kg（374.0±64.0lb），p<0.0001。RYGB 后平均随访时间为 28.1±18.9 个月。总体而言，幸福感评分从术前的 3.7 分提高到了术后的 4.2 分，p=0.001。在 203 名回答者中，共有 160 名（79%）报告体重有一定程度的反弹，从最低点开始。在报告体重反弹的患者中，有 30 名（15%）出现了明显的反弹，定义为体重比最低点增加≥15%。显著体重反弹的独立预测因素包括食物欲望增加（比值比（OR）=5.10，95%置信区间 1.83-14.29，p=0.002）、术后幸福感严重下降（OR=21.5，95%置信区间 2.50-183.10，p<0.0001）和对酒精或药物使用的担忧（OR=12.74，95%置信区间 1.73-93.80，p=0.01）。BDI 评分越高，发生显著体重反弹的风险越低（OR 每增加 1 分，95%置信区间 0.91-0.98，p=0.001）。术后进行自我监测的患者在接受 RYGB 后体重反弹的可能性较小（OR=0.54，95%置信区间 0.30-0.98，p=0.01）。尽管术后随访频率与体重反弹呈负相关，但在多变量模型中这一变量并不具有统计学意义。
RYGB 术后显著体重反弹的预测因素包括基线时食物欲望增加、幸福感下降和对成瘾行为的担忧等指标。术后的自我监测行为与无体重反弹密切相关。这些数据表明，部分体重反弹可以在术前评估中预测，并通过 RYGB 后的自我监测策略来减少。
