Weight loss effects of Bariatric Surgery after nutrition education in extremely obese patients

Eun-Ha Jeong; Hong-Chan Lee; Jung-Eun Yim

doi:10.4163/jnh.2015.48.1.30

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Jeong, Lee, and Yim: Weight loss effects of Bariatric Surgery after nutrition education in extremely obese patients

Research Article

J Nutr Health 2015;48(1):30-45.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.1.30

Weight loss effects of Bariatric Surgery after nutrition education in extremely obese patients

Eun-Ha Jeong¹, Hong-Chan Lee², Jung-Eun Yim^1,^†

¹Department of Food & Nutrition, Changwon National University, Changwon, Gyeongnam 641-773, Korea

²CHAN Bariatric Surgery Hospital, Seoul 135-887, Korea

^†To whom correspondence should be addressed. tel: +82-55-213-3517, e-mail: jeyim@changwon.ac.kr

^∗ This work was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the ministry of Education, Science and Technology (2013R1A1A3010917).

Received 18 September 2014 Revised 12 November 2014 Accepted 30 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was planned to determine the characteristics of extremely obese patients during Bariatric surgery and to evaluate how the difference in the number of postsurgical personal nutritional educations they received affected the weight loss.

Methods:

This is a retrospective study on the basis of the medical records of extremely obese patients for 15 months after receiving gastric banding. A total of 60 people were selected as the study subjects and they were divided into the Less Educated Group and the More Educated Group according to the average number of personal nutritional educations they received. We investigated both groups to determine the general characteristic, health related lifestyle habits, obesity related complications and symptoms in possession, and eating habits before their surgery, the body composition measurement result, obesity determination indices at 1, 3, 6, 9, 12, and 15 months before and after their surgery, and the biochemical parameters at 6 months before and after their surgery.

Results:

Body fat and weight showed rapid reduction until 6 months after the surgery, but thereafter reduced slowly depending on the result of body composition measurement. Regarding body fat and weight, the More Educated Group, who received nutrition education more often, showed significantly lower levels than the Less Educated Group at 15 months after surgery. Regarding BMI and degree of obesity, the More Educated Group showed significantly lower levels than the Less Educated Group at 15 months after surgery. Here, we were assured that BMI is reversely proportional to the number of personal nutritional educations at 15 months, which is more outstanding after surgery than before surgery.

Conclusion:

Long-term nutritional education is a key factor for the extremely obese patient in maintaining the effects of Bariatric surgery on weight and body fat reduction onwards. In the next stage, considering the characteristics of the study subjects, adoption of individual nutrition education is recommended for postsurgical prospective arbitration of obesity in order to monitor blood pressure, obesity related complications, symptoms in possession, and how eating habits and health related life habits change, and to judge the actual effect of the nutritional education method at the same time.

Keywords: bariatric surgery, nutrition education, severe obese patients

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Fig. 1.

Weight changes of preoperation and postoperation

Table 1.

Nutrition education contents

	Educational contents
Preoperation	The importance of regular meals Basic guidelines of meal plans
	Snack intake
	Cooking method and examples of menu
	The importance of ensuring meal times
	The importance of preoperative diet adjustment
	The importance of psychological by associated with binge eating and emotional eating
	The Importance of Exercise
Operation	How to water intake
	The method proceeds to step (fluid food, soft diet, general diet)
	The need for vitamin and mineral supplements
	Precautions and prevention of associated with vomiting
	Symptoms can be caused by overeating
Postoperation	How to choose low calorie foods
	How to adjust fat intake
	A well-balanced diet
	Basic food groups
	Protein source food
	Food substitution table
	Meal management of eat out
	The advantages of a meal diary
	Examples of menu
	Side effects and prevention of vomiting, overeating

Table 2.

General characteristics of the subjects according to level of education

Variables	Total (n = 60)	Less educated (n = 29)	More educated (n = 31)	χ²
Sex (n)
Female	56 (93.3)	26 (89.7)	30 (96.8)	1.2204
Male	4 (6.7)	3 (10.3)	1 (3.2)	1.2204
Age (year)	32.30 ± 7.82	31.62 ± 6.50	32.94 ± 8.94	3.2190
18~29	24 (40.0)	10 (34.5)	14 (45.2)
30~39 40~49	26 (43.3) 8 (13.3)	15 (51.7) 4 (13.8)	11 (35.5) 4 (12.9)
50~59	2 (3.3)	0 (0.0)	2 (6.5)
Height (cm)	162.52 ± 5.64	162.23 ± 6.22	162.79 ± 5.14
Weight (kg)	98.05 ± 15.45	98.19 ± 14.31	97.92 ± 16.68
BMI (kg/m²)	37.07 ± 5.33	37.19 ± 4.29	36.96 ± 6.21	1.4132
30.0~<35.0	23 (38.3)	9 (31.0)	14 (45.2)
35.0~<40.0	23 (38.3)	13 (44.8)	10 (32.3)
≥ 40.0	14 (23.3)	7 (24.1)	7 (22.6)
SBP (mmHg)	127.81 ± 13.29	123.96 ± 14.41	131.52 ± 11.12∗
DBP (mmHg)	78.70 ± 12.31	76.46 ± 10.93	80.86 ± 13.36
PULSE (bpm)	92.28 ± 13.81	89.96 ± 13.27	94.52 ± 14.19

Values are presented as number (%) or Mean ± SD. BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure. Analyzed using t-test for continuous variables and chi-square test for categorical variables. Significantly different at ∗p < 0.05.

Table 3.

Health-related lifestyle of the subjects according to level of education

	Total (n = 60)		Less educated (n = 29)		More educated (n = 31)		χ²
	No	Yes	No	Yes	No	Yes	χ²
Alcohol drinking	35 (58.3)	25 (41.7)	17 (58.6)	12 (41.4)	18 (58.1)	13 (41.9)	0.0487
< 0.5 bottle/once		6 (24.0)		2 (16.7)		4 (30.8)
0.5~1 bottle/once		2 (8.0)		0 (0.0)		2 (15.4)
1~2 bottles/once		6 (24.0)		3 (25.0)		3 (23.1)	7.4163
2~3 bottles/once		9 (36.0)		7 (58.3)		2 (15.4)
≥ 3 bottles/once		2 (8.0)		0 (0.0)		2 (15.4)
Smoking	43 (71.7)	17 (28.3)	22 (75.9)	7 (24.1)	21 (67.7)	10 (32.3)	0.4865
< 0.5 pack/day		9 (52.9)		2 (28.6)		7 (70.0)
0.5~1 pack/day		4 (23.5)		3 (42.9)		1 (10.0)	3.3528
1~2 packs/day		4 (23.5)		2 (28.6)		2 (20.0)
Folk Remedies used	39 (68.3)	19 (31.7)	24 (82.8)	5 (17.2)	17 (54.8)	14 (46.7)	4.7959∗

Values are presented as number (%). Analyzed using chi-square test.

∗p < 0.05 Less education vs. More education by chi-square test.

Table 4.

Obesity complications of the subjects according to level of education

	Total (n = 60)		Less educated (n = 29)		More educated (n = 31)		χ²
	No	Yes	No	Yes	No	Yes	χ²
Hypertension	53 (88.3)	7 (11.7)	26 (89.7)	3 (10.3)	27 (87.1)	4 (12.9)	0.0952
Diabetes mellitus	55 (91.7)	5 (8.3)	27 (93.1)	2 (6.9)	28 (90.3)	3 (9.7)	0.1517
Hyperlipidemia	55 (97.7)	5 (8.3)	28 (96.6)	1 (3.5)	27 (87.1)	4 (12.9)	1.7535
Gastroesophageal reflux disease	49 (81.7)	11 (18.3)	23 (79.3)	6 (20.7)	26 (83.9)	5 (16.1)	0.2081
Urinary incontinence	56 (93.3)	4 (6.7)	27 (93.1)	2 (6.9)	29 (93.6)	2 (6.5)	0.0048
Arthritis	59 (98.3)	1 (1.7)	28 (96.6)	1 (3.5)	31 (100.0)	0 (0.0)	1.0871
Breath problem	56 (93.3)	4 (6.7)	26 (89.7)	3 (10.3)	30 (96.8)	1 (3.2)	1.2204
Back, waist, leg pain	13 (21.7)	47 (78.3)	7 (24.1)	22 (75.9)	6 (19.4)	25 (80.7)	0.2020
Sleep problem	52 (86.7)	8 (13.3)	27 (93.1)	2 (6.9)	25 (80.7)	6 (19.4)	2.0125
Sleep apnea	54 (90.0)	6 (10.0)	24 (82.8)	5 (17.2)	30 (96.8)	1 (3.2)	3.2703
Iron deficiency anemia	58 (96.7)	2 (3.3)	28 (96.6)	1 (3.5)	30 (96.8)	1 (3.2)	0.0023
Depression	56 (93.3)	4 (6.7)	29 (100.0)	0 (0.0)	27 (87.1)	4 (12.9)	4.0092∗
Gestational diabetes	59 (98.3)	1 (1.7)	28 (96.6)	1 (3.5)	31 (100.0)	0 (0.0)	1.0871
Menstrual Irregularity	41 (68.3)	19 (31.7)	21 (72.4)	8 (27.6)	20 (64.5)	11 (35.5)	0.4319
Snore	25 (41.7)	35 (58.3)	8 (27.6)	21 (72.4)	17 (68.0)	14 (45.2)	4.5784∗

Values are presented as number (%). Analyzed using chi-square test.

∗p < 0.05 Less education vs. More education by chi-square test.

Table 5.

Dietary habits of the subjects according to level of education

	Total (n = 60)		Less educated (n = 29)		More educated (n = 31)		χ²
	No	Yes	No	Yes	No	Yes	χ²
Irregular meal time	26 (43.33)	34 (56.67)	12 (41.38)	17 (58.62)	14 (45.16)	17 (54.84)	0.0873
Without a meal	59 (98.33)	1 (1.67)	29 (100.00)	0 (0.00)	30 (96.77)	1 (3.23)	0.9513
Overeating	18 (30.00)	42 (70.00)	12 (41.38)	17 (58.62)	6 (19.35)	25 (80.65)	3.4610
Frequent snacks	29 (48.33)	31 (51.67)	13 (44.83)	16 (55.17)	16 (51.61)	15 (48.39)	0.2762
Night meal	33 (55.000	27 (45.00)	14 (48.28)	15 (51.72)	19 (61.29)	12 (38.71)	1.0254
Stress meal	26 (43.33)	34 (56.67)	10 (34.48)	19 (65.52)	16 (51.61)	15 (48.39)	1.7905
Quick feed	8 (13.33)	52 (86.67)	4 (13.79)	25 (86.21)	4 (12.90)	27 (87.10)	0.0103
Sugary food	48 (80.00)	12 (20.00)	25 (86.21)	4 (13.79)	23 (74.19)	8 (25.81)	1.3515
Junk food	32 (53.33)	28 (46.67)	16 (55.17)	13 (44.83)	16 (51.61)	15 (48.39)	0.0763

Values are presented as number (%). Analyzed using chi-square test. There is no difference between the groups by chi-square test.

Table 6.

Nonoperative treatments of the subjects according to level of education

	Total (n = 60)		Less educated (n = 29)		More educated (n = 31)		χ²
	No	Yes	No	Yes	No	Yes	χ²
Nonoperative therapy	2 (3.33)	58 (96.67)	1 (3.45)	28 (96.55)	1 (3.23)	30 (96.77)	0.0023
Diet therapy	24 (40.00)	36 (60.00)	9 (31.03)	20 (68.97)	15 (48.39)	16 (51.61)	1.8799
Fasting		8 (22.22)		6 (30.00)		2 (12.50)
One-food diet		8 (22.22)		3 (15.00)		5 (31.25)
Dietary supplement		13 (36.11)		7 (35.00)		6 (37.50)	9.2466
Calorie restriction		4 (11.11)		4 (20.00)		0 (0.00)
Non-response		3 (8.33)		0 (0.00)		3 (18.75)
Exercise therapy	17 (28.33)	43 (71.67)	9 (31.03)	20 (68.97)	8 (25.81)	23 (74.19)	0.2017
Aerobic		18 (41.86)		11 (55.00)		7 (30.43)
Aerobic·anaerobic²⁾		24 (55.81)		9 (45.00)		15 (65.22)	3.1951
Non-response		1 (2.33)		0 (0.00)		1 (4.35)
Behavior modification therapy	59 (98.33)	1 (1.67)	29 (100.00)	0 (0.00)	30 (96.77)	1 (3.23)	0.9513
Pharmacotherapy	5 (8.33)	55 (91.67)	3 (10.34)	26 (89.66)	2 (6.45)	29 (93.55)	0.2973
1 kind		9 (16.36)		1 (3.85)		8 (27.59)
2 kinds		12 (21.82)		5 (19.23)		7 (24.14)	7.1649
3 kinds		17 (30.91)		9 (34.62)		8 (27.59)	7.1649
≥ 4 kinds		17 (30.91)		11 (42.31)		6 (20.69)

¹⁾ Values are presented as number (%). Analyzed using chi-square test. 2) Aerobic, Aerobic exercise; Aerobic· Anaerobic, Aerobic exercise and Anaerobic exercise. There is no difference between the groups by chi-square test.

Table 7.

Body composition of the subjects according to level of education¹⁾

	Less educated (n = 29)							More educated (n = 31)
	Preop²⁾	P1M³⁾	P3M⁴⁾	P6M⁵⁾	P9M⁶⁾	P12M⁷⁾	P15M⁸⁾	Preop	P1M	P3M	P6M	P9M	P12M	P15M
ICW⁹⁾	23.80	22.52	21.98	20.91	21.47	20.92	22.18	23.88	22.89	22.20	21.50	21.06	20.60	20.91
(L)	± 3.33^a	± 2.97^ab	± 3.32^ab	± 3.30^b	± 3.47^b	± 2.58^b	± 3.42^ab	± 3.03^a	± 2.84^ab	± 2.49^abc	± 2.71^bc	± 2.93^c	± 2.96^c	± 2.47^c
ECW¹⁰⁾	14.58	13.95	13.60	13.05	13.56	13.14	13.82	14.76	14.16	13.69	13.51	13.36	13.02	13.18
(L)	± 2.16^a	± 1.91^ab	± 2.12^ab	± 1.99^b	± 2.17^ab	± 1.53^b	± 2.11^ab	± 1.83^a	± 1.72^ab	± 1.75^bc	± 1.78^bc	± 1.90^bc	± 1.87^c	± 1.57^bc
TBW¹¹⁾	38.37	36.47	35.57	33.98	35.03	34.07	36.02	38.65	37.05	35.88	35.00	33.60	33.60	34.07
(L)	± 5.47^a	± 4.87^ab	± 5.42^ab	± 5.24^b	± 5.61^b	± 4.08^b	± 5.53^ab	± 4.81^a	± 4.50^ab	± 4.07^bc	± 4.46^bc	± 6.67^c	± 4.81^c	± 4.01^c
FFM¹²⁾	52.23	49.60	48.49	46.27	47.73	46.43	49.08	52.58	50.51	48.92	47.68	46.76	45.75	46.43
(kg)	± 7.40^a	± 6.74^ab	± 7.34^ab	± 7.14^b	± 7.56^b	± 5.56^b	± 7.47^ab	± 6.47^a	± 6.15^ab	± 5.49^bc	± 6.02^bc	± 6.52^c	± 6.55^c	± 5.46^c
BFM¹³⁾	45.97	41.13	35.27	26.72	24.66	24.84	27.28	45.32	39.40	33.81	27.02	22.73	21.33	21.69
(kg)	± 9.04^a	± 8.89^a	± 9.28^b	± 7.42^c	± 8.22^c	± 8.18^c	± 11.96^c	± 12.16^a	± 11.70^b	± 9.58^c	± 7.49^d	± 6.54^de	± 7.88^e	± 7.25^e∗
Vfat¹⁴⁾	164.60	136.20	113.80	93.40	74.50	73.60	86.80	179.40	149.80	131.30	92.50	76.10	78.00	72.10
(cm²)	± 43.85^a	± 42.27^b	± 38.07^c	± 36.06^cd	± 27.14^d	± 33.96^d	± 46.26^d	± 73.16^a	± 68.20^b	± 71.89^b	± 39.19^c	± 26.89^c	± 36.47^c	± 38.48^c
W¹⁵⁾	98.19	90.80	83.74	72.98	72.39	71.28	76.34	97.92	89.90	82.74	74.70	69.59	67.08	68.13
(kg)	± 14.31^a	± 13.10^ab	± 14.32^bc	± 11.78^d	± 14.32^d	± 11.76^d	± 18.18^cd	± 16.68^a	± 14.88^b	± 12.82^c	± 10.33^d	± 9.04^de	± 10.65^e	± 8.78^de∗

¹⁾ Values are Mean ± SD. Analyzed using t-test, ANOVA followed by the Duncan's multiple range test.

²⁾ Preop, Preoperation

³⁾ P1M, 1 Month Postoperation

⁴⁾ P3M, 3 Month Postoperation

⁵⁾ P6M, 6 Month Postoperation

⁶⁾ P9M, 9 Month Postoperation

⁷⁾ P12M, 12 Month Postoperation

⁸⁾ P15M, 15 Month Postoperation

⁹⁾ ICW, Intracellular Water

¹⁰⁾ ECW, Extracelluar Water

¹¹⁾ TBW, Total Body Water

¹²⁾ FFM Free Fat Mass

¹³⁾ BFM Body Fat Mass

¹⁴⁾ Vfat, Visceral fat area

¹⁵⁾ W, Weight

∗p < 0.05 P15M of Less education vs. P15M of More education by t-test.

a-e values with different superscript letter are significantly differentat p < 0.05.

Table 8.

Change of nutritional assessment index¹⁾

	Less educated (n = 29)						More educated (n = 31)
	Preop²⁾	P1M³⁾	P3M⁴⁾	P6M⁵⁾	P9M⁶⁾	P12M⁷⁾	P15M⁸⁾	Preop	P1M	P3M	P6M	P9M	P12M	P15M
BMI⁹⁾ (kg/m²)	37.19	34.39	31.74	27.75	27.17	26.86	28.52	36.97	33.98	31.44	28.22	26.32	25.25	25.73
BMI⁹⁾ (kg/m²)	± 4.29^a	± 3.93^b	± 4.32^c	± 3.65^d	± 3.93^d	± 3.89^d	± 5.71^d	± 6.21^a	± 5.46^b	± 4.69^c	± 3.81^d	± 3.21^de	± 3.93^e	± 3.36^e∗
PBF¹⁰⁾ (%)	46.63	44.98	41.64	36.96	33.40	34.18	34.53	45.70	43.08	38.74	35.72	32.30	31.13	31.33
PBF¹⁰⁾ (%)	± 4.3^a	± 5.0^a	± 5.9^b	± 7.6^c	± 5.8^c	± 6.5^c	± 6.7^c	± 5.4^a	± 6.9^a	± 9.3^b	± 6.3^bc	± 6.8^cd	± 7.7^d	± 7.4^d
WHR¹¹⁾	0.99	0.97	0.94	0.90	0.89	0.89	0.88	0.99	0.96	0.94	0.91	0.88	0.88	0.88
WHR¹¹⁾	± 0.03^a	± 0.03^ab	± 0.04^b	± 0.04^c	± 0.05^c	± 0.05^c	± 0.11^c	± 0.04^a	± 0.05^ab	± 0.05^b	± 0.05^c	± 0.04^d	± 0.05^d	± 0.05^d
Obes¹²⁾ (%)	175.7	162.2	149.9	131.1	128.3	127.1	134.4	175.2	160.9	147.4	133.7	124.6	119.5	121.8
Obes¹²⁾ (%)	± 19.7^a	± 18.5^b	± 19.6^c	± 17.1^d	± 18.4^d	± 18.6^d	± 25.5^d	± 28.8^a	± 25.4^b	± 21.8^c	± 17.9^d	± 15.1^de	± 18.3^e	± 15.8^e∗

¹⁾ Values are Mean ± SD. Analyzed using t-test.

²⁾ Preop, Preoperation

³⁾ P1M, 1 Month Postoperation

⁴⁾ P3M, 3 Month Postoperation

⁵⁾ P6M, 6 Month Postoperation

⁶⁾ P9M, 9 Month Postoperation

⁷⁾ P12M, 12 Month Postoperation

⁸⁾ P15M, 15 Month Postoperation

⁹⁾ BMI, body mass index

¹⁰⁾ PBF, percent body fat

¹¹⁾ WHR, Waist Hip Ratio

¹²⁾ Obes, obesity degree

∗p < 0.05 P15M of Less education vs. P15M of More education by t-test.

a-e values with different superscript letter are significantly different at p < 0.05.

Table 9.

Blood biochemical parameters in preoperation and 6 months postoperation¹⁾

	Less educated (n = 29)		More educated (n = 31)
	Before	After	Before	After
Total cholesterol (mg/dl)	206.83 ± 40.41	201.18 ± 42.61	199.35 ± 25.03	199.29 ± 34.01
Triglyceride (mg/dl)	189.66 ± 116.24	126.09 ± 109.87∗	163.32 ± 74.59	92.25 ± 33.56∗∗∗
HbA1c (%)	6.12 ± 0.67	5.57 ± 0.31∗∗∗	6.06 ± 0.97	5.44 ± 0.43∗∗∗
AST²⁾ (IU/L)	32.41 ± 17.90	19.40 ± 8.09∗∗	33.52 ± 19.42	18.17 ± 7.29∗∗
ALT³⁾ (IU/L)	44.17 ± 34.05	16.05 ± 8.57∗∗∗	38.07 ± 32.19	12.13 ± 4.16∗∗∗
Total protein (g/dl)	7.40 ± 0.46	7.36 ± 0.48	7.70 ± 0.58	7.43 ± 0.56∗
Albumin (g/dl)	4.47 ± 0.30	4.51 ± 0.32	4.50 ± 0.23	4.46 ± 0.31
Total bilirubin (mg/dl)	0.43 ± 0.16	0.68 ± 0.33∗∗∗	0.58 ± 0.29	0.80 ± 0.40∗
BUN⁴⁾ (mg/dl)	12.24 ± 3.09	10.64 ± 2.57∗	12.03 ± 2.69	12.00 ± 3.67
Creatinine (mg/dl)	0.73 ± 0.13	0.70 ± 0.10	0.74 ± 0.16	0.70 ± 0.11
Hemoglobin (g/dl)	13.72 ± 1.10	13.58 ± 1.04	13.76 ± 0.62	13.40 ± 1.03∗
Hematocrit (%)	42.07 ± 2.97	40.64 ± 2.72∗∗	41.92 ± 1.73	40.46 ± 2.77∗

¹⁾ Values are Mean ± SD. Analyzed using paired t-test.

²⁾ AST, Aspartate Transaminase

³⁾ ALT, Alanine Transaminase

⁴⁾ BUN, Blood Urea Nitrogen

∗p < 0.05,

∗∗p < 0.01,

∗∗∗p < 0.001 Before vs. After, by paired t-test.

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