Weight regain post bariatric surgery Jane Ogden

Transcript:Weight regain post bariatric surgery Jane Ogden:
Weight regain post bariatric surgery Jane Ogden Professor in Health Psychology University of Surrey UK (just about!) Overview Success The problem Predictors of weight regain What happens? Solutions?? A success story..... Remains most effective method of weight loss (1-2 yrs; Cochrane Review, 2014) All > non surgery LRYGB=Sleeve> Band (BMI diff -5.2) BPD>RYGB for super obese (BMI diff-7.3) SOS: 10 yr -16.1% weight loss Band: -47% EWL Bypass: -67% EWL Non surgery: -2.46kg by 1 year (NICE 2014); 95% regain by 5 yrs; mean gained by 10 yrs The problem.... Weight regain.... Definitions Increase of at least 10% of lowest post op weight Kg regained Change in BMI % EWL (nightmare reporting!) Weight regain Roux en Y: 23.7% (2 yrs) (Da Silva et al, 2016) 23.4% (mean 6yrs) (Cooper et al, 2015) 41% (10 yrs) (Monaco-Ferreira & Leandro-Mehi, 2016) Sleeve: 59% (10kg); 45% (15kg); 13% (>25kg) (10yrs) (Felsenreich et al, 2016) SOS – 2-10yrs: 23.4% -16.1% Predictors of weight regain Pt vs surgical factors (Karmali et al, 2013) Multifactorial (Kushner & Sorensen, 2015) Behaviour / diet / psychological / physical / medical (Mcgrice & Don Paul, 2015) Behaviour Poor diet Lack of activity Non follow ups Endocrinology Higher plasma ghrelin Abnormal glucose tolerance Non modifiable Younger Female Time since surgery No co-morbidities Genetics?? Surgical Stomal dilation Pouch length Revision New procedure Psychology Binge eating Depression Drug & alcohol Impulsivity What actually happens?.......... (Ogden et al, 2005; 2006; Ogden, Avenell and Ellis, 2011) Cheating ‘I found that if I chewed the food tremendously to a pulp I could actually get more of it, erm, quite frequently...I actually ate anything I felt like eating’ Rebelling ‘I was really depressed about not having to eat initially. That really, really got to me. So much so that I rebelled and tried to eat stuff that I used to eat. (Laura) Grazing They say that you mustn’t drink in-between eating because it causes a flush but I would drink during eating . . . I mean I would have chinese half well quarter of the chinese at night, I’d get up in the middle of the night and have some more and then I would get up and the rest probably for breakfast’ (Ruth). Substitute behaviours “Post surgery, I definitely transferred to alcohol ‘cos I couldn’t eat… It was easier and easier to drink to fulfil the need in me.” Why? Emotional regulation “If you’ve