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Success Habits of Long-Term Gastric Bypass Patients

Colleen M.Cook; Charles Edwards, MD, FACS

St. Mark's Center for the Surgical Treatment of Obesity, Salt Lake City, Utah, USA

Background:

By identifying common habits of the most successful long-term gastric bypass patients, one is able to establish more specific guidelines for new patients to follow. The first postoperative year is a critical time that must be dedicated to changing old behavior and forming new, lifelong habits.

Methods:

100 gastric bypass patients from 1979 to 1995 participated in a comprehensive survey. Surveys were completed in person, by phone, or in writing. Participants were asked to answer questions regarding their eating,drinking, sleeping, exercise, and personal habits.

Results:

The survey revealed that specific habits are common in gastric bypass patients who have maintained their weight loss for many years.

Conclusion:

Identifying and defining the common habits of patients who are successful with long-term weight-loss enabled specific guidelines to be established for new patients to implement during the initial weight loss phase, which will contribute to life-long success.

Key words: Behavior, exercise, gastric bypass, habits, morbid obesity,surgery.

Since 1979, the surgeons* at the Rocky Mountain Associated Physicians office in Salt Lake City, Utah, have collectively performed over 8000Roux-en- Y gastric bypass procedures. In those nearly 20 years, much has been learned about the habits and behaviors that contribute to or are detrimental to the long- term success of gastric bypass patients.

The success of weight loss surgical procedures is most commonly defined by the total weight loss during the initial weight loss phase. However, fore- most in the minds of weight loss surgery patients are the questions "Will this be a long-term permanent solution?" and "What can I do to insure my life- long success?"

Methods

We conducted a random survey of 100 gastric bypass patients who had undergone surgery from the years 1979 to 1995. They were asked questions regarding their eating, sleeping, drinking, exercising, and personal habits. From our research, we identified six key habits that are common among our most successful long-term gastric bypass patients. Surveys were completed in person, by phone, or in writing. Our research details are as follows:

Success was defined as maintenance of at least 740f the initial weight loss. Patient demographics are shown in Table 1. Survey data are shown in Table 2.

The habits surveyed were eating, drinking, sleeping, exercise, and personal habits.

Table1. Patient demographics

Results

Successful gastric bypass patients had each implemented several life-long habits that contributed to their ability to maintain significant weight loss for many years. We identified six common habits among the patients surveyed, and established guidelines for those habits that will provide needed direction for new weight loss surgery patients.

Eating

Successful patients ate three well-balanced meals and two snacks per day. Daily servings for each of the food groups were as follows:three servings of protein, three servings of vegetables, one serving of fruit,two servings of bread/ starches, and two servings of sweets.

Drinking

Successful patients drank water and did not drink carbonated beverages. On the average, patients drank 40-64 oz of water per day: 58 ofpatients do not drink carbonated beverages of any kind; 55 0o not drink juices or sweetened beverages; 53 0o not drink caffeinated beverages; and 74 0o not drink alcoholic beverages.

Vitamins and Supplements

Successful patients took daily multiple vitamins, calcium,and iron if needed; 92 0f patients took a daily multiple vitamin, 68% took supplemental calcium, primarily in the form of tums, and 39 continued to take supplemental iron, such as Trinsicon or Chromagen.

Table 2. Survey data

Sleeping

Successful patients slept 7 hours per night on the average,and 760f patients rated their personal energy as being average or high.

Exercising

Successful patients exercised regularly to maintain their weight; 770f patients exercised. The average was four times per week for at least 40 min. Patients reported exercise as a key factor in their ability to maintain their weight. Comments such as "helps me keep my weight in check" and "keeps me in control" were noted.

Personal Responsibility

Successful patients took personal responsibility for staying in control. Of the patients, 69% weighed themselves at least weekly. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that the surgery was a tool that they used to reach and maintain a healthy weight. By weighing often and allowing themselves only a few kilograms of leeway, patients stayed in control.

In those patients surveyed who were not classified as successful, an absence of at least one or more of the six success habits was found. The most common were lack of exercise, poorly balanced meals, constant grazing and snacking, and drinking carbonated beverages.

In the entire number of patients surveyed, including those who have gained back part of their weight, 970f patients viewed their gastric bypass as a success.

Discussion

Successful patients ate three well-balanced meals and two snacks daily; drank water and avoided carbonated beverages of any kind; took multiple vitamins, iron, and calcium; slept 7 hours per night; exercised regularly; and took personal responsibility for weight control.

Carbonated beverages may be detrimental to the long-term success of gastric bypass for the following reasons:

1. Carbonation: When the cold beverage is consumed, it warms and releases gases, distending the stomach pouch. The stretching of the stomach then creates undue stress and subsequently causes stretching of the anastomosis,
2. Caloric intake: Many carbonated beverages are high in calories, are low in nutritional value, and contain simple sugars. Not only do they add additional calories with low nutritional value, but they are absorbed quickly into the blood stream, causing a rapid rise in blood sugar, elevated insulin levels and increased hunger.
3. Caffeine: Many carbonated beverages contain caffeine, an appetite stimulant, which is detrimental to initial weight loss and long-term weight control.

The first postoperative year is a critical time that must be dedicated to changing old behavior and forming new, lifelong habits. By identifying these six common habits of our most successful long-term gastric bypass patients, we have established more specific guidelines for new patients to implement. Guidelines formulated from the results of this survey have provided needed direction.

Acknowledgments

The authors acknowledge the assistance of Dawn L. Armstrong, St. Mark's Center for the Surgical Treatment of Obesity; Mary Ann Christiansen, Rocky Mountain Associated Physicians; and Anita Hansen, Rocky Mountain Associated Physicians.

(Received July 2, 1998, accepted September 18, 1998)

Presented at Allied Health Session, 15th Annual Meeting of ASBS, Orlando,June 29, 1998.

Reprint requests to: Colleen M. Cook, Vice President and Founder, Bariatric Support Centers International, 4001 South 700 East Suite 40, Salt Lake City, Utah 84107, USA.Tel: 801-327-6500; Fax: 801-327-0600.

Copyright, © 2003, Glenn Goldberg. All rights reserved.
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