Wellbeing and family effect of Roux-en-Y gastric bypass surgery : results from an observational study and RCT

Abstract: Introduction: Obesity is a world-wide public health issue. Bariatric surgery has shown to be the only effective way to reduce and maintain weight loss over time, with Roux- en-Y Gastric Bypass (RYGB) as the most common method used in Sweden. Technical complications after surgery have decreased substantially, thus, our focus of research has turned towards the wellbeing of these patients. Physical part of quality of life increases substantially after surgery, with a peak after approximately one year, followed by a gradual decline. The mental part of quality of life has shown less clear results, as is also the case with objectively measured physical activity, eating behavior and other psychosocial aspects. Psychosocial interventions after bariatric surgery might help to improve these outcomes. Additionally, the major lifestyle changes that relate to bariatric surgery have made researchers ask questions how this might affect the patients’ families, but little is known about this topic. Aims: The general aims of this thesis were to see if there were any long-term effects from mothers’ RYGB surgery on their children’s weight status, eating attitudes, body- esteem, self-concept, physical activity and sedentary time. Additional aims include to investigate if a dissonance-based group intervention can improve wellbeing after RYGB surgery and if health related quality of life was associated with physical activity before and after RYGB. Methods: This thesis consists of two data collections. The first one consists of a prospective cohort study of women undergoing RYGB surgery and their children, with a 4-year follow-up of psychosocial outcomes and physical activity. This data collection included home visits to the families, wearing accelerometers to objectively assess data on physical activity, and a number of psychosocial scales. The other data collection consists of a randomized controlled intervention study. Women waiting for RYGB surgery were recruited and then randomized to a dissonance- based group intervention (4 sessions) post-RYGB surgery or control group (standard care). These women also wore accelerometers and answered some psychosocial scales before, and one year after surgery. Results: Sixty-nine women and 81 of their children were recruited and 35 women and 43 of their children participated in all 3 measurements (pre-surgery, 9 months and 4 years post-surgery). Out of these, 30 women and 40 children provided valid accelerometer data. Children’s prevalence of overweight and obesity decreased 9 months post-surgery but increased again at 4 years follow-up. The same pattern was seen for children’s eating attitudes and women’s eating behavior, sleep quality and symptoms of depression and anxiety. Children’s self-concept and body-esteem declined gradually. There were no differences in women’s physical activity levels from pre- to post-surgery and children decreased their physical activity and increased their sedentary time over the same time period. The intervention study recruited 259 women with 156 women randomized to the intervention group and 103 to the control group. Fifty-three women from the intervention group did not attend any group sessions and 203 women in total completed one-year follow up assessments. A great improvement in quality of life was seen one-year post RYGB, but there were no differences between the intervention and control group in any of the measured outcomes. Moreover, physical activity was associated with quality of life both pre- and post-RYGB surgery (the data set included over 60 women from the control group with complete data). Conclusions: There might be an effect of mothers’ RYGB surgery on their children, but more research, preferable studies including a control group, are needed to tease out if this effect is a natural pattern or not. Women and children did not increase their physical activity levels after the mothers’ RYGB surgery and a decline in children’s psychosocial variables were shown. Many of women’s psychosocial variables showed a rebound effect 4 years after surgery, despite that weight remained stable from 9 months to 4 years post-surgery. Physical activity is associated with health-related quality of life in women both before and after RYGB surgery. Meeting with physical activity recommendations showed overall stronger associations post- compared to pre-RYGB. We found no early one-year effect on health-related quality of life, physical activity, social adjustment, body-esteem or eating behavior of a dissonance-based group intervention after RYGB surgery