Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery. Longitudinal Assessment of Physical Activity in Women Undergoing Roux-en-Y Gastric Bypass Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: a randomised controlled trial Physical Activity Predicts Weight Loss Following Gastric Bypass Surgery: Findings from a Support Group Survey Preoperative Lifestyle Intervention in Bariatric Surgery: Initial Results from a Randomized, Controlled Trial Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Increased exercise capacity after surgically induced weight loss in morbid obesity. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study Quality of life before and after laparoscopic sleeve gastrectomy. A prospective cohort study. Musculoskeletal function following bariatric surgery. Supervised Physical Training Improves Weight Loss After Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year?
The purpose of this study was to determine whether pre- to postoperative increases in physical activity ( PA ) are associated with weight loss and health-related quality of life ( HRQoL )  following bariatric surgery . Participants were 199 Roux-en-Y gastric bypass ( RYGB ) surgery patients . The International Physical Activity Question naire ( IPAQ ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level : ( i ) Inactive/Active ( < 200-min/week/>or=200-min/week ) , ( ii ) Active/Active ( > or=200-min/week/>or=200-min/week ) and ( iii ) Inactive/Inactive ( < 200-min/week/<200-min/week ) . The  Medical Outcomes Study Short Form-36 ( SF-36 ) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes . Inactive/Active participants , compared with Inactive/Inactive individuals , had greater reductions in weight ( 52.5 + /- 15.4 vs. 46.4 + /- 12.8 kg ) and BMI ( 18.9 + /- 4.6 vs. 16.9 + /- 4.2 kg/m(2 ) ) . Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other . Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary ( MCS ) score and the general health , vitality and mental health domains ( P < 0.01 ) . Although the direction of causation is not clear , these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active . Future r and omized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes OBJECTIVE To test the effectiveness of two levels of physical activity interventions before and up to 6½ months after bariatric surgery . METHODS Before surgery , individuals completed submaximal exercise testing on a treadmill . After r and om assignment to st and ard care , pedometer use , or exercise counseling plus pedometer , participants wore an accelerometer for approximately 2 weeks and returned it to the bariatric center before surgery and 2 , 4 , and 6 months postoperatively . RESULTS Individuals in exercise counseling plus pedometer had higher steps per day and bout minutes of exercise per week than st and ard care and pedometer use over the course of the study . There were no group differences related to exercise tolerance ; however , all groups made significant improvement . There was no statistically significant change in sedentary or light activity nor was there a difference between groups . CONCLUSIONS Exercise counseling using pedometers increases physical activity from the perioperative period to 6½ months after surgery , but providing pedometers without professional feedback may not be more effective than st and ard bariatric surgery treatments . Rapid weight loss increases exercise tolerance and may mask the fitness improvements achieved through a modest physical activity intervention during the first 6 months after bariatric surgery Background Patients undergoing bariatric surgery  do not seem to increase objective ly measured  physical activity ( PA ) after surgery , despite substantial weight loss . The aims of the present study were ( i ) to objective ly characterize 3 months pre-surgery to 9 months postsurgery PA and sedentary behavior changes in women undergoing Roux-en-Y gastric bypass ( RYGB )  using tri-axial accelerometers and ( ii ) to examine associations between pre-surgery versus postsurgery PA and sedentary behavior with anthropometric measures taken in home environment . Methods Fifty-six women , with an average pre-surgery body mass index ( BMI ) of 37.6 ( SD 2.6 ) and of age 39.5 years ( SD 5.7 ) , were recruited at five Swedish hospitals .  PA  was measured for 1 week by the Actigraph GT3X+ accelerometer , and anthropometric measures were taken at home visits 3 months pre-surgery and 9 months postsurgery , thus limiting seasonal effects . Results Average BMI loss , 9 months postsurgery , was 11.7 ( SD 2.7 ) BMI units . There were no significant pre- to postsurgery differences in PA or sedentary behavior . However , pre-surgery PA showed negative association with PA change and positive association with postsurgery PA . Adjustments for pre-surgery BMI had no impact on these associations . Conclusions No significant differences were observed in objective ly measured changes in PA or time spent sedentary from 3 months pre-surgery to 9 months postsurgery among women undergoing RYGB . However , women with higher pre-surgery PA decreased their PA postsurgery while women with lower pre-surgery PA increased their PA OBJECTIVE To examine the impact of a pre-bariatric surgery physical activity intervention ( PAI ) , design ed to increase bout-related ( ≥10 min ) moderate to vigorous PA ( MVPA ) , on health-related quality of life ( HRQoL ) . METHODS Analyses included 75 adult participants ( 86.7 % female ; BMI = 45.0 ± 6.5 kg m(-2 ) ) who were r and omly assigned to 6 weeks of PAI ( n = 40 ) or st and ard pre-surgical care ( SC ; n = 35 ) .  PAI received 6 individual weekly counseling sessions to increase walking exercise . Participants wore an objective PA monitor for 7 days and completed the SF-36 Health Survey  at baseline and post-intervention to evaluate bout-related MVPA and HRQoL changes , respectively . RESULTS PAI increased bout-related MVPA from baseline to post-intervention ( 4.4 ± 5.5 to 21.0 ± 21.4 min day(-1 ) ) versus no change ( 7.9 ± 16.6 to 7.6 ± 11.5 min day(-1 ) ) for SC ( P = 0.001 ) . PAI reported greater improvements than SC on all SF-36 physical and mental scales ( P < 0.05 ) , except role-emotional . In PAI , better baseline scores on the physical function and general health scales predicted greater bout-related MVPA increases ( P < 0.05 ) , and greater bout-related MVPA increases were associated with greater post-intervention improvements on the physical function , bodily pain , and general health scales ( P < 0.05 ) . CONCLUSIONS Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery c and i date s. Future studies should examine whether this effect improves surgical safety , weight loss outcomes , and postoperative BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery Background : Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases , although increasing evidence is showing weight regain ~12–24 months postsurgery . Weight regain increases the risk of physical function decline , which negatively affects an individual 's ability to undertake activities of daily living . The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery . Methods : Twenty-four inactive adult bariatric surgery patients whose body mass index remained ⩾30 kg m2 12 to 24 months post surgery were r and omised to an exercise intervention ( n=12 ) or control group ( n=12 ) . Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks . Control participants received usual care .  The incremental shuttle walk test ( ISWT ) was used to assess functional walking performance after the 12-week exercise intervention , and at 24 weeks follow-up . Measures of anthropometric , physical activity , cardiovascular and psychological outcomes were also examined . Using an intention-to-treat protocol , independent t-tests were used to compare outcome measures between groups . Results : Significant improvements in the exercise group were observed for the ISWT , body composition , physical function , cardiovascular and self-efficacy measures from baseline to 12 weeks . A large baseline to 12-week change was observed for the ISWT ( exercise : 325.00±117.28 m ; control : 355.00±80.62 m , P<0.001 ) . The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group . Conclusions : A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention , with further improvements at the 24-week follow-up Background Patient adherence to recommended eating and physical activity behaviors is considered important to weight loss outcomes following gastric bypass surgery , but there has been little systematic research in this area to investigate behavioral predictors of weight loss . Method We developed a measure of postsurgical behaviors , the bariatric surgery self-management question naire ( BSSQ ) . A survey was conducted of 200 patients attending postsurgical support groups ( mean time since surgery 14 months , mean age 40 years , 85 % female , presurgical weight 150 kg ) . Patients completed the BSSQ  and measures of treatment regimen distress , perceived benefits of weight loss , and weight-related physical symptoms . Results Mean BSSQ adherence was in the 70 % range , with subscale scores varying considerably . Distress levels associated with the new lifestyle were consistently low ( ≈20 % ) and perceived benefits of weight loss were high early on and maintained consistently ( 70–90 % ) . A final predictive model showed premorbid weight , time since surgery , and BSSQ physical activity subscale were significant predictors of weight loss , accounting for 73 % of variance .  Conclusions Physical activity adherence was the sole significant behavioral predictor of weight loss , although maladaptive dietary habits and patient selection issues were identified for future research . It will be important to replicate the current study in prospect i ve , longitudinal studies with representative patient cohorts . A challenge for research ers will be to develop novel , intensive recruiting and retention strategies to allow closer examination of these issues OBJECTIVE To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual ( insurance-m and ated physician supervised diet ) . DESIGN AND METHODS After completing a baseline assessment , c and i date s for surgery were r and omized to a 6-month , evidence -informed , manualized lifestyle intervention ( LIFESTYLE , n = 121 ) or to preoperative care as usual ( USUAL CARE , n = 119 ) . At 6 months , 187 participants remained c and i date s for bariatric surgery and were included in the analyses . RESULTS LIFESTYLE participants  lost significantly more weight than those receiving USUAL CARE [ 8.3 ± 7.8 kg vs. 3.3 ± 5.5 kg , F(1,183 ) = 23.6 , P < 0.0001 ] , with an effect size of 0.72 . Additionally , logistic regression modeling indicated that LIFESTYLE patients were significantly more likely to lose at least 5 % of initial body weight than those in USUAL CARE [ OR ( 95 % CI ) = 2.94 ( 1.253 , 6.903 ) ] , as were participants who were heavier [ OR ( 95 % CI ) = 1.07 ( 1.001 - 1.14 ) for each unit increase in BMI ] or with larger improvements in eating behaviors [ OR ( 95 % CI ) = 1.1 ( 1.049 , 1.145 ) for each unit increase on the Eating Behavior Inventory ) . CONCLUSIONS A behavioral lifestyle intervention for severely overweight individuals leads to clinical ly significant weight loss prior to bariatric surgery . Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes The present study was design ed to evaluate the 3 year effects of a lifestyle intervention on weight loss and maintenance , dietary , and physical activity habits and eating behavior of patients following vertical b and ed gastroplasty ( VBG ) . Thirty severely obese female volunteers were included in the study and they were r and omly assigned to one of two intervention groups : usual care ( UC ) or lifestyle intervention ( LS ) group . Patients were followed for 3 years postoperatively . Outcome measures included weight loss , dietary habits , physical activity level ( PAL ) , and eating behavior changes . Weight was significantly lower in the LS group after 12 months ( 84.4 + /- 3.9 kg vs. 98.4 + /- 4.4 kg , P < 0.05 ) , 24 months ( 83.0 + /- 3.3 vs. 101.9 + /- 5.3 kg , P < 0.05 ) , and 36 months following surgery ( 84.2 + /- 3.3 vs. 102.5 + /- 3.5 kg , P < 0.05 ) . Repeated measures ANOVA revealed significant differences between the two groups overall and at specific time points for the PAL and TV viewing . With regard to eating behavior , the LS group scored significantly better in total Dutch Eating Behavior Question naire ( DEBQ ) , Restraint Eating and External Eating scales at all postoperative time points . Similarly , significant differences were found between the two groups in dietary intake . These findings outline the importance of lifestyle intervention on weight loss and maintenance following bariatric surgery . The favorable effects of lifestyle intervention may be through adoption of healthier eating behaviors and increased physical activity OBJECTIVE To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity ( MO ) . RESEARCH METHODS AND PROCEDURES A prospect i ve 1-year follow-up study was carried out , with patients being their own controls . A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients ( BMI > 40 kg/m2 ) before and 1 year after undergoing bariatric surgery .  RESULTS At 1 year after surgery , weight was reduced from 146 + /- 33 to 95 + /- 19 kg ( p < 0.001 ) , and BMI went from 51 + /- 4 to 33 + /- 6 kg/m2 ( p < 0.001 ) . After weight loss , obese patients performed each workload with lower oxygen consumption , heart rate , systolic arterial pressure , and ventilatory volume ( p < 0.001 ) . This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 + /- 3.8 to 21 + /- 4.2 minutes ( p < 0.001 ) . Upon finishing the exercise , MO patients before surgery were able to reach only 83 % of their age-predicted maximal heart rate , and their respiratory exchange ratio was 0.87 + /- 0.06 . After weight loss , those values were 90 % and 1 + /- 0.08 , respectively ( p < 0.01 ) . When we compared the peak O2 pulse corrected by fat free mass before and after surgery , no significant differences between the groups were found . DISCUSSION After surgically induced weight loss , MO patients markedly improved their exercise capacity . This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress , optimizing the use of cardiac reserve . There were no differences in cardiac function before and after surgery Background Many insurance payors m and ate that bariatric surgery c and i date s undergo a medically supervised weight management ( MSWM ) program as a prerequisite for surgery . However , there is little evidence to support this requirement . We evaluated in a r and omized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric b and ing ( LAGB ) in a publicly insured population . Methods This pilot r and omized trial was conducted in a large academic urban public hospital . Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a m and atory 6-month MSWM program  were r and omized to a MSWM program with monthly visits over 6 months ( individual or group ) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively . Demographics , weight , and patient behavior scores , including patient adherence , eating behavior , patient activation , and physical activity , were collected at baseline and at 6 months ( immediately preoperatively and postoperatively ) . Results A total of 55 patients were enrolled in the study with complete follow-up on 23 patients . Participants r and omized to a MSWM program attended an average of 2 sessions preoperatively . The majority of participants were female and non-Caucasian , mean age was 46 years , average income was less than $ 20,000/year , and most had Medicaid as their primary insurer , consistent with the demographics of the hospital ’s bariatric surgery program . Data analysis included both intention-to-treat and completers ’ analyses . No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively , suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB . Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively . Conclusion MSWM does not appear to confer additional benefit as compared to the st and ard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population BACKGROUND There is a lack of adequate prospect i ve data on quality -of-life ( QOL ) and its predictors in patients undergoing laparoscopic sleeve gastrectomy ( LSG ) .  The aim of this study was to assess longitudinal changes in QOL after LSG with the use of the obesity-specific Moorehead-Ardelt II question naire ( MAII ) and to identify clinical parameters associated with QOL outcome . METHODS Morbidly obese patients consecutively admitted for LSG , over a 30-month period , were prospect ively studied . QOL was assessed using the vali date d Greek version of the MAII question naire and a visual analogueue scale ( VAS ) , preoperatively and at 6 , 12 , and 24 months postoperatively . Anthropometric data and obesity-related co-morbidities were recorded . RESULTS A total of 111 patients with a mean age 36.8±9.2 years were included . Mean preoperative body mass index ( BMI ) was 49.1±7.5 kg/m2 . Percentage excess BMI loss ( % EBL ) was 51.1±14.9 , 64.2±17.9 and 66.4±18.0 at 6 , 12 , and 24 months , respectively . Postoperatively , all obesity-related co-morbidities were significantly improved . MAII score increased from -.40±1.30 preoperatively to 1.75±.83 , 2.18±.80 , and 1.95±.71 at 6 , 12 , and 24 months postoperatively ( trend P<.001 ) . Preoperative median ( interquartile range ) VAS was 3 ( 1 ) increasing to 9 ( 2 ) , 10 ( 1 ) , and 9 ( 1 ) at 6 , 12 , and 24 months postoperatively ( P<.001 ) . % EBL and reduction in obesity-related co-morbidities , especially resolution of diabetes and sleep apnea , correlated significantly with higher QOL during the course of the study . CONCLUSION LSG , a safe and effective bariatric operation , results in sustained weight loss and significant improvements in QOL . Both weight loss and amelioration of co-morbidities contribute to higher level of postsurgical QOL OBJECTIVE Bariatric surgery is an effective method for acute weight loss . While the impact of bariatric surgery on general medical conditions ( e.g. , type 2 diabetes ) is well documented , few studies focus on physical functional outcomes following weight-loss induced by bariatric surgery . DESIGN AND METHODS We report on 50 women aged 20 - 74 scheduled for Roux-en-Y gastric bypass ( RYGB ) procedure who were enrolled for a prospect i ve 1-year study . Height , weight , and waist circumference were recorded preoperatively and at 6 and 12 months , postoperatively . To track musculoskeletal/physical function changes , the  timed-get-up- and -go ( TGUG ) and short-form health survey-36 ( SF-36 ) and short musculoskeletal function assessment ( SFMA ) question naires were administered . RESULTS Patients had significant weight loss and functional improvement . At 1 year mean weight loss was 48.5 kg and mean TGUG improvement was 3.1 s. SMFA and SF-36 also showed improvement in functional components with weight loss at 6 months and 1-year post surgery . Significant associations were observed between TGUG and SMFA measures at all time points . Final weight at 1 year post bariatric surgery was also significantly correlated with most functional outcomes and changes in these outcomes . Partial correlations controlling for age revealed additional associations between body weight and functional outcomes , especially at the 6-month visit . CONCLUSION Our results suggest that significant rapid weight loss , such as that attained by bariatric surgery , acutely improves musculoskeletal function in morbidly obese patients . Additionally , for patients with musculoskeletal disease or injury , weight loss result ing from bariatric surgery may serve as an adjunct for improving global functional outcome , and enhancing the rehabilitation potential OBJECTIVE Bariatric surgery results in significant weight loss and reduces cardiovascular morbidity . However , a large variation in postsurgery weight loss is seen . Physical activity promotes weight loss in nonsurgically treated subjects with obesity . The aim of this study was to investigate the effects of 6 months of supervised physical training following Roux-en-Y gastric bypass surgery ( RYGB ) on body weight and cardiovascular risk markers . METHODS Sixty participants eligible for RYGB were included . Six months post surgery , the participants were r and omly assigned to either twice-weekly supervised physical training sessions in a fitness center ( INT ) or a control group ( CON ) for 26 weeks . Before surgery and 6 , 12 , and 24 months after surgery , the participants underwent an examination program that included  anthropometric measurements , blood pressure , heart rate , blood sample s  , and an  abdominal computed tomography scan .  RESULTS RYGB significantly reduced body weight and improved cardiovascular risk markers ( all P < 0.01 ) . The supervised physical training intervention result ed in a 4.2-kg ( CI : -0.2 to -8.3 kg ) lower body weight in INT compared with CON at the study end ( P = 0.042 ) . The high-density lipoprotein concentration was significantly higher in INT than in CON at the termination of the intervention , but this was not maintained at the 24-months examination . CONCLUSIONS Physical training following RYGB improves weight loss and cardiovascular health BACKGROUND Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery OBJECTIVE To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity . DESIGN / SETTING Prospect i ve r and omized , controlled trial conducted in a laparoscopic institution . PARTICIPANTS / INTERVENTIONS During the Phase 1 clinical trial ( from preoperative evaluation to 6 months after surgery ) , all participants received st and ard care . During Phase 2 ( 6 - 12 months after surgery ) , participants were r and omly assigned to receive either st and ard care ( n = 72 ) or comprehensive support ( n = 72 ) . Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling . MAIN OUTCOME MEASURES Depression scores and weight change over time . ANALYSIS Independent sample s t tests and regression analysis assessed relationships among depression scores and excess weight loss . RESULTS Participants receiving behavioral-motivational intervention scored significantly lower on Beck 's Depression Inventory question naire scores than those receiving st and ard care . For those with depressive symptoms at r and omization , 24 % of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery , compared with 6 % of those who received st and ard care ( P < .001 ) . Patients ' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions ( P < .001 ) . CONCLUSIONS AND IMPLICATION S Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss BACKGROUND Prior evidence indicates that predictors of weight loss outcomes after  gastric bypass surgery  fall within 5 domains : 1 ) presurgical factors , 2 ) postsurgical psychosocial variables ( e.g. , support group attendance ) , 3 ) postsurgical eating patterns , 4 ) postsurgical physical activity , and 5 ) follow-up at postsurgical clinic . However , little data exist on which specific behavioral predictors are most associated with successful outcomes ( e.g.,≥ 50 % excess weight loss ) when considering the 5 domains simultaneously . The objective of this study was to specify the behavioral variables , and their respective cutoff points , most associated with successful weight loss outcomes . METHODS Signal detection analysis evaluated associations between 84 pre- and postsurgical behavioral variables ( within the 5 domains ) and successful weight loss at ≥ 1 year in 274 postgastric bypass surgery patients .  RESULTS Successful weight loss was highest ( 92.6 % ) among those reporting dietary adherence of>3 on a 9-point scale ( median = 5 ) who grazed no more than once-per-day . Among participants reporting dietary adherence<3 and grazing daily or less , success rates more than doubled when highest lifetime body mass index was<53.7 kg/m(2 ) . Success rates also doubled for participants with dietary adherence = 3 if attending support groups . No variables from the physical activity or postsurgical follow-up domains were significant , nor were years since surgery . The overall model 's sensitivity = .62 , specificity = .92 . CONCLUSIONS To our knowledge , this is the first study to simultaneously consider the relative contribution of behavioral variables within 5 domains and offer clinicians an assessment algorithm identifying cut-off points for behaviors most associated with successful postsurgical weight loss . Such data may inform prospect i ve study design s and postsurgical interventions
No relationship was identified between changes in weight and walking performance post-surgery .
Although physical activity performed after bariatric surgery is associated with enhanced weight loss outcomes , there is limited information on patients ' physical activity behaviour in this context .
This systematic review and meta- analysis assessed pre-operative to post-operative changes in physical activity and physical function outcomes among obese adults undergoing bariatric surgery .