Researchers from Saudi Arabia emphasize the significance of addressing psychological and behavioral aspects for the long-term success of Bariatric Surgery

Obesity, a rising public health concern, is associated with various health complications and significantly reduces life expectancy. In Saudi Arabia, the prevalence of obesity, defined by a Body Mass Index (BMI) of 30 or higher, was recorded at 21.7% in 2020. The cost of managing obesity in the country is substantial, constituting about 2.4% of its total GDP, equivalent to USD 19 billion. If no interventions are implemented, this cost is predicted to escalate to 4.1% of the GDP by 2060, amounting to USD 78 billion. However, the Saudi Arabian government, in collaboration with the Quality-of-Life Program 2020, is initiating various programs focused on reducing obesity by 3% by 2030.

Weight Loss Strategies: Navigating the Options
In the last decade, numerous strategies for weight loss, including behavioral, therapeutic, and surgical interventions, have been introduced. These are administered within a multidisciplinary context involving dietitians, endocrinologists, physiotherapists, and sometimes, surgeons. However, among these, bariatric surgery or weight loss surgery is the most effective and sustainable treatment for obesity. The surgical procedures, including gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch, have demonstrated positive outcomes in managing conditions such as diabetes, high blood pressure, sleep apnea, and high cholesterol, among others.

There has been a lack of research on behavioral changes in patients following bariatric surgery. However, understanding the differences between individuals who have undergone surgical treatment for obesity and those who have not opted for such procedures is crucial. This study aims to scrutinize the lifestyle choices, behavioral patterns, psychological elements, and eating habits of individuals who have undergone bariatric surgery, in contrast to those with obesity who have not undergone this procedure.

Methods:
This study is a secondary analysis of the Sharik Diet and Health National Survey (SDHNS) dataset, a comprehensive cross-sectional investigation conducted from 2020 to 2022. The analysis focuses on demographic factors such as age, gender, educational attainment, and monthly earnings. Additionally, variables including physical activity, sitting habits, smoking patterns, weight management strategies, and eating behaviors are examined.

Results:
A chi-square analysis was conducted to compare the lifestyle and behavior variables of participants who had bariatric surgery with those who had not undergone any surgical weight loss procedures for obesity. Out of the 22 variables analyzed, 18 showed significant differences between the two groups. These variables included physical activity, smoking habits, weight management efforts, eating habits, self-satisfaction with overall health, classification of weight, risk of anxiety and depression, and consumption levels of various food and drink categories.

Multivariate Analysis:
A logistic regression analysis was performed to identify factors associated with continued obesity after bariatric surgery. The analysis revealed that advanced age, limited educational attainment, female gender, reduced income, waterpipe smoking habits, and the consumption of carbonated drinks were key elements influencing ongoing obesity in the post-surgery phase.

Comparison of Obesity Status Groups:
This study compared three obesity status groups: individuals who had bariatric surgery regardless of their obesity status, individuals who were obese but did not opt for surgical weight loss options, and individuals with obesity who had not undergone any weight-loss surgery. Out of 26 variables analyzed, 21 showed significant differences among the three groups.

Implications and Conclusion:
This groundbreaking study provides valuable insights into the lifestyle and behavior changes among individuals who have undergone bariatric surgery for obesity. By identifying the challenges faced by these patients, such as smoking habits, poor dietary choices, and mental health risks, targeted interventions can be developed to prevent future health issues and weight regain. Incorporating these insights into post-surgery care can significantly improve the long-term health outcomes and quality of life for individuals who have had bariatric surgery, ultimately reducing the impact of obesity.

In conclusion, this study highlights the importance of understanding behavioral changes in patients following bariatric surgery. By addressing the identified factors and developing tailored interventions, healthcare professionals can support patients in achieving and maintaining weight loss success, ultimately enhancing their overall well-being.

The Prominence of Bariatric Surgery in Saudi Arabia

Saudi Arabia has approximately 20 accredited public obesity centers that perform weight loss surgeries. In 2021, these centers carried out over 30,000 surgeries at an average cost ranging between USD 6,600 and USD 10,000. These operations represent 10% of the Ministry of Health’s annual budget. In late 2022, the Saudi Council of Health Insurance mandated all private health insurance companies to cover all types of bariatric surgery for individuals with a BMI of 30 kg/m2 or above. However, despite the potential benefits, bariatric surgery may not yield expected benefits for a significant number of patients.

Weight Regain and Suboptimal Weight Loss: The Bariatric Surgery Paradox

Bariatric surgery, although generally superior to non-surgical interventions for weight loss, often results in suboptimal weight loss (SWL) and weight regain (WR) for a significant number of patients. Suboptimal weight loss is identified as a failure to achieve a loss translating to 40–60% of the baseline excess body weight over a span of 1–2 years. Post-bariatric surgery, approximately 11–22% of patients exhibit this suboptimal weight loss. On the other hand, the phenomenon of weight regain—defined as an initial achievement of expected weight loss post-surgery followed by a weight increase—exhibits a higher prevalence within the bariatric patient population.

References: 

1- https://www.dovepress.com/comparing-lifestyle-and-behavior-of-post-bariatric-surgery-and-partici-peer-reviewed-fulltext-article-DMSO

2- https://www.frontiersin.org/articles/10.3389/fnut.2023.1273164/full