Bariatric surgery, which involves making changes to the digestive system, is a common treatment for severe obesity that produces substantial weight loss and health improvements for a majority of patients. However, nearly all patients experience some degree of weight recurrence within two years of the surgery.
If left untreated, this weight recurrence can lead to the return of health problems that existed before surgery and a decreased degree of surgery satisfaction.
The implementation of post-surgical exercise interventions is an important part of preventing weight recurrence, but there has been little research on how effective these interventions are and what kind of interventions are the most beneficial.
A collaboration between UConn researchers and Hartford Hospital found that very few studies properly evaluate post-bariatric-surgery exercise interventions, leaving clinicians with little guidance.
The team included Dale Bond, director of research integration at Hartford Hospital; Linda Pescatello, professor of kinesiology in UConn’s College of Agriculture, Health and Natural Resources; Katherine Manuel, director of the Coordinated Program in Dietetics at Howard University who completed the online graduate certificate in exercise prescription at UConn in 2019; Dr. Pavlos Papasavas, a bariatric surgeon and director of surgical research at Hartford Hospital; Yin Wu, a former PhD student and postdoc in UConn’s Department of Kinesiology and current senior scientist at Hartford Hospital; Jill Livingston, a librarian at Wesleyan University; and Aurélie Baillot, a professor of nursing at Université du Québec en Outaouais.
This project started with Manuel completing a systemic review paper for one of the classes in the exercise prescription certificate program that Pescatello developed and teaches. It soon grew to include more collaborators and was published in Surgery for Obesity and Related Diseases.
The team evaluated 1,368 studies and found only five random control trials included any description of what exercise prescription practitioners provided to patients. The studies they did find included small sample sizes as well, a further indication of the lack of appropriate scientific research on the subject.
The researchers say while they did expect the literature to be sparse, they did not expect there to be as few studies as there were.
“We used this study as evidence to say we need much more research to understand this question,” Bond says. “To us, this was an opportunity to highlight some things future studies should do.”
At a minimum, Bond says future studies should specify the exercise prescription that practitioners should provide to patients, framed by the Frequency, Intensity, Time, and Type or FITT principle Pescatello introduced to the field in 2009. They also recommend future studies specify how well patients follow the prescription, and patient status as still losing weight, weight stable, or experiencing weight recurrence.
Dr. Papasavas says there is a great deal of ignorance surrounding obesity, with many people thinking all one needs to do is exercise and eat healthy, without considering other factors and barriers that contribute to this condition. This also leads to patients often feeling stigmatized and guilty when they experience post-surgical weight recurrence.
The team emphasizes that many clinicians have no training in delivering an effective exercise prescription. Pescatello’s research has focused on the FITT principle of exercise prescription, something she hopes to implement in future interventions for this population.
“There’s no specific prescription for post-bariatric surgery,” Pescatello says. “This paper is a step in the right direction towards that.”
The research group emphasizes that they hope that this successful collaboration is the first of many between the University of Connecticut and Hartford Hospital.
“I’m very excited about this collaboration between our two institutions – Hartford Hospital and UConn,” says Dr. Papasavas. “We’re neighbors and there’s a huge opportunity to collaborate. I believe it’s the beginning of many future collaborations.”
This work relates to CAHNR’s Strategic Vision area focused on Enhancing Health and Well-Being Locally, Nationally, and Globally.
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