Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 2/2017

01-02-2017 | Original Contributions

Predictors of Vitamin Adherence After Bariatric Surgery

Authors: Supreet Sunil, Vincent A. Santiago, Lorraine Gougeon, Katie Warwick, Allan Okrainec, Raed Hawa, Sanjeev Sockalingam

Published in: Obesity Surgery | Issue 2/2017

Login to get access

Abstract

Background

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients.

Methods

A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis.

Results

Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001).

Conclusions

Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.
Literature
1.
2.
3.
4.
5.
6.
Matsuda M, Shimamura I. Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obes Res Clin Pract. 2013;7:e330–41.CrossRefPubMed
7.
Neilson A, Schneider H. Obesity and its comorbidities: present and future importance on health status in Switzerland. Soz Praventivmed. 2005;50(2):78–86.CrossRefPubMed
8.
Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Med Clin N Am. 2011;95(5):919–37.CrossRefPubMed
9.
10.
Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138(1):24.CrossRefPubMed
11.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
12.
Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158(2):135–45.CrossRefPubMed
13.
O’Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol. 2010;25:1358–65.CrossRefPubMed
14.
Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, Clegg AJ. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190 .215–357, iii-ivCrossRef
15.
16.
Xanthakos S. Nutritional deficiencies in obesity and after bariatric surgery. Pediatr Clin N Am. 2009;56(5):1105–21.CrossRef
17.
Bal BS, Koch TR, Finelli FC, Sarr MG. Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol. 2010;7(6):320–34.PubMed
18.
Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28(2):481–4.CrossRefPubMed
19.
Dogan K, Aarts EO, Koehestanie P, et al. Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93:e169.CrossRefPubMedPubMedCentral
20.
Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.CrossRefPubMed
21.
Schweitzer DH, Posthuma EF. Prevention of vitamin and mineral deficiencies after bariatric surgery: evidence and algorithms. Obes Surg. 2008;18(11):1485–8.CrossRefPubMed
22.
Hng KN, Ang YS. Overview of bariatric surgery for the physician. Clin Med. 2012;12(5):435–40.CrossRef
23.
Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.CrossRefPubMed
24.
Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2:436–42.CrossRefPubMed
25.
26.
Dempe C, Jünger J, Hoppe S, Katzenberger ML, Möltner A, Ladwig KH, Herzog W, Schultz JH. Association of anxious and depressive symptoms with medication nonadherence in patients with stable coronary artery disease. J Psychosom Res. 2013;74(2):122–7.CrossRefPubMed
27.
Grenard JL, Munjas BA, Adams JL, Suttorp M, Maglione M, McGlynn EA, Gellad WF. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med. 2011;26(10):1175–82.CrossRefPubMedPubMedCentral
28.
Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.PubMed
29.
Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMed
30.
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.CrossRefPubMed
31.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMed
32.
Cassin S, Sockalingam S, Hawa R, Wnuk S, Royal S, Taube-Schiff M, Okrainec A. Psychometric properties of the Patient Health Questionnaire (PHQ-9) as a depression screening tool for bariatric surgery candidates. Psychosomatics. 2013;54(4):352–8.CrossRefPubMed
33.
Lo C, Walsh A, Mikulincer M, Gagliese L, Zimmermann C, Rodin G. Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief Experiences in Close Relationships scale. Psychooncology. 2009;18(5):490–9.CrossRefPubMed
34.
Mikulincer M, Shaver PR. Attachment in adulthood: structure, dynamics, and change. NY: Guilford; 2007.
35.
Agh T, Inotai A, Meszaros A. Factors associated with medication adherence in patients with chronic obstructive pulmonary disease. Respiration. 2011;82:328–34.CrossRefPubMed
36.
Sockalingam S, Blank D, Abdelhamid N, Abbey SE, Hirschfield GM. Identifying opportunities to improve management of autoimmune hepatitis: evaluation of drug adherence and psychosocial factors. J Hepatol. 2012;57:1299–304.CrossRefPubMed
37.
Kane SV, Cohen RD, Aikens JE, Hanauer SB. Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001;96:2929–33.CrossRefPubMed
38.
D’Incà R, Bertomoro P, Mazzocco K, Vettorato MG, Rumiati R, Sturniolo GC. Risk factors for non-adherence to medication in inflammatory bowel disease patients. Aliment Pharmacol Ther. 2008;27:166–72.CrossRefPubMed
39.
Friedman KE, Applegate KL, Grant J. Who is adherent with preoperative psychological treatment recommendations among weight loss surgery candidates? Surg Obes Relat Dis. 2007;3:376–82.CrossRefPubMed
40.
Wheeler E, Prettyman A, Lenhard MJ, Tran K. Adherence to outpatient program postoperative appointments after bariatric surgery. Surg Obes Relat Dis. 2008;4:515–20.CrossRefPubMed
41.
Larjani S, et al. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis 2015; In Press.
42.
Aarts F, Geenen R, Gerdes VEA, van de Laar A, Brandjes DPM, Hinnen C. Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery. Obes Surg. 2015;25(4):666–72.CrossRefPubMed
43.
Mikulincer M, Florian V. The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. In: Simpson J, Rholes S, editors. Attachment theory and close relationships (pp. 143–165). New York: Guilford; 1998.
Metadata
Title
Predictors of Vitamin Adherence After Bariatric Surgery
Authors
Supreet Sunil
Vincent A. Santiago
Lorraine Gougeon
Katie Warwick
Allan Okrainec
Raed Hawa
Sanjeev Sockalingam
Publication date
01-02-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 2/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2306-x

Other articles of this Issue 2/2017

Obesity Surgery 2/2017 Go to the issue

Original Contributions

Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB—Data Analysis of German Bariatric Surgery Registry

Letter to Editor/LED Reply

Response to Letter to the Editor: Intragastric Balloon for Management of Severe Obesity: a Systematic Review

Original Contributions

Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes

Review Article

Zinc Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review

Original Contributions

Performance of the Bard Scoring System in Bariatric Surgery Patients with Nonalcoholic Fatty Liver Disease

Original Contributions

MILEPOST Multicenter Randomized Controlled Trial: 12-Month Weight Loss and Satiety Outcomes After pose SM vs. Medical Therapy