Background: Bariatric surgery, particularly biliopancreatic diversion with duodenal switch (BPD/DS), is an effective approach to treating severe obesity. However, long-term weight regain is frequently observed which may be related to eating behaviors. This study examines the evolution of eating behaviors as a function of weight changes over a 15-year period after BPD/DS.
METHODS AND RESULTS: Assessments were conducted at three time points for the surgery group: before undergoing BPD/DS, at 12 months post-surgery, and again at 15 years. The control group, consisting of individuals with severe obesity who did not undergo bariatric surgery, was assessed at the initial visit and again after 12 months. Eating behaviors were evaluated using the Three Factor Eating Questionnaire (TFEQ). Weight regains was defined as a weight increase of 10% or more between the 12-month and 15-year follow-ups
Results: The study involved 71 participants (group 1; 46 BPD/DS, group 2; 25 controls). At baseline, the groups were similar in terms of age, sex, weight and eating behavior. After 12 months, weight decreased significantly in the surgery group (137.4 ± 27.3 to 86.2 ± 18.1 kg; p < 0.001, -37.1 ± 6.9%) compared with a no change in the control group (124.6 ± 28.3 to 124.2 ± 30.0 kg; p=0.568, -0.5 ± 5.0%). The surgery group also showed a greater reduction in dietary disinhibition (-1.2 ± 1.1 vs. -0.4 ± 0.9, p < 0.05). Fifteen years after surgery, 22 patients (48%) regained weight. They were younger (56 ± 10 vs. 62 ± 9 years, p = 0.06) and had lower rates of hypertension (14 vs. 46%, p = 0.02) and diabetes (0 vs. 17%, p = 0.04) than those who had maintained their weight loss. In the group that had regained weight, hunger sensitivity increased (0.5 ± 0.6 to 1.0 ± 0.8, p = 0.02), as did dietary disinhibition (3.1 ± 0.3 to 3.7 ± 1.1, p = 0.03), while both remained stable in the group that had not regained weight).
Conclusion: BPD/DS has been shown to improve eating behaviors, notably by reducing dietary disinhibition within the first 12 months, contributing to substantial weight loss. At 15 years post-BPD/DS, individuals who experience weight regain tend to be younger and have higher levels of hunger sensitivity and disinhibition.. These findings suggest that behavioral factors play an important role in long-term weight maintenance following BPD/DS.
