Research
Original Research
Comprehensive Nutrition and Lifestyle Education Improves Weight Loss and Physical Activity in Hispanic Americans Following Gastric Bypass Surgery: A Randomized Controlled Trial

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Abstract

Background

As morbid obesity increasingly affects Hispanic Americans, the incidence of bariatric procedures among this population is rising. Despite this, prospective research on the effects of comprehensive postoperative education-centered interventions on weight loss and physical activity focused on Hispanic Americans is lacking.

Objective

To examine whether a comprehensive nutrition education and behavior modification intervention improves weight loss and physical activity in Hispanic Americans with obesity following Roux-en-Y gastric bypass surgery (RYGB).

Methods

A prospective randomized-controlled trial was conducted between November 2008 and April 2010. At 6 months following RYGB, 144 Hispanic Americans with obesity were randomly assigned to a comprehensive nutrition and lifestyle educational intervention (n=72) or a noncomprehensive approach (comparison group n=72). Those in the comprehensive group received education sessions every other week for 6 weeks in small groups and frequent contact with a registered dietitian. Those in the comparison group received brief, printed healthy lifestyle guidelines. Patients were reassessed at 12 months following surgery. Main outcome measures were excess weight loss and physical activity changes over time. Statistical analyses used t test, χ2 test, Wilcoxon signed rank, Mann-Whitney U test, and intent-to-treat analysis, significance P<0.05.

Results

Participants (mean age 44.5±13.5 years) were mainly Cuban-born women (83.3%). Mean preoperative excess weight and body mass index (calculated as kg/m2) were 72.20±27.81 kg and 49.26±9.06, respectively. At 12 months following surgery, both groups lost weight significantly, but comprehensive group participants experienced greater excess weight loss (80% vs 64% from preoperative excess weight; P<0.001) and greater body mass index reduction (6.48±4.37 vs 3.63±3.41; P<0.001) than comparison group participants. Comprehensive group participants were significantly more involved in physical activity (+14 min/wk vs −4 min/wk; P<0.001) than comparison group participants. Mean protein intake was significantly lower in the comparison group than that in the comprehensive group (P<0.024).

Conclusions

Findings support the importance of comprehensive nutrition education for achieving more effective weight reduction in Hispanic Americans following RYGB.

Section snippets

Study Design

This study was a prospective, randomized controlled trial conducted between November 2008 and April 2010 at the Laparoscopic Institute of South Florida. The cohort comprised 144 Hispanic Americans with obesity who had recently (6 months±6 weeks before recruitment) undergone laparoscopic RYGB surgery for reversing morbid obesity at the Palmetto General Hospital in Hialeah, FL. All surgical procedures were performed by the same surgeon using identical surgical technique. Eligibility criteria also

Study Participants

The sample consisted of 144 Hispanic-American adults (mean age 44±13.5 years) who were randomized into the comprehensive intervention (n=72) and comparison groups (n=72). There was a 57% response rate to in-person recruitment and 7.64% attrition rate at 1 year (Figure 1). There were no significant differences in demographic characteristics at randomization between groups (Table 1). The sample represented primarily Cuban-born bilingual women with obesity.

Twenty-seven of 72 participants randomly

Discussion

Because minority populations are affected disproportionately by obesity (4), this study focused on Hispanic-American adults who have undergone RYGB for weight reduction. All participants lost weight significantly over time, as expected from prior evidence from the literature (9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 43, 44). One year after surgery, only those participants who received the comprehensive nutrition- and behavior-education intervention achieved greater weight

Conclusions

This study provides important new information on the effects of a comprehensive nutrition and lifestyle education intervention on body weight and physical activity behaviors on adult Hispanic Americans who have recently undergone RYGB surgery. The comprehensive educational approach, which incorporated behavior change and motivation strategies into nutrition counseling, significantly increased weight loss and physical activity between 6 and 12 months following surgery. Further research studies

M. Petasne Nijamkin is a medical doctor, family practitioner, and doctor in Dietetics and Nutrition, Department of Dietetics and Nutrition, Robert Stempel School of Public Health and Social Work, Florida International University, Miami.

References (48)

  • G.X. Ayala et al.

    A systematic review of the relationship between acculturation and diet among Latinos in the United States: Implications for future research

    J Am Diet Assoc

    (2008)
  • E. Parkes

    Nutritional management of patients after bariatric surgery

    Am J Med Sci

    (2006)
  • A. Must et al.

    The disease burden associated with overweight and obesity

    JAMA

    (1999)
  • J. Xu et al.

    Deaths: Final data for 2007Centers for Disease Control and Prevention

    Natl Vital Stat Rep

    (May 2010)
  • L.M. Candib

    Obesity and diabetes in vulnerable populations: Reflection on proximal and distal causes

    Ann Fam Med

    (2007)
  • K.M. Flegal et al.

    Prevalence and trends in obesity among US adults, 1999-2008

    JAMA

    (2010)

  • Overweight and obesity

  • C.C. Curioni et al.

    Long-term weight loss after diet and exercise, a systematic review

    Int J Obes(Lond)

    (2005)
  • Z. Li et al.

    Meta-analysis: Pharmacologic treatment of obesity

    Ann Intern Med

    (2005)
  • M. Deitel et al.

    The development of the surgical treatment of morbid obesity

    J Am Coll Nutr

    (2002)
  • J. Echols

    Obesity weight management and bariatric surgery case management programs: A review of literature

    Prof Case Manag

    (2010)
  • J. Pinkney et al.

    Current status of bariatric surgery in the treatment of type 2 diabetes

    Obes Rev

    (2004)
  • L. Sjöström et al.

    Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery

    N Engl J Med

    (2004)

    • Cited by (0)

    M. Petasne Nijamkin is a medical doctor, family practitioner, and doctor in Dietetics and Nutrition, Department of Dietetics and Nutrition, Robert Stempel School of Public Health and Social Work, Florida International University, Miami.

    A. Campa is an associate professor, Department of Dietetics and Nutrition, Robert Stempel School of Public Health and Social Work, Florida International University, Miami.

    M. Baum is a professor, Department of Dietetics and Nutrition, Robert Stempel School of Public Health and Social Work, Florida International University, Miami.

    S. Himburg is a professor emeritus, Department of Dietetics and Nutrition, Robert Stempel School of Public Health and Social Work, Florida International University, Miami.

    J. Sosa is a bariatric surgeon, fellow of the American College of Surgeons at Palmetto General Hospital and at the Laparoscopic Institute of South Florida, Hialeah.

    P. Johnson is a statistical consultant, College of Arts and Sciences, Florida International University, Miami.

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