Wellness Check: Nutrition

Nonnormative eating behaviors may be associated with lower quality of life after bariatric surgery

1. Nonnormative eating behaviors and eating disorders are common in patients seeking bariatric surgery and improve post-surgery to varying degrees.

2. Presence of loss of control eating behavior post-surgery is associated with lower total body weight loss and quality of life.

Evidence Rating Level: 2 (Good)

Patients with severe obesity presenting for bariatric surgery often have concurrent nonnormative eating behaviors (NEBs) or eating disorders (ED) pre- and post-surgery. However, how surgery effects NEB/ED and the long-term influence these comorbidities have on weight loss and health-related quality of life (HRQOL) post-surgery remains unclear.

This was a multi-center cohort study of 748 German adult patients that examined the prevalence and prospective clinical significance of NEBs and EDs pre- and post-surgery. Patients underwent either gastric bypass or sleeve gastrectomy and were followed for up to 6 years post-surgery. Patients who did not speak German or were noncompliant were excluded. NEB and EDs were identified using the Eating Disorder Examination interview. The main outcomes measured were total body weight loss (TBWL) and HRQOL.

Overall, patients lost mean of 26.7% total body weight and had a 35.4% increase in HRQOL after surgery. NEBs and EDs were common prior to surgery with most behaviors improving post-surgery. The presence of several NEBs, especially loss-of-control eating, was associated with lower % TBWL (1.83%) and HRQOL (4.57%). However, this study was limited by potential inaccuracies in diagnosis of NEB/EDs due to current diagnostic criteria that may not be fully applicable to patients after receiving bariatric surgery. Nonetheless, given the demonstrated risk of reduced long-term HRQOL associated with loss-of-control eating behavior, further work that evaluates this association and furthermore, tests the effectiveness of targeted preventative psychotherapy in mitigating this risk would be beneficial.

Commercial dietary vitamins targeting the immune system may have inaccurate labeling

1. In this study, majority of commercial dietary supplements targeting the immune system had inaccurate labels.

2. Significant proportion of commercial dietary supplements had ingredients listed that were not detectable and detected ingredients not listed on label.

Evidence Rating Level: 4 (Below Average)

During the COVID-19 pandemic, supplements boosting or modulating the immune system rose in popularity. Unlike drugs, supplements are not approved by the United States of America Food and Drug administration (FDA) for safety and efficacy. However, the FDA has issued specific regulations in product manufacturing and labeling. How well the dietary supplements currently on the market observe these regulations has not been well studied.

This case-series study examined whether dietary supplements advertised as supporting or boosting the immune system were accurately labeled. The top 30 featured supplements sold through Amazon in May 2021 were purchased and their ingredients were analyzed using liquid chromatography-mass spectrometry. Ingredients were then compared to the product labeling to determine accuracy. Furthermore, claims made on the product label were assessed using the Operation Supplement Safety Scorecard’s set of questions.

Of the 30 products evaluated, only 13 had accurate labels. Of the 17 with inaccurate labels, 13 had ingredients listed on the label that were not detected in mass spectrometry analysis and 9 had detected ingredients not claimed on the label. However, this study was limited by the number of products tested, potential bias due to mass spectrometry being less sensitive for polysaccharides, lipids, enzymes, and proteins, and the binary rather than quantitative nature of analysis performed. Nonetheless, these results highlighted a concerning trend since many of the products tested had inaccurate labels and claims that were inconsistent with FDA’s requirements for dietary supplements. Therefore, further work is needed to improve quality control measures for dietary supplements.

Commercial weight loss programs lead to greater weight loss than do-it-yourself methods

1. In this study, a commercial weight loss program resulted in greater weight loss at 3 and 12-months compared to do-it-yourself weight loss methods.

2. Both commercial and do-it-yourself weight loss methods led to improved blood pressure, heart rate, aerobic stamina, flexibility, and sleep quality.

Evidence Rating Level: 1 (Excellent)

With the growing obesity pandemic, effective and sustainable treatment options for combating obesity are much needed. Both commercial weight management programs and online resources that help people lose weight through a do-it-your (DIY) approach are widely available. However, the relative efficacy of these two types of methods has not been rigorously studied.

This study was a randomized control trial with 373 adult patients (72.9% female) with a body mass index (BMI) of 25-45 in the United States, Canada, and the United Kingdom. Patients who were pregnant, with recent weight loss of greater than 5kg, and prior or planned bariatric surgery were excluded. Patients were randomized 1:1 to either participation in commercial weight loss program with reduced requirements for dietary self-monitoring or a DIY approach. At the end of the 12-months observational period, those randomized into DIY group had free access to the commercial program. The primary outcomes were weight loss at 3 and 12 months. Secondary outcomes included measures of cardiovascular health such as blood pressure, heart rate, as well as flexibility and aerobic stamina.

Results demonstrated that at both 3 and 12 months, participants in the commercial group had greater mean weight loss compared to DIY group, with mean difference between group of -2kg and -2.6kg, respectively. Interestingly, there were no significant differences in improvements in blood pressure, heart rate, aerobic stamina, sleep quality, and flexibility in both groups. This study was limited by potential bias in weight loss motivation in DIY group due to the incentive of receiving free access to commercial program after 12 months as well as the relatively small sample size and short follow-up period. However, these results do suggest that commercial programs have greater effectiveness in reducing weight compared to DIY weight loss strategies, and may be something clinicians should consider when counseling patients about strategies for combating obesity.

Image: PD

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