Maladaptive eating behavior after bariatric surgery is an im-portant cause of postoperative weight regain. However, the depth and reliability of its related research has been greatly hindered partially by non-unification of its concept and inappro-priate words used to explain the concept.
To clarify the concept of maladaptive eating behavior after bariatric surgery.
In May 2022, database of CNKI, WanFang Data, SinoMed, PubMed, Web of Science and CINAHL were systematically searched for studies in Chinese or English mainly about maladaptive eating behavior after bariatric surgery from inception to May 10, 2022, involving related concepts, definition attributes, antecedents and consequences. The contents of included literature were analyzed using the Rodgers' process of concept analysis, involving the evolution, attributes, antecedents, consequences, related concepts, typical case, assumptions and enlightenment for further development.
Altogether, 36 studies were included, 33 of which in English, and the other three were in Chinese. The conceptual attributes of maladaptive eating behavior after bariatric surgery were composed of six aspects: uncontrolled eating, grazing, emotional eating, food craving, food addiction and compensatory behaviors. The antecedents include subjective factors (containing self-efficacy, dietary attitude, psychological status, work pressure and so on) , and objective factors (containing age, gender, education level, obesity history and others) . Eating disorders, mental illness, weight-loss outcome, nutritional status and quality of life compose the consequences.
The concept of maladaptive eating behavior after bariatric surgery is still non-unified. Its meanings in China should be discussed according to the national condition, and in-depth research on relevant theories, assessment tools, influencing factors and intervention should be conducted on this foundation, so as to maintain the effect of bariatric surgery and improve the quality of life in these patients.
With the growing problem of obesity, the demand for bariatric surgery has increased these years. Patients still need to maintain good living habits after surgery to consolidate the weight loss effects. While the behavioral guidelines are relatively mature, patient's behavioral compliance is not ideal, resulting in a high rate of postoperative weight regain. In that case, we can depend on strategies to promote dietary and physical activity behaviors in patients from the cognitive perspective.
To systematically code and merge the dietary and physical activity behavior promotion strategies after bariatric surgery from the cognitive perspective.
In June 2022, the WHITTEMORE and KNAFL's integrative review methodology was used. Studies written in English related to dietary and physical activity behavior promotion strategies after bariatric surgery were searched in databases of PubMed, Web of Science, the Cochrane Library and CINAHL, and those in Chinese were searched in databases of CNKI and Wanfang Data from January 1994 to June 2022. The 2016 version of the Critical Appraisal Skills Program (CASP) was used to evaluate the quality of the literature. Studies meeting the inclusion criteria were included, and the strategies extracted from which were uniformly coded and merged according to the CALO-RE taxonomy.
A total of 25 studies were included, including 17 randomized controlled trials, 4 observational studies, and 4 reviews. After coding, all strategies were covered by CALO-RE taxonomy, involving 25 kinds, mainly including self-monitoring of behavior, social support, goal setting, identifying barriers/problem resolution, etc. A total of 46 strategies were obtained and used to create a strategy set named "promotion strategies of dietary and physical activity behaviors after bariatric surgery".
Through the application of the integrative review methodology and the guidance of CALO-RE taxonomy, this study systematically coded and merge the dietary and physical activity behavior promotion strategies from the cognitive perspective for applicable to patients after bariatric surgery, providing a reservoir of techniques for postoperative behavioural management. After assessing patients' behavioural levels and cognitive factors, bariatric surgery providers can select appropriate strategies to improve patients' behavioural compliance. This strategy set can be further validated and optimised in future empirical studies.
The change of food preference after bariatric surgery is an important factor affecting postoperative weight loss. It is particularly important to assess the specific characteristics and predictive factors of food preference changes after the surgery. It is difficult to guide postoperative weight maintenance based on the large variability in results between available studies.
To investigate the characteristics of food preference change and its effect on weight loss outcomes in patients undergoing bariatric surgery, and to analyze the predictive factors of food preference change.
A convenient sampling method was used to select 245 patients undergoing bariatric surgery who were admitted to Outpatient Weight Loss Follow-up Department, the First Affiliated Hospital of Nanjing Medical University from February to August, 2022. The self-developed General Demographic Questionnaire, Weight Loss Outcome Questionnaire and Food Preference Change Features after Bariatric Surgery were used to collect relevant data. Independent samples t-test was used to compare the effects of changes of food preference after bariatric surgery on the weight loss outcome. Univariate analysis and disordered multi-class Logistic regression were performed to analyze the predictive factors of food preference changes after bariatric surgery.
Two hundred and thirty-seven (96.7%) patients who returned responsive questionnaires were finally enrolled, and 97.0% of them had food preference changes after bariatric surgery. Patients with and without changes in food preferences after bariatric surgery had statistically significant differences in postoperative weight, body mass index drop value and total weight loss percentage (P<0.05) . Disordered multi-class Logistic regression analysis showed that postoperative time was the predictor of changes in preferences of patients undergoing bariatric surgery for vegetables and fruits (P<0.05) ; marital status and preoperative comorbidities were predictors of changes in preference of patients undergoing bariatric surgery for high-quality protein foods (P<0.05) ; place of residence (northern or southern China) was the predictor of changes in preference of patients undergoing bariatric surgery for spicy foods (P<0.05) ; gender, place of residence and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for salty snacks (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for high-fat meat (P<0.05) ; gender and postoperative time were predictors of changes in preferences of patients undergoing bariatric surgery for sweet food (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for sweet drinks (P<0.05) .
The incidence of food preference changes in patients undergoing bariatric surgery is high, showing a decrease in their preference for high calorie foods and an increase in their preference for healthy foods. Gender, marital status, place of residence, preoperative comorbidities, bariatric surgery methods, and postoperative time are predictors of various food preference changes in patients undergoing bariatric surgery. Weight loss professionals should identify the target population at early stage, pay more attention to postoperative dietary education and guidance for patients, in order to improve the postoperative dietary experience and effectively ensure the effect of bariatric surgery.
The grazing behavior after bariatric surgery is significantly related to postoperative weight regain, and its incidence will increase with the extension of time after surgery. So it is particularly important to early detect and accurately evaluate the grazing behavior of patients undergoing bariatric surgery. At present, the assessment tools for grazing behavior in these patients in China are still lacking.
To translate the Repetitive Eating Questionnaire〔Rep (eat) -Q) 〕into Chinese and evaluate its reliability and validity among patients undergoing bariatric surgery.
The Brislin's model of translation was adopted for translation. We developed the Chinese version of Rep (eat) -Q following the process of translation of the English version of the Rep (eat) -Q, back translation, expert review and a pilot study. On 2022-08-31, patients undergoing bariatric surgery admitted to the bariatric follow-up clinic of the First Affiliated Hospital with Nanjing Medical University from March to August 2022 were selected for the study using convenience sampling. Then we used the general information questionnaire, Chinese version of Rep (eat) -Q and the 21-item Three-Factor Eating Questionnaire (TFEQ-R21) to conduct a survey among 294 patients undergoing bariatric surgery to test the reliability and validity of the Chinese version of Rep (eat) -Q.
According to the score of the Chinese version of Rep (eat) -Q, these patients were divided into high-score group (n=79) and low-score group (n=78) by the critical ratio. High-score group scored higher in each item of the Chinese version of Rep (eat) -Q compared with the low-score group (P<0.05) . The score of each item in the Chinese version of Rep (eat) -Q was linear positively correlated with the total score (r=0.368-0.782, P<0.05) . The value of Cronbach's α for the scale, repetitive eating subscale and compulsive grazing subscale was 0.943, 0.928 and 0.898, respectively. The value of split-half reliability for the scale, repetitive eating subscale and compulsive grazing subscale was 0.835, 0.938 and 0.891, respectively. And the value of test-retest reliability of the scale, repetitive eating subscale and compulsive grazing subscale was 0.867, 0.800, and 0.836, respectively. The item-level content validity index (CVI) ranged from 0.80 to 1.00. The scale-level CVI /universal agreement and S-CVI/average were 0.92 and 0.98, respectively. Two common factors were obtained after varimax orthogonal rotation by principal component analysis, whose eigenvalues were 7.086, and 1.596, respectively, explaining 72.35% of the total variance. The factor loading values of all items ranged 0.637 to 0.878. The confirmatory factor analysis indicated that the values ofχ2/df, GFI, AGFI, NFI, IFI, CFI and RMSEA were 2.211, 0.905, 0.860, 0.920, 0.955, 0.954, and 0.080, respectively. 294 patients' total score of the Chinese version of Rep (eat) -Q showed a significant correlation with three dimensions of the TFEQ-R21 (P<0.05) .
The Chinese version of Rep (eat) -Q has good reliability and validity, and is simple and easy-to-operate, which can be used to assess the grazing behavior among Chinese patients undergoing bariatric surgery.
