Jassil, Friedrich Christie Bin;
(2022)
BARI-LIFESTYLE Trial: assessing and maximising the health benefits of bariatric surgery.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Bariatric surgery is the most effective treatment for people living with severe obesity, but weight loss and health outcomes vary markedly from person to person. This thesis aimed to evaluate the efficacy of a post-surgery lifestyle programme in maximising the health benefits of bariatric surgery. One hundred fifty-three patients (78.4% female) with a mean (SD) age of 44.2 (10.6) years and body mass index (BMI) of 42.4 (5.7) kg/m² undergoing Roux‐en‐Y gastric bypass (28.8%), one anastomosis gastric bypass (16.3%) and sleeve gastrectomy (54.9%) were enrolled in a BARI-LIFESTYLE observational study. On the day of surgery, participants were randomised to receive standard post-surgery care (CON) (n=74) or the BARI-LIFESTYLE intervention study (INT) (n=79), consists of 17 sessions of nutritional-behavioural tele-counselling and 12-week supervised exercise programme. Anthropometric measurements, body composition, bone mineral density (BMD), physical activity levels and sedentary behaviour, physical function and strength, health-related quality of life (HRQoL) and depressive symptomatology were assessed periodically in the first postoperative year. Participants’ views and experiences of the lifestyle programme including the tele-exercise classes during the COVID-19 lockdown were assessed qualitatively. Bariatric surgery reduced body weight, fat mass, fat-free mass, and BMD (total hip, femoral neck, and lumbar spine). Physical function and strength, HRQoL, and depressive symptomatology improved following surgery. Percentage weight loss at 6-month post-surgery (primary outcome), did not differ between groups (mean difference [MD]=-1.0%; 95% CI, -3.4 to 1.4; p=0.39). The improvement in six-minute walk test was higher in INT than CON (MD=+19.6 metres; 95% CI, 0.9 to 38.2; p=0.04). Per-protocol analysis showed favourable impacts of the programme on relative handgrip test (MD=+0.1 kg/BMI; 95% CI, 0.0 to 0.2; p=0.02) and whole-body BMD (MD=+1.5%; 95% CI, 0.1 to 2.8; p=0.04). Patient-reported outcomes support the beneficial impacts of the lifestyle programme including the tele-exercise in helping them adapt to life after bariatric surgery.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | BARI-LIFESTYLE Trial: assessing and maximising the health benefits of bariatric surgery |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10147420 |
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