Physical Activity Benefits Post Bariatric Surgery
P
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In accordance with «EACCME criteria for the Accreditation of Live Educational Events», please disclose whether you have or you have not
any conflict of interest with the companies:
[X ] I have no potential conflict of interest to report
[ ] I have the following potential conflict(s) of interest to report:
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
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E
E
R
R
M
M
E
E
T
T
A
A
B
B
O
O
L
L
I
I
C
C
&
&
B
B
A
A
R
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I
I
A
A
T
T
R
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C
C
S
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U
U
R
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G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Safety &
complications
Improved co-
morbidities
Patient
satisfaction
Safety &
complications
Weight
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
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R
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M
M
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E
T
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A
A
B
B
O
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L
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C
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&
&
B
B
A
A
R
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I
A
A
T
T
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I
C
C
S
S
U
U
R
R
G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Improvements
in co-
morbidities
Patient
satisfaction
Safety &
complications
Weight
Safety &
complications
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
E
E
R
R
M
M
E
E
T
T
A
A
B
B
O
O
L
L
I
I
C
C
&
&
B
B
A
A
R
R
I
I
A
A
T
T
R
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I
I
C
C
S
S
U
U
R
R
G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Patient
satisfaction
Safety &
complications
Weight
Safety &
complications
Improvements
in co-
morbidities
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
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R
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M
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A
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B
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O
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A
A
R
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A
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I
C
C
S
S
U
U
R
R
G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Impact on
quality of life
& wellbeing
Weight
Patient
satisfaction
Safety &
complications
Improvements
in co-
morbidities
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
E
E
R
R
M
M
E
E
T
T
A
A
B
B
O
O
L
L
I
I
C
C
&
&
B
B
A
A
R
R
I
I
A
A
T
T
R
R
I
I
C
C
S
S
U
U
R
R
G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Weight &
adiposity
Patient
satisfaction
Improved co-
morbidities
Safety &
complications
Impact on
quality of life
& wellbeing
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
E
E
R
R
M
M
E
E
T
T
A
A
B
B
O
O
L
L
I
I
C
C
&
&
B
B
A
A
R
R
I
I
A
A
T
T
R
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I
I
C
C
S
S
U
U
R
R
G
G
E
E
R
R
Y
Y
(
(
M
M
B
B
S
S
)
)
Weight &
adiposity
Long-
standing
metric of
success
Patients,
providers,
and payers
care about
I
I
N
N
F
F
L
L
U
U
E
E
N
N
C
C
E
E
S
S
O
O
N
N
W
W
E
E
I
I
G
G
H
H
T
T
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
Patient
characteristics
Surgery type
Lifestyle
behaviors
I
I
N
N
F
F
L
L
U
U
E
E
N
N
C
C
E
E
S
S
O
O
N
N
W
W
E
E
I
I
G
G
H
H
T
T
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
Patient
characteristics
Surgery type
Lifestyle
behaviors
W
W
H
H
O
O
I
I
A
A
M
M
Clinical psychologist
focused on weight /
obesity management
Obesity & physical
activity clinical
researcher
•
General
behavioral medicine
clinics
•
Specialty weight
management & MBS
clinics
•
MBS clinical
research studies
P
P
H
H
Y
Y
S
S
I
I
C
C
A
A
L
L
A
A
C
C
T
T
I
I
V
V
I
I
T
T
Y
Y
(
(
P
P
A
A
)
)
A
A
F
F
T
T
E
E
R
R
M
M
B
B
S
S
Often default to thinking
about PA promotion in the
context of supporting
weight loss &
maintenance, but this
may not be the most
helpful approach
A
A
L
L
T
T
E
E
R
R
N
N
A
A
T
T
I
I
V
V
E
E
A
A
L
L
T
T
E
E
R
R
N
N
A
A
T
T
I
I
V
V
E
E
Patients who are most successful with becoming &
staying active are NOT doing it primarily for the weight.
Need to find something else to make it worth it.
P
P
A
A
&
&
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
E
E
R
R
M
M
B
B
S
S
:
:
T
T
H
H
E
E
R
R
E
E
S
S
E
E
A
A
R
R
C
C
H
H
King et al., 2022.
Ann Surg;
Jacobi et al., 2011.
Obes Rev;
Bellicha et al.,
2021.
Obes Rev;
Bellicha et al., 2018.
Obes Rev;
Bond et al, 2023.
SOARD.
P
P
A
A
&
&
O
O
U
U
T
T
C
C
O
O
M
M
E
E
S
S
A
A
F
F
T
T
E
E
R
R
M
M
B
B
S
S
:
:
T
T
H
H
E
E
R
R
E
E
S
S
E
E
A
A
R
R
C
C
H
H
•
Summary:
Greater PA appearsto
relate to better weight outcomes after
MBS, at least during the 1
st
year
King et al., 2022.
Ann Surg;
Jacobi et al., 2011.
Obes Rev;
Bellicha et al.,
2021.
Obes Rev;
Bellicha et al., 2018.
Obes Rev;
Bond et al, 2023.
SOARD.
S
S
O
O
,
,
W
W
H
H
A
A
T
T
’
’
S
S
T
T
H
H
E
E
P
P
R
R
O
O
B
B
L
L
E
E
M
M
?
?
Y
Y
E
E
T
T
…
…
PA does help support better weight outcomes & has many
other health benefits
behavior we want to promote
Weight can be ONE
motivator for PA, but
if the ONLY
motivator, probably
not enough
R
R
E
E
C
C
A
A
P
P
?
?
?
A
A
M
M
O
O
R
R
E
E
H
H
E
E
L
L
P
P
F
F
U
U
L
L
A
A
P
P
P
P
R
R
O
O
A
A
C
C
H
H
More
ACUTE,
short-
term
benefits
E
E
N
N
E
E
R
R
G
G
Y
Y
&
&
M
M
O
O
O
O
D
D
:
:
T
T
H
H
E
E
R
R
E
E
S
S
E
E
A
A
R
R
C
C
H
H
•
Greater PA after MBS is related to greater improvements in
energy, attentiveness & fatigue, seemingly independent of %
total weight loss
Schumacher et al., 2021.
Obes Surg;
Nuijten et al., 2021.
Obes Surg
; Sellberg et
al., 2019.
Qual Life Res
; Bond et al., 2015.
Obesity
; King et al., 2020.
Ann Surg.
E
E
N
N
E
E
R
R
G
G
Y
Y
&
&
M
M
O
O
O
O
D
D
:
:
T
T
H
H
E
E
R
R
E
E
S
S
E
E
A
A
R
R
C
C
H
H
Key finding
Key finding
: days with more PA = days
: days with more PA = days
with greater energy & attentiveness. This
with greater energy & attentiveness. This
was independent of weight loss
was independent of weight loss
•
71 MBS patients
71 MBS patients
•
PA sensors +
PA sensors +
smartphone surveys
smartphone surveys
•
Pre- and 3-, 6, and
12-months post MBS
Schumacher et al., 2021.
Obes Surg.
E
E
N
N
E
E
R
R
G
G
Y
Y
&
&
M
M
O
O
O
O
D
D
Reed et al., 2006.
Psychol Sport Exer
; Rethorst et al., 2009.
Sports Med
; Conn
2009.
Ann Behav Med
; Petruzzello et al. 1991.
Sports Med.
P
P
A
A
T
T
I
I
E
E
N
N
T
T
S
S
’
’
E
E
X
X
P
P
E
E
R
R
I
I
E
E
N
N
C
C
E
E
Reinforcing &
motivating
…to the point some
patients very
surprised
P
P
A
A
T
T
I
I
E
E
N
N
T
T
S
S
’
’
E
E
X
X
P
P
E
E
R
R
I
I
E
E
N
N
C
C
E
E
1. May take some exploration
2. During vs. after exercise
3. Sweet spot for intensity
L
L
E
E
S
S
S
S
O
O
N
N
S
S
A
A
M
M
O
O
R
R
E
E
H
H
E
E
L
L
P
P
F
F
U
U
L
L
A
A
P
P
P
P
R
R
O
O
A
A
C
C
H
H
Look at the
bigger
picture.
What does it
get them?
F
F
I
I
N
N
D
D
I
I
N
N
G
G
T
T
H
H
E
E
“
“
W
W
H
H
Y
Y
”
”
What does PA or improved
health actually do for me?
What other things that I care
about does it connect to and
help make better?
“Better health” can be a
slippery motivator
F
F
I
I
N
N
D
D
I
I
N
N
G
G
T
T
H
H
E
E
“
“
W
W
H
H
Y
Y
”
”
Mobility to play with
kids/grandkids
Better fitness for daily
activities, travel, etc.
Being a positive role
model for others
PA as a way to
explore the world
or meet others
A
A
C
C
C
C
E
E
P
P
T
T
A
A
N
N
C
C
E
E
-
-
B
B
A
A
S
S
E
E
D
D
I
I
N
N
T
T
E
E
R
R
V
V
E
E
N
N
T
T
I
I
O
O
N
N
C
l
a
r
i
f
y
v
a
l
u
e
s
&
c
o
n
n
e
c
t
t
o
h
e
a
l
t
h
b
e
h
a
v
i
o
r
s
M
O
T
I
V
A
T
I
O
N
R
e
d
u
c
e
t
h
o
u
g
h
t
s
&
f
e
e
l
i
n
g
s
a
s
b
a
r
r
i
e
r
s
t
h
r
o
u
g
h
m
i
n
d
f
u
l
n
e
s
s
/
a
c
c
e
p
t
a
n
c
e
-
b
a
s
e
d
s
t
r
a
t
e
g
i
e
s
A
D
H
E
R
E
N
C
E
I
n
c
r
e
a
s
e
a
w
a
r
e
n
e
s
s
o
f
t
h
e
s
e
v
a
l
u
e
s
i
n
d
a
i
l
y
l
i
f
e
M
O
T
I
V
A
T
I
O
N
Forman & Butryn, 2016.
Appetite;
Forman et al., 2015.
Curr Opin Psychol;
Lillis
& Kendra, 2016.
J Context Behav Sci;
Bradley et al., 2016.
Obes Surg.
F
F
O
O
C
C
U
U
S
S
O
O
N
N
T
T
H
H
E
E
B
B
I
I
G
G
P
P
I
I
C
C
T
T
U
U
R
R
E
E
How might PA
enhance these
things?
What are people’s big
values?
L
L
E
E
S
S
S
S
O
O
N
N
S
S
W
W
R
R
A
A
P
P
U
U
P
P
1.
Short-term
benefits like
improved energy
& mood
2.
Connections to
broader areas of
life (the “why”)
Weight part of the
picture, but part of a
larger picture
C
C
O
O
N
N
T
T
A
A
C
C
T
T
Leah Schumacher, PhD
Assistant Professor
College of Public Health
Temple University
Philadelphia, PA
leah.schumacher@temple.edu
www.linkedin.com/in/leah-
schumacher
Are the advantages of promoting physical activity after bariatric surgery worth the effort? Dr. Leah Schumacher delves into the outcomes and impact of metabolic and bariatric surgery (MBS) on patient satisfaction, safety, weight, co-morbidities, and quality of life. Understanding these factors is crucial for patients, providers, and payers involved in bariatric care.
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Promoting physical activity after bariatric surgery: worth the weight? Leah Schumacher, PhD Assistant Professor Licensed Clinical Psychologist
CONFLICT OF INTEREST DISCLOSURE CONFLICT OF INTEREST DISCLOSURE In accordance with EACCME criteria for the Accreditation of Live Educational Events , please disclose whether you have or you have not any conflict of interest with the companies: [X ] I have no potential conflict of interest to report [ ] I have the following potential conflict(s) of interest to report:
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patient satisfaction Safety & complications Weight Safety & complications Improved co- morbidities
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patient satisfaction Safety & complications Improvements in co- morbidities Weight Safety & complications
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patient satisfaction Safety & complications Improvements in co- morbidities Weight Safety & complications
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patient satisfaction Safety & complications Improvements in co- morbidities Weight Impact on quality of life & wellbeing
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patient satisfaction Safety & complications Weight & adiposity Impact on quality of life & wellbeing Improved co- morbidities
OUTCOMES AFTER METABOLIC & BARIATRIC SURGERY (MBS) Patients, providers, and payers care about Long- standing metric of success Weight & adiposity
INFLUENCES ON WEIGHT OUTCOMES Patient characteristics Lifestyle behaviors Surgery type
INFLUENCES ON WEIGHT OUTCOMES Patient characteristics Lifestyle behaviors Surgery type
WHO I AM General behavioral medicine clinics Specialty weight management & MBS clinics MBS clinical research studies Clinical psychologist focused on weight / obesity management Obesity & physical activity clinical researcher
PHYSICAL ACTIVITY (PA) AFTER MBS Often default to thinking about PA promotion in the context of supporting weight loss & maintenance, but this may not be the most helpful approach
ALTERNATIVE 1 2 Energy + mood Positive changes in valued life domains
ALTERNATIVE Patients who are most successful with becoming & staying active are NOT doing it primarily for the weight. Need to find something else to make it worth it.
PA & OUTCOMES AFTER MBS: THE RESEARCH Observational research Greater PA = more weight loss (e.g., King et al, 2022; Jacobi et al., 2011) Experimental research (exercise training vs. control) Weight loss Bellicha et al., 2021: -1.8 kg greater weight loss Bellicha et al., 2018: -2.4 kg greater weight loss Maintenance/recurrence ( 12 M outcome) Bond et al. 2023: -2.4 kg difference but NOT statistically different King et al., 2022. Ann Surg; Jacobi et al., 2011. Obes Rev; Bellicha et al., 2021. Obes Rev; Bellicha et al., 2018. Obes Rev; Bond et al, 2023. SOARD.
PA & OUTCOMES AFTER MBS: THE RESEARCH Summary: Greater PA appearsto relate to better weight outcomes after MBS, at least during the 1st year King et al., 2022. Ann Surg; Jacobi et al., 2011. Obes Rev; Bellicha et al., 2021. Obes Rev; Bellicha et al., 2018. Obes Rev; Bond et al, 2023. SOARD.
SO, WHATS THE PROBLEM? 1 2 3 Average effects quite small Long-term outcome PA can be very effortful & not enjoyable De-motivating; short-term consequences best for behavior change Motivating enough?? Can be a challenge
YET PA does help support better weight outcomes & has many other health benefits behavior we want to promote
RECAP Weight can be ONE motivator for PA, but if the ONLY motivator, probably not enough ? ? ?
A MORE HELPFUL APPROACH 1 More ACUTE, short- term benefits Energy + mood
ENERGY & MOOD: THE RESEARCH Greater PA after MBS is related to greater improvements in energy, attentiveness & fatigue, seemingly independent of % total weight loss Schumacher et al., 2021. Obes Surg; Nuijten et al., 2021. Obes Surg; Sellberg et al., 2019. Qual Life Res; Bond et al., 2015. Obesity; King et al., 2020. Ann Surg.
ENERGY & MOOD: THE RESEARCH Key finding: days with more PA = days with greater energy & attentiveness. This was independent of weight loss 71 MBS patients PA sensors + smartphone surveys Pre- and 3-, 6, and 12-months post MBS Schumacher et al., 2021. Obes Surg.
ENERGY & MOOD Reed et al., 2006. Psychol Sport Exer; Rethorst et al., 2009. Sports Med; Conn 2009. Ann Behav Med; Petruzzello et al. 1991. Sports Med.
PATIENTS EXPERIENCE Reinforcing & motivating to the point some patients very surprised
PATIENTS EXPERIENCE 1. May take some exploration 3. Sweet spot for intensity 2. During vs. after exercise
LESSONS Focusing on energy & mood rather than weight is often much more motivating and rewarding for patients 1
A MORE HELPFUL APPROACH 2 Look at the bigger picture. What does it get them? Positive changes in valued life domains
FINDING THE WHY What does PA or improved health actually do for me? What other things that I care about does it connect to and help make better? Better health can be a slippery motivator
FINDING THE WHY Being a positive role model for others Mobility to play with kids/grandkids PA as a way to explore the world or meet others Better fitness for daily activities, travel, etc.
ACCEPTANCE-BASED INTERVENTION Increase awareness of these values in daily life MOTIVATION Clarify values & connect to health behaviors MOTIVATION Reduce thoughts & feelings as barriers through mindfulness / acceptance-based strategies ADHERENCE Forman & Butryn, 2016. Appetite; Forman et al., 2015. Curr Opin Psychol; Lillis & Kendra, 2016. J Context Behav Sci; Bradley et al., 2016. Obes Surg.
FOCUS ON THE BIG PICTURE How might PA enhance these things? What are people s big values?
LESSONS Focusing on energy & mood rather than weight is often much more motivating and rewarding for patients 1 Seeing if / how PA connects to the things that patients care more about in life to make the why clearer 2
WRAP UP 1. Short-term benefits like improved energy & mood 2. Connections to broader areas of life (the why ) Weight part of the picture, but part of a larger picture
CONTACT Leah Schumacher, PhD Assistant Professor College of Public Health Temple University Philadelphia, PA leah.schumacher@temple.edu www.linkedin.com/in/leah- schumacher
