Application effects of mindful eating intervention in patients after bariatric and metabolic surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Jinyi ,  YANG Ningli , LIANG Hui , GUAN Wei , SHEN Jiajia , HUA Hongxia

Department of Bariatric Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P. R. China;

Corresponding author：

YANG Ningli, Email: njyangningli2002@163.com

Keywords：

mindful eating; bariatric and metabolic surgery; dietary adherence; weight-loss effect

DOI：

10.7507/1007-9424.202410089

Video：

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Objective To explore the effects of mindful eating intervention on the dietary adherence and surgical outcomes for patients after bariatric and metabolic surgery. Methods A total of 124 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2023 to May 2024 were recruited by convenience sampling method. The patients were randomly equally divided into the observation group and the control group respectively. Mindful eating intervention and routine follow-up management were given in the two groups respectively. The dietary aderence and the effects of bariatric and metabolic surgery were compared between the two groups. Results A total of 124 patients were included based on sample size calculation, with 62 patients in each group. The baseline characteristics, including gender, age, body mass index (BMI), surgical approach, and comorbidities, showed no statistically significant differences between the two groups (P>0.05). The overall dietary adherence, dietary control, fluid intake, and eating habits of the observation group were significantly better than those of the control group (P<0.05). The dietary control and eating habits were affected by time effects. There was no significant difference in the nutrient intake between the two groups (P>0.05). The BMI, percentage of excess weight loss, and remission of comorbidities in the observation group were significantly better than those in the control group at 6 months after surgery (P<0.05), there was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion The preliminary results of this study suggest that mindful eating intervention after bariatric and metabolic surgery can effectively improve patients’ dietary adherence and promote surgical results.

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2.	中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识. 中国预防医学杂志, 2022, 23(5): 321-339.
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5.	王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版). 中国实用外科杂志, 2019, 39(4): 301-306.
6.	Zhu H, Zhao K, Ren Z, et al. Determinants of dietary adherence among Chinese patients after bariatric surgery based on the attitude-social influence-efficacy model. Obes Surg, 2022, 32(9): 3064-3073.
7.	Felske AN, Williamson TM, Rash JA, et al. Proof of concept for a mindfulness-informed intervention for eating disorder symptoms, self-efficacy, and emotion regulation among bariatric surgery candidates. Behav Med, 2022, 48(3): 216-229.
8.	朱涵菲. 基于ASE模型的减重代谢术后患者饮食依从性和影响因素问卷的编制及应用. 南京: 南京医科大学, 2021.
9.	王存川, 张鹏, 董志勇, 等. 肥胖与代谢病外科疗效报告的标准规范. 中华肥胖与代谢病电子杂志, 2020, 6(2): 73-77.
10.	刘潇, 蔡春凤, 余立平. 2型糖尿病患者饮食依从性研究进展. 中国健康教育, 2019, 35(6): 538-541.
11.	Ritsch N, Guyot E, Domingie S, et al. Food choices, microstructure of ingestive behavior and sensory perceptions after bariatric surgery in women: A cross-sectional study. Appetite, 2025, 206: 107800. doi: 10.1016/j.appet.2024.107800.
12.	Zhao K, Xu X, Zhu H, et al. Trajectory analysis and predictors of the percentage of body fat among chinese sleeve gastrectomy patients. Diabetes Metab Syndr Obes, 2021, 14: 4959-4970.
13.	刘玄巾, 王滢茹, 杨斯钰, 等. 正念饮食的国外研究进展. 解放军护理杂志, 2019, 36(8): 55-58.
14.	Chacko SA, Yeh GY, Davis RB, et al. A mindfulness-based intervention to control weight after bariatric surgery: Preliminary results from a randomized controlled pilot trial. Complement Ther Med, 2016, 28: 13-21.
15.	Li Z, Pan Y, Zhang Y, et al. Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review. Obes Surg, 2022, 32(6): 2023-2034.
16.	Carrière K, Khoury B, Günak MM, et al. Mindfulness-based interventions for weight loss: a systematic review and meta-analysis. Obes Rev, 2018, 19(2): 164-177.
17.	Bevilacqua LA, Obeid NR, Spaniolas K, et al. Early postoperative diet after bariatric surgery: impact on length of stay and 30-day events. Surg Endosc, 2019, 33(8): 2475-2478.
18.	刘雁军. 减重代谢手术在肥胖症综合治疗中的应用. 中国普外基础与临床杂志, 2023, 30(3): 260-263.
19.	廉东波, 刘晨, 闫巍, 等. 减重代谢手术效果综合评价系统(BAROS)的引进和初步应用. 中国微创外科杂志, 2020, 26(6): 498-502,506.
20.	Davis JA, Saunders R. Earlier provision of gastric bypass surgery in Canada enhances surgical benefit and leads to cost and comorbidity reduction. Front Public Health, 2020, 8: 515. doi: 10.3389/fpubh.2020.00515.
21.	Rogers JM, Ferrari M, Mosely K, et al. Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes. Obes Rev, 2017, 18(1): 51-67.
22.	Porto EBS, Montero-Marin J, Quadros LG, et al. Mindfulness and compassion-based programs on eating behavior of post-bariatric surgery patients: A two phased clinical trial protocol. MethodsX, 2024, 13: 102885. doi: 10.1016/j.mex.2024.102885.
23.	Newman AK, Herbozo S, Russell A, et al. Psychosocial interventions to reduce eating pathology in bariatric surgery patients: a systematic review. J Behav Med, 2021, 44(3): 421-436.
24.	Mantzios M, Bahia H, Hussain M, et al. Exploring the experiences of people with obesity and post-bariatric surgery patients after three months using the mindful eating reflective practice: An interpretative phenomenological analysis. Nutr Health, 2024: 2601060241281779. doi: 10.1177/02601060241281779.

1. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
2. 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识. 中国预防医学杂志, 2022, 23(5): 321-339.
3. Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet, 2021, 397(10287): 1830-1841.
4. 杜靖, 刘丹丹, 刘秀, 等. 肠道菌群在减重手术后的变化及改善代谢的机制. 中国普外基础与临床杂志, 2023, 30(3): 279-284.
5. 王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版). 中国实用外科杂志, 2019, 39(4): 301-306.
6. Zhu H, Zhao K, Ren Z, et al. Determinants of dietary adherence among Chinese patients after bariatric surgery based on the attitude-social influence-efficacy model. Obes Surg, 2022, 32(9): 3064-3073.
7. Felske AN, Williamson TM, Rash JA, et al. Proof of concept for a mindfulness-informed intervention for eating disorder symptoms, self-efficacy, and emotion regulation among bariatric surgery candidates. Behav Med, 2022, 48(3): 216-229.
8. 朱涵菲. 基于ASE模型的减重代谢术后患者饮食依从性和影响因素问卷的编制及应用. 南京: 南京医科大学, 2021.
9. 王存川, 张鹏, 董志勇, 等. 肥胖与代谢病外科疗效报告的标准规范. 中华肥胖与代谢病电子杂志, 2020, 6(2): 73-77.
10. 刘潇, 蔡春凤, 余立平. 2型糖尿病患者饮食依从性研究进展. 中国健康教育, 2019, 35(6): 538-541.
11. Ritsch N, Guyot E, Domingie S, et al. Food choices, microstructure of ingestive behavior and sensory perceptions after bariatric surgery in women: A cross-sectional study. Appetite, 2025, 206: 107800. doi: 10.1016/j.appet.2024.107800.
12. Zhao K, Xu X, Zhu H, et al. Trajectory analysis and predictors of the percentage of body fat among chinese sleeve gastrectomy patients. Diabetes Metab Syndr Obes, 2021, 14: 4959-4970.
13. 刘玄巾, 王滢茹, 杨斯钰, 等. 正念饮食的国外研究进展. 解放军护理杂志, 2019, 36(8): 55-58.
14. Chacko SA, Yeh GY, Davis RB, et al. A mindfulness-based intervention to control weight after bariatric surgery: Preliminary results from a randomized controlled pilot trial. Complement Ther Med, 2016, 28: 13-21.
15. Li Z, Pan Y, Zhang Y, et al. Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review. Obes Surg, 2022, 32(6): 2023-2034.
16. Carrière K, Khoury B, Günak MM, et al. Mindfulness-based interventions for weight loss: a systematic review and meta-analysis. Obes Rev, 2018, 19(2): 164-177.
17. Bevilacqua LA, Obeid NR, Spaniolas K, et al. Early postoperative diet after bariatric surgery: impact on length of stay and 30-day events. Surg Endosc, 2019, 33(8): 2475-2478.
18. 刘雁军. 减重代谢手术在肥胖症综合治疗中的应用. 中国普外基础与临床杂志, 2023, 30(3): 260-263.
19. 廉东波, 刘晨, 闫巍, 等. 减重代谢手术效果综合评价系统(BAROS)的引进和初步应用. 中国微创外科杂志, 2020, 26(6): 498-502,506.
20. Davis JA, Saunders R. Earlier provision of gastric bypass surgery in Canada enhances surgical benefit and leads to cost and comorbidity reduction. Front Public Health, 2020, 8: 515. doi: 10.3389/fpubh.2020.00515.
21. Rogers JM, Ferrari M, Mosely K, et al. Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes. Obes Rev, 2017, 18(1): 51-67.
22. Porto EBS, Montero-Marin J, Quadros LG, et al. Mindfulness and compassion-based programs on eating behavior of post-bariatric surgery patients: A two phased clinical trial protocol. MethodsX, 2024, 13: 102885. doi: 10.1016/j.mex.2024.102885.
23. Newman AK, Herbozo S, Russell A, et al. Psychosocial interventions to reduce eating pathology in bariatric surgery patients: a systematic review. J Behav Med, 2021, 44(3): 421-436.
24. Mantzios M, Bahia H, Hussain M, et al. Exploring the experiences of people with obesity and post-bariatric surgery patients after three months using the mindful eating reflective practice: An interpretative phenomenological analysis. Nutr Health, 2024: 2601060241281779. doi: 10.1177/02601060241281779.

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