Ecological momentary assessment of recommended postoperative eating and activity behaviors

Successful weight loss after bariatric surgery depends on the patient's adherence to prescribed eating and physical activity behaviors. However, few studies have assessed patients' adherence to the behavioral recommendations and most have used retrospective self-report measures. The present study is the first to use ecological momentary assessment (EMA) via a palmtop computer to assess bariatric surgery patients' eating and activity behaviors in real-time in the natural environment. The study was conducted at Miriam Hospital (Providence, RI).

A total of 21 patients (14 laparoscopic adjustable gastric banding and 7 Roux-en-Y; 81% women; mean age 48.5 yr) were studied 6.1 ± 2.1 months postoperatively. The participants used a palmtop computer for 6 days to report on all eating and physical activity episodes as they occurred in the natural environment.

All participants demonstrated good compliance with the EMA, using the device on ≥5 full days. Most participants (94.8%) adhered to the recommendation to not drink while eating, and most took their vitamin supplements and medication as prescribed (85.7% and 90.5%, respectively). Few (4.8%) participants ate the recommended ≥5 meals daily, most participants exceeded the recommended portion sizes during meals and snacks (100% and 72.0% of the participants, respectively), and 47.6% of the participants consumed ≥5 servings of fruit and vegetables daily. Only 15.8% regularly consumed adequate liquids. Only 23.8% of participants engaged in moderate to vigorous physical activity for ≥30 minutes daily, as recommended.

The EMA results suggested that adherence to the recommended behaviors varied considerably, depending on the behavior, with greater adherence to simple versus complex behaviors. EMA might eventually be a useful tool to help optimize the outcomes of bariatric surgery by identifying behavioral targets for additional monitoring and intervention.