Chewable or Swallowable? Patient-Reported Adherence and Satisfaction with Post Metabolic and Bariatric Surgery...

Metabolic and bariatric surgery (MBS) provides durable weight loss and metabolic improvement but can also predispose patients to micronutrient deficiencies due to altered gastrointestinal anatomy. Lifelong nutrient supplementation is therefore essential; however, adherence typically declines over time. While chewable formulations are often recommended early postoperatively for presumed tolerability, real-world evidence comparing patient adherence, satisfaction, and preferences between chewable and swallowable supplements remains limited particularly in resource-constrained settings such as India, where cost, availability, and taste heavily influence long-term compliance.

To compare adherence, tolerability, and satisfaction between chewable and swallowable supplements in an Indian patient cohort, and to explore factors influencing formulation choice, discontinuation, and perceived health impact.

A cross-sectional survey was conducted among 110 adults at least one month post metabolic and bariatric surgery (Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG)) attending a tertiary center in Mumbai. A structured, self-administered questionnaire assessed supplement type, adherence patterns, swallowing difficulty, satisfaction (5-point Likert scale), and preference drivers (e.g., taste, cost, convenience). Associations between supplement formulation and adherence outcomes were analyzed.

Participants were predominantly female (74%) with mean age 43 years; 60% had undergone RYGB. Swallowable formulations were most commonly preferred (70%). Overall, 41% had discontinued supplements after surgery, primarily due to forgetfulness (35%), cost or safety concerns (22%), and swallowing difficulty (14%). Swallowable users reported higher satisfaction (68% vs. 30%) and significantly greater current use compared with chewable/both users (93.5% vs. 75.8%, p = 0.021). Preference was mainly driven by ease of swallowing (35%), taste/mouthfeel (34%), and physician advice (23%). A majority of participants (72%) believed that supplement formulation could influence long-term health outcomes. Common improvement suggestions included fewer pills, better taste, easier swallowing, and affordability.

These findings suggest that swallowable formulations may be acceptable in routine practice and highlight the importance of incorporating patient preference in long-term supplementation strategies. Despite widespread swallowing concerns, swallowable formulations were associated with higher patient satisfaction and better sustained adherence. While this study has many limitations, it provides a snapshot of patient preferences in an area that is relatively unexplored. In the Indian context, with limited specialized products and cost sensitivity, these findings highlight the need for patient centred supplement strategies emphasizing palatability, convenience, and accessibility.