Surgery to restrict the size of the stomach (bariatric surgery) is a treatment for individuals who have obesity complicated by another medical condition. For patients considering or waiting to undergo bariatric surgery, assessing food preferences and lifestyle habits may provide information to assist in their overall success. With funding from UConn’s InCHIP seed grant competition, Valerie Duffy, professor in the Department of Allied Health Sciences (AHS) and registered dietitian (RD), created a collaborative and multidisciplinary study to understand food and activity preferences of patients considering surgery and one year after the surgery.
The AHS project team includes Duffy, Ph.D. student and RD Patrice Hubert and Marina Zoghbi, a 2016 an AHS major who graduated in 2016 and who worked on the study as part of her honors project. She is currently a student at the UConn School of Dental Medicine.
The project also involves several collaborators: Pavlos Papsavas, MD, Darren Tisher, MD, and Andrea Stone, all from the Hartford Hospital Department of Surgery; and Helen Swede, UConn Health’s Department of Community Medicine and Health Care.
“This study has fueled continued collaboration, while engaging students at all levels by translating what is done in the laboratory to clinical settings,” says Duffy.
Says Zogbi, “I believe that this experience helped me as a student in many ways. As a future provider, I know that it is important to listen to your patient’s history to provide them with an individualized treatment plan. Through my honors project I strengthened my skills for reading scientific papers and performing and understanding biostatistics. I believe that every future provider should develop these skills so that they can practice evidence-based medicine.”
“This project demonstrated that a liking survey is a feasible method of collecting reliable and valid information on dietary intake in obesity treatment settings,” Zoghbi points out. “The results from this survey can be used to create tailored intervention for long-term weight loss in bariatric surgery patients.”
The study is designed around a simple liking chart that patients find easy to complete. Traditional food diaries itemize what a patient actually eats, not what they like. When patients are asked to complete food diaries, often they may not remember, or may feel uncomfortable sharing.
“This was a way of rapidly assessing usual diet behaviors,” Duffy says. “It is socially problematic for people to admit to everything they eat. There is an assumption that people who are morbidly obese love everything, but that may not be the case. We eat for a lot of different reasons–boredom, anxiety, depression or simply mindless eating.”
“In previous studies, we found that reported liking correlates nicely with biological measures of consumption,” Duffy explains. “Studies in adults find that what they like in food and activities clearly associates with many health measures, including cardiovascular risk factors. These surveys are easy to collect and help us understand preferences for food as well as behaviors.”
These straight-forward surveys seem to be even more successful than having people taste foods in a clinical setting. And patients enjoy completing them. The information will be used by clinicians to follow patients after surgery.
How will this information help patients be successful after bariatric surgery? For successful long-term weight loss and maintenance, it’s not only important for patients to restrict unhealthy foods, but to learn to like healthy foods. Part of this tool is to assess what they like before surgery, and to see if some changes in food preference result from the surgery itself.
We know that surgery assists patients by restricting stomach size, but it’s still essential that patients change behavior. People can learn to like different foods. For instance, patients on a sodium restricted diet will eventually learn to like less salt. After twelve weeks, the taste palate adjusts, and salty food becomes less appealing.
“I think this project can help patients understand how surgery might impact them in a different way besides reducing the size of their stomach and altering how much they can eat, but also how it may impact what they like,” says Hubert. “For some that might be a big change that they may not be ready for. It also highlights the importance of improving dietary habits in order to be successful, that surgery isn’t a one stop tool and there is more work to be done even after surgery.”
“Before returning to UConn, I worked as a bariatric dietitian with adolescents,” Hubert says. “I remember a particular patient who was always reporting how she didn’t like certain foods anymore. I knew taste may change after surgery but working on this project provided me with a lot more insight.”
The next step is to help patients change their food and activity preferences and find pleasure in activities that do not include food. Duffy plans additional research in the area of message tailoring.
“We’re using the same approach to tailor messages that encourage healthier eating in children,” Duffy says. “Research shows that if you receive information specific to your preferences, it’s more meaningful. We’ve started with children and will add adults. The messages are tailored to what people say they like, while encouraging healthier habits.”