Being able to walk to a nearby grocery store may be a key determinant of long-term weight loss after bariatric surgery, according to new research.
Still, the researchers found that simply living near a grocery store isn't a surefire path to long-term weight loss, especially when the market is dominated by processed convenience foods. The findings were published in the journals Surgery of Obesity and Related Disorders and Bariatric Surgery.
Overall, an analysis of data from hundreds of bariatric surgery patients in central Ohio showed an association between proximity to food stores and better weight loss two years after surgery.
Taking a closer look at a store's offerings influenced whether that proximity was beneficial, showing that living within a five-minute walk of a store with poor-quality food was actually associated with weight loss two years after surgery.
“Proximity to lower-quality stores predicted less weight loss, but closer proximity to higher-quality stores did not predict greater weight loss,” said Keeley Pratt, associate professor of humanities at Ohio State University and lead author of both studies. These findings are presented. “So the lower quality stores really lead to poor outcomes.”
The research team examined community characteristics and other social determinants of health that may contribute to or hinder sustained weight loss up to two years after bariatric surgery.
The analysis included select data from the electronic health records of all patients who underwent bariatric surgery at The Ohio State University Wexner Medical Center in Franklin County, Ohio, between 2015 and 2019. Data included race, type of insurance, procedure, and percent overall weight loss 2 to 24 months after surgery.
The researchers combined health records with census and county data, which allowed the team to not only count the number of food stores, parks/recreation areas, and fitness facilities in the county, but also precisely calculate their location relative to the patient's home address.
Bariatric surgery, which reduces the size of the stomach and causes rapid weight loss, requires patients to eat small amounts of soft food initially, then gradually transition back to a more varied diet, with six months of guidance from a dietitian and a nurse practitioner.
“Then what we're seeing is from six months to a year and a year later, if the food intake increases due to not maintaining healthy behaviors or going back to previously unhealthy foods, then the weight may rebound,” Pratt said. He also serves as a general surgery faculty member, said. “That being said, it doesn't mean patients have ready access to something they can eat where they live – that's the connection we're trying to make clear. Our patients know what to eat, so it's not an education or knowledge issue , but may be an acquisition issue.”
Previous research has shown that living in a healthier area helps people manage their weight, but little research has looked at the social determinants of health that affect patients who achieve weight loss through major surgery, she said.
The patient sample included 772 patients who had undergone one of two types of gastric reduction surgery. Of these, 60 percent were white and 82 percent were women.
The preliminary study found that while black surgery patients had higher rates of poverty and unemployment than white patients, consistent with previous research, these variables did not negatively affect weight loss outcomes. Nor do you live near vacant lots or fitness and recreational facilities.
Greater access to food stores within a 10-minute walk was associated with a higher proportion of weight loss among all patients. But there were some nuances: Black patients had more food stores within a 10-minute walk, and they lost more weight over two years. For white patients, the optimal distance for sustained weight loss was a five-minute walk from the store.
The researchers later categorized food stores as low, medium, or high diversity based on product selection, which roughly translates to corner or convenience stores, specialty markets, and full-service supermarkets.
For all patients, living within a 5-minute or 10-minute walk of a moderate- or high-diversity store had no effect on weight loss, but having a low-diversity store or a maximum of two low-diversity stores within a 5-minute walk of 10 The minute distance was associated with less durable weight loss.
Living near these stores did not indicate that patients would actually shop at the markets closest to home — but the nature of the most readily available food stores might indicate larger economic forces at play, the researchers noted.
“The real goal is figuring out how to make connections from clinic to community and community to clinic,” Platt said, suggesting that Ohio State could work with stores to upgrade their food options and with fitness facilities to offer discounts to patients .
“This is really a starting point for figuring out how we can help patients in Franklin County and ultimately make sure that postoperative weight loss is fair for other patients, that resources are fair and available to all postoperative patients.”
