Eating Behaviors, Physical Activity and Weight Loss after Motivational Interviewing in Patients who have Undergone Laparoscopic Sleeve Gastrectomy

Eating Behaviors, Physical Activity and Weight Loss after Motivational Interviewing in Patients who have Undergone Laparoscopic Sleeve Gastrectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Eating Behaviors, Physical Activity and Weight Loss after Motivational Interviewing in Patients who have Undergone Laparoscopic Sleeve Gastrectomy Zahra Sobhani, Hamid Poursharifi, Hajar Khazraei, Seyed Vahid Hosseini This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4381126/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: There is strong evidence that obesity, especially morbid obesity, is associated with serious and dangerous physical illnesses, and that weight loss in these patients can improve their social functioning, quality of life, and mental health. Objectives: The goal of this study was to evaluate eating behaviors, physical activity, and weight loss after motivational interviewing (MI) in patients who have undergone laparoscopic sleeve gastrectomy (LSG). Setting: Mother and Child Hospital in Shiraz during spring and summer of 2019. Methods: The thirty obese patients (Body Mass Index:BMI ≥ 35) who had undergone LSG were selected and randomly divided into two groups of control and experimental. Data were collected using bariatric surgery self-management behaviors questionnaire. MI was conducted for the experimental group during four weeks. Results: The results indicated that MI caused a significant difference between the two groups in at least one of the dependent variables (eating behaviors, supplement consumption and physical activity). Therefore, MI is effective and appropriate in obese patients who had undergone LSG towards achieving optimal weight loss. Conclusion: Changing the lifestyle in patients that have undergone bariatric surgery is achieved by meeting the psychological needs, namely autonomy, competence, and communication with others. Eating Behaviors Physical Activity weight Loss Motivational Interviewing Laparoscopic Sleeve Gastrectomy Introduction Obesity is a very common chronic disorder that is directly and indirectly associated with many diseases and is one of the important areas of study in health psychology. The prevalence of obesity in the world is on the rise, with approximately 396 million adults, or 0.98% of the adult population of the world is obese (1) . There is strong evidence that obesity, especially morbid obesity, is associated with serious and dangerous physical illnesses, and weight loss in these patients can improve their social functioning, quality of life, and mental health (2, 3) . Treatment options for obesity include medication, low-calorie diet, behavior modification, exercise, and surgery (4) . Bariatric surgery is a method that might lead to long-term reduction in weight, eliminating, or ameliorating obesity-related diseases and thus to an improving the quality of life (5) ; it, has a significant role in healthcare and is highly recommended after bariatric surgery, physical activity, dietary changes, and supplement consumption (6, 7) . Laparoscopic sleeve gastrectomy (LSG) is the most commonly used surgical method in bariatric surgery, in which about 60 to 80 percent of the stomach is removed. Although it is the most effective method for treatment of severe obesity, up to 30% of people have fail to achieve or maintain optimal weight loss (8) . Eating behaviors are diet-related outcomes and are influenced by weight variations among individuals (9, 10) . Diet quality improvement plays an important role in the prevention of chronic diseases (11) . Few people (28–40%) meet guideline levels of regular moderate-intensity physical activity despite strong recommendations about its health benefits (12) . Healthy behaviors such as intake of fruit and vegetable (5 servings daily), and exercise (30 minutes 12 times monthly) have significantly decreased among obese patients (13) . Elkins et al. (14) have reported the noncompliance with eating and exercise recommendations in about 40% of patients after bariatric surgery. The relationship between the behavioral recommendations and weight after surgery is an important issue (5) . In the study by Sarwer et al. (15) , the dietary adherence at 20 weeks was associated with weight loss at 40, 66, and 92 weeks positively after the surgery. Psychosocial interventions improve eating behaviors after bariatric surgery (13,16) . Motivational interviewing is an effective method in persuading the patients to follow the treatment recommendations. Expressing empathy, avoiding conflict, revealing incongruity, supporting self-efficacy, and coping with resistance are clinical principles of motivational interviewing (17) . This is client-centered method used to enhance intrinsic motivation in order to establish self-efficacy to create changes in the patients’ beliefs (17, 18) . The efficacy of motivational interviewing in improving a broad range of diseases and health behaviors has proved successful (19) . This method improves dietary behaviors and eating disorders by a standard psycho-education, increases the physical activity, and improves the bariatric patients' confidence for change in eating behaviors (20–24) . About 25% of patients experienced a suboptimal weight loss or a significant weight regain after the surgery that might be due to physiologic processes, behavioral factors, or psychological characteristics (25) . So far, there are few studies on motivational interviewing for people who have undergone bariatric surgery (13, 23, 24) . Increasing knowledge, skills, motivation, self-confidence, self-efficacy, and self-monitoring of obese patients after surgery seems essential (26) . Therefore, the goal of this study was to evaluate eating behaviors, physical activity, and weight loss after motivational interviewing (MI) in patients who have undergone laparoscopic sleeve gastrectomy. Material and Methods Participants This is a semi-experimental study with pre-test, post-test and control group. The study population consisted of all patients (Body Mass Index:BMI > 35) aged 21 to 58 years old (mean 38.23 and standard deviation 9.87) who had undergone LSG in Mother and Child Hospital in Shiraz during spring and summer of 2019. The inclusion criteria were having BMI greater than 35, receiving LSG at least the previous 12 months, failing to achieve successful weight loss, and being able to read and write in Persian. Thirty patients who had the inclusion criteria were selected as the samples by the sealed envelope site. Block sizes were 4, 6, and 8, and the patients were selected according to the patient list, and randomly divided into two groups of control and experimental, each containing 15 participants. Tools The following tools were used in this study: 1- Bariatric Self-Management Behaviors Questionnaire (BSSQ): In order to assess eating behaviors, supplement consumption and physical activity, the bariatric surgery self-management behaviors questionnaire (BSSQ) was used. This questionnaire was originally developed by Welch et al. (7) . The seven BSSQ behavioral domains were ( 1 ) eating behaviors (eight EB items); ( 2 ) fluid intake (eight FI items); ( 3 ) protein intake (three PI items); ( 4 ) physical activity (three PA items); ( 5 ) dumping syndrome management (four DSM items); ( 6 ) fruit, vegetable, and whole grains intake (three FVW items); and ( 7 ) vitamin and mineral supplement intake (four SI items). In 2017, Sobhani et al. revised the original version of this questionnaire and used it for her research (27) . To prevent any language barrier and ensure maximum comprehension, we translated the BSSQ into Persian to avoid any kind of misinterpretation on the part of the participants. To check for the originality of the meaning of the translated version, the Persian version was back-translated into English by an expert. The congruency between the two texts was found to be about 80%. Finally, based on the comparisons, a few modifications were made in the Persian version to tailor it to the context of the study. The reliability of the Persian version was computed using Cronbach's Alpha; it was 0.78. In Sobhani et al.’s study, in order to have consistency and ease in data analysis procedure, some other changes were applied. The reliability coefficient for this questionnaire (Cronbach's alpha = 0.90) was obtained and using the split-correlation method, the two-part correlation was 0.78, indicating the desired reliability of the self-management behavior questionnaire after bariatric surgery (27) . Based on the findings of the present study, high adherence to these behaviors was anticipated to improve the likelihood of the patient’s success after surgery in terms of excess weight loss and adequate nutritional status. All the subscales and the total scores were converted to a 0–99 range for ease of interpretation, with higher scores indicating higher adherence. 2- Waight and Body mass index (BMI): Height was measured using a stadiometer (SECA, Chino CA) to the nearest 0.1 cm. Weight was measured using a medical scale to the nearest 0.1 kg (Detecto-Medic, Brooklyn NY). BMI was calculated based on this formula: BMI (kg / m 2 ) = \(\frac{\text{W}\text{e}\text{i}\text{g}\text{h}\text{t} \left(\text{k}\text{g}\right)}{\text{H}\text{e}\text{i}\text{g}\text{h}\text{t} \left(\text{m}\right)2}\) Procedure Individuals, who were selected based on inclusion criteria, completed the bariatric BSSQ. The experimental group received motivational interviewing during 4 sessions of 90 minutes in the obesity clinic of Hospital. Three months after the pre-test, BSSQ was distributed again among all the participants. The topics of the 4 sessions of motivational interviewing sessions about the self-management behaviors after bariatric surgery were as follows: 1- Understanding the stages of change aiming at raising awareness, 2- One day of life aiming at increasing awareness about the quantity and quality of self-care behaviors and its effects, 3- Positive and negative values ​​and aspects aiming at self-reevaluation and balanced decision making, and 4) Temptation and self-esteem; goal setting and preparation for change, self-efficacy, and commitment to change behavior (23) . Using SPSS 19 software, we used descriptive statistics (mean and standard deviation) and inferential statistics (multivariate analysis of covariance) to analyze the data and P < 0.05 was considered significant. Results In terms of demographic variables, there was no statistically significant difference between the two groups. The mean and standard deviation of the age of the control group was 37.99 ± 9.79 and the minimum and maximum age of the participants was 21 and 55 years, respectively. In the experimental group, the mean and standard deviation of age was 38.53 ± 10.29 and the minimum and maximum age was 22 and 53 years, respectively. Independent t-test showed no significant difference between the two groups in terms of age (t = 0.16, p = 28, df = 28). Table 1 shows the mean and standard deviation of the two groups in the pre-test and post-test conditions. The descriptive data illustrated in Table 1 indicated that the mean and standard deviation of the groups in the pre-test and post-test were not the same. The scores of the experimental group at the post-test stage improved on the overall score of eating behaviors, supplement consumption, and physical activity after bariatric surgery. Table 1 Mean and standard deviation of the subscales of eating behaviors, supplement consumption, physical activity, weight and BMI in the experimental and control groups in two stages of pre-test and post-test variables Group Number of Participants Pre-test Mean ± SD Post-test Mean ± SD P-value Eating Behaviors Experimental 15 16.13 ± 4.63 19.27 ± 4.27 0.0637 Control 15 16.33 ± 4.15 15.81 ± 2.45 0.6792 Supplement Consumption Experimental 15 5.27 ± 2.58 6.81 ± 1.47 0.0543 Control 15 4.53 ± 2.42 4.67 ± 2.69 0.8820 Physical Activity Experimental 15 4.53 ± 1.68 5.93 ± 2.02 0.0484 Control 15 4.87 ± 1.77 4.87 ± 2.29 1.00 Weight Experimental 15 92.3 ± 14.58 81.33 ± 12.62 0.0360 Control 15 92.60 ± 16.88 88.20 ± 14.57 0.4511 BMI Experimental 15 36.67 ± 4.19 31.15 ± 3.48 0.0005 Control 15 36.52 ± 7.12 34.75 ± 6.28 0.4762 The significant differences in the study showed by multivariate analysis of covariance. However, before proceeding to do so, it was necessary to check the preconception of the equality of covariance via the Levene’s test. The results of the Levene’s test showed that the preconception of the equality of variances held true. Therefore, covariance analysis can be used to examine the data. Multivariate analysis of covariance was used to test the hypothesis that motivational interviewing influences eating behaviors, supplement consumption, and physical activity after bariatric surgery. The results are presented in Table 2 . Table 2 Results of Multivariate Covariance Analysis on eating behaviors, supplement consumption, physical activity, weight, and BMI after laparoscopic sleeve gastrectomy Name of test Value F Df Hypothesis df error Eta Coefficient Statistical Power P-value Pillai’s Trace 0.83 7.46 8 12 0.83 0.99 0.001 Wilk’s Lambda 0.16 7.46 8 12 0.83 0.99 0.001 Hoteling’s Trace 4.97 7.46 8 12 0.83 0.99 0.001 Roy’s largest Root 4.97 7.46 8 12 0.83 0.99 0.001 Table 2 shows that there is a significant difference between the experimental group and the control group in terms of the dependent variables at the level of p < 0.001 and the explanatory power of 0.83; therefore, the hypothesis of the present study is confirmed. Accordingly, it can be stated that there is a significant difference between the two groups in at least one of the dependent variables (eating behaviors, supplement consumption and physical activity). In order to determine this difference, we used MANCOVA (Table 3 ). In addition, the effect size coefficient shows that the 0.83 difference between the two groups is the result of motivational interviewing intervention. Table 3 Results of the MANCOVA analysis on the mean scores of the post-test of eating behaviors, supplement consumption, physical activity, weight and BMI in the experimental and control groups Variables Change sources Sum of squares Degree of freedom Mean of squares F P-value Eta coefficient Statistical power Eating Behaviors Pre-test 15.409 1 15.409 3.920 0.062 0.171 0.468 Group 106.935 1 106.935 27.06 0.0001 0.586 0.99 Error 46.711 14 3.337 Supplement Consumption Pre-test 2.446 1 2.446 0.991 0.332 0.05 0.157 Group 19.692 1 19.692 7.47 0.01 0.286 0.73 Error 45.258 14 3.233 Physical Activity Pre-test 5.196 1 5.196 1.321 0.265 0.065 0.194 Group 8.70 1 8.70 2.217 0.155 0.10 0.29 Error 44.526 14 3.180 Weight Pre-test 541.69 1 541.69 59.73 0.0001 0.74 1 Group 79.06 1 79.06 8.72 0.008 0.29 0.8 Error 190.464 21 9.07 BMI Pre-test 99.23 1 99.23 75.59 0.0001 0.78 0.08 Group 13.96 1 13.96 9.98 0.005 0.32 0.85 Error 27.569 21 1.31 According to Table 3 , the differences between the experimental and control groups in terms of the variables of eating behaviors (P = 0.0001, F = 27.06), supplement consumption (P = 0.01, F = 7.47), weight (P = 0.008, F = 8.72) and BMI (P = 0.005, F = 9.98) were significant, whereas the difference between the experimental and control groups in terms of physical activity (F = 2.21, P < 0.15) was not significant. Discussion The goal of this study was to evaluate the effectiveness of motivational interviewing on eating behaviors, physical activity, and weight loss in patients who had undergone bariatric surgery. Findings showed that motivational interviewing was effective on eating behaviors, supplement consumption, weight loss, and BMI in patients who had undergone bariatric surgery; these findings are consistent with those of previous research on motivational interviewing for dietary adherence, confidence for change, and binge eating disorder (BED) (13, 18, 20–24) . After bariatric surgery, people are expected to abandon unhealthy habits such as: binge eating, emotional eating, eating at night, drinking high-calorie fluids, and returning to the pre-surgery lifestyle (7) . Adherence to dietary and physical guidelines following bariatric surgery is critical in reducing postoperative complications and increasing the positive outcomes of weight loss. Therefore, pre- and post-obesity counseling aimed at increasing treatment compliance, and the importance of follow-up sessions over the long term have been emphasized (6, 7, 26) . Patients who have undergone bariatric surgery usually do not adhere to healthy postoperative behavioral instruction like their behavior before bariatric surgery, despite their agreements to do so (13) . Negative weight-related effects on health are associated with dysregulated eating behaviors (10) . Changing lifestyle such as adopting healthy eating habits and physical activity is associated with weight loss and sustained postoperative improvement in quality of life (28, 29) . Motivational interviewing significantly increased the eating behavior and supplement consumption. Since weight gain is influenced by the patients’ lifestyles, motivational interviewing sessions attempt to resolve the patients’ ambivalence over change or continuation of their current lifestyle in favor of change. In some studies, control of over- weight might be achieved as a result of direct control over eating habits (13, 21) . The process includes discussing different post-surgery behavioral patterns and pinpointing discrepancies between the current patient behaviors and desired behaviors, which is consistent with the findings of this study, suggesting the effectiveness of motivational interviewing on improving behavior after bariatric surgery (23) . Clark et al. (30) reported that motivational interviewing could improve and maintain the patient’s motivation and confidence levels for positive lifestyle changes. Evidence suggests that motivational interviewing helps the patients employ medical information and instructions, including adherence to a low-calorie diet, by providing the necessary motivations as fuel and energy for behavioral change. The above point is achieved by satisfying the fundamental psychological needs via implementation of the principles and techniques of motivational interviewing (17, 31) , illustrating the effectiveness of motivational interviewing on different aspects of post-surgery self-management behaviors. In a study carried out by Cassin et al. (20) , motivational interviewing was used for BED patients and they found that this method reduced the frequency of binge eating after16 weeks. Also, David et al (24) reported that the addition of one motivational interviewing session to standard post-operative bariatric care improved patient’s confidence for change, binge eating symptoms, self-efficacy for resisting overeating in tempting situations, and adhering to the postoperative guidelines. West et al. (21) found that the patients who received 5 sessions of motivational interviewing showed a significant weight loss, consistent with the results of the present study. Physical activity adherence is a behavioral predictor of weight loss (7) . Wiklund et al (32) found that the patients experienced both achievements and failures with regard to physical activity one year after the surgery and they understood the benefits of physical activities. Findings show that motivational interviewing was not effective on physical activity in patients who had undergone bariatric surgery, one possible explanation for this being that humans resist behavioral changes initiated from external pressures and thus they are more likely to adopt treatment recommendations if they feel they have an active role in their treatment process. The enhancement of self-efficacy could be one of the mechanisms that changes the physical activity behavior after motivational interviewing after a long time (17) . The finding that motivational interviewing did not affect the physical activity subscale is accordance with the research conducted by Dalle et al. (33) . It might be argued that the lack of significant change in the level of physical activity may be due to the fact that obese patients are less active due to being overweight and consequently they are afflicted by depression, and hopelessness (14) . So, the change in diet seems an easier solution compared to physical exercise. As for people undergoing bariatric surgery, the surgery itself might be the cause of inactivity, lack of energy, and physical weakness for which supplements consumption is a possible remedy. Another possible reason might be that physical activity is a habitual behavior, and that the duration of the intervention may not have been enough to significantly increase it. Patients increased long-term changes in physical activity behavior 12 months or more after interviewing compared with those who used a 12-week follow-up (34) . For greater effectiveness, the interventions need to both contain high-intensity behavioral modification (more than one person-to-person session per month for a period of three months) and include extensive ongoing contact according to a dose-response relationship between counselling sessions attended and changes in clinical motivational outcomes (11) . Overall, research supports the efficacy of motivational interviewing in weight loss, adherence to dietary guidelines, and supplement consumption after bariatric surgery. Adopting a new lifestyle with new eating behaviors could adjust the patients’ metabolism and consequently reproduce the energy and motivation required to follow the instructions. Further research is recommended to be conducted to determine the optimal number of consultations needed to promote autonomous forms of motivation and sustainable physical activity adherence. Limitations The patients did not volunteer to participate in the study and data gathering was too hard. Conclusion We aimed to identify the participants’ perceptions throughout the course of the intervention in relation to physical activity and diet. Motivational interviewing is effective in changing the lifestyle in obese patients undergoing bariatric surgery and improves their eating behaviors and supplement consumption towards achieving optimal weight loss; however, longer-term interventions are needed to motivate the patients to increase their physical activity. Changing the lifestyle in patients who have undergone bariatric surgery is achieved by meeting their psychological needs, namely autonomy, competence, and communication with others. Declarations Acknowledgment: We would like to show our gratitude to the staff of the Laparoscopy Research Center and Obesity Clinic, Shiraz Mother and Child Hospital, who helped and assisted this research. The authors also thank all the participants involved in this research study for their sincere cooperation. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval Statement This study was approved by the research ethics committee of University of Medical Sciences (no. IR.SUMS.REC.1402.461). Consent Statement Informed consent was obtained from all individual participants included in the study. Funding Declaration: There was no founding. Data Availability declaration: Data was supporting the results that reported in the article by Mother and Child hospital in Shiraz. The Hospital dataset that provided from all patients that have surgery there. Author Contribution Z.S. and H.P. designed the study, SV.H. and H.Kh. wrote the main manuscript text and prepared the tables and all the authors reviewed and approved the final manuscript. References Ogden J. The psychology of eating: From healthy to disordered behavior. Wiley; 2011. Yazdani NPC, Hosseini SM, Amini MM, Sobhani ZP, Sharif FP, Khazraei HP. 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Br J Gen practice: J Royal Coll Gen Practitioners. 2005;55(513):305–12. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4381126","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305372594,"identity":"9195909a-543d-4eef-a715-052791072acd","order_by":0,"name":"Zahra Sobhani","email":"","orcid":"","institution":"Islamic Azad University","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Sobhani","suffix":""},{"id":305372597,"identity":"7f438742-ef58-4301-9881-ed7bef90de8e","order_by":1,"name":"Hamid Poursharifi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hamid","middleName":"","lastName":"Poursharifi","suffix":""},{"id":305372598,"identity":"34270834-27a4-4c2b-aae0-64e49eca1e79","order_by":2,"name":"Hajar Khazraei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACgwMMCQwMBw5AeAkVQIKZuYEULWdAWhgJamFAaGFsA5MEtBw/8PBzxZk78vKzDz988HBebTR/O1DLj4ptOLXYn0lIljxz45lhY1+asUHituO5Mw4zNjD2nLmNx2EJCZINHw4zNvMwmEkkbjuW2wDUwszYhkfL+QfJP4Fa7Nt42L//SJxzLHc+QS03EtIkG24cTuzh4TFjSGyoyd1AWMuDNMuGM4eTZ/DwFEskHDuQuxGo5SBev5zPSb7ZcOyw7fwe9o0ff9TU5c47f/jggx8VuLUwMPAkIPMOg8kDeNQDATuKfB1+xaNgFIyCUTAiAQA3S2rSATybnAAAAABJRU5ErkJggg==","orcid":"","institution":"Colorectal research center, Shiraz University of medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hajar","middleName":"","lastName":"Khazraei","suffix":""},{"id":305372600,"identity":"3cb52e0d-d8f2-4da0-8745-141302680681","order_by":3,"name":"Seyed Vahid Hosseini","email":"","orcid":"","institution":"Colorectal research center, Shiraz University of medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Vahid","lastName":"Hosseini","suffix":""}],"badges":[],"createdAt":"2024-05-07 07:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4381126/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4381126/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73156903,"identity":"d1df7874-c160-4aaa-90d6-e224743c6ef5","added_by":"auto","created_at":"2025-01-07 09:09:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":666937,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4381126/v1/6df24ec2-815e-4c4d-8dbe-6d3c847e53c8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Eating Behaviors, Physical Activity and Weight Loss after Motivational Interviewing in Patients who have Undergone Laparoscopic Sleeve Gastrectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a very common chronic disorder that is directly and indirectly associated with many diseases and is one of the important areas of study in health psychology. The prevalence of obesity in the world is on the rise, with approximately 396\u0026nbsp;million adults, or 0.98% of the adult population of the world is obese \u003csup\u003e(1)\u003c/sup\u003e. There is strong evidence that obesity, especially morbid obesity, is associated with serious and dangerous physical illnesses, and weight loss in these patients can improve their social functioning, quality of life, and mental health\u003csup\u003e(2, 3)\u003c/sup\u003e. Treatment options for obesity include medication, low-calorie diet, behavior modification, exercise, and surgery\u003csup\u003e(4)\u003c/sup\u003e. Bariatric surgery is a method that might lead to long-term reduction in weight, eliminating, or ameliorating obesity-related diseases and thus to an improving the quality of life\u003csup\u003e(5)\u003c/sup\u003e; it, has a significant role in healthcare and is highly recommended after bariatric surgery, physical activity, dietary changes, and supplement consumption\u003csup\u003e(6, 7)\u003c/sup\u003e. Laparoscopic sleeve gastrectomy (LSG) is the most commonly used surgical method in bariatric surgery, in which about 60 to 80 percent of the stomach is removed. Although it is the most effective method for treatment of severe obesity, up to 30% of people have fail to achieve or maintain optimal weight loss\u003csup\u003e(8)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEating behaviors are diet-related outcomes and are influenced by weight variations among individuals\u003csup\u003e(9, 10)\u003c/sup\u003e. Diet quality improvement plays an important role in the prevention of chronic diseases\u003csup\u003e(11)\u003c/sup\u003e. Few people (28\u0026ndash;40%) meet guideline levels of regular moderate-intensity physical activity despite strong recommendations about its health benefits\u003csup\u003e(12)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHealthy behaviors such as intake of fruit and vegetable (5 servings daily), and exercise (30 minutes 12 times monthly) have significantly decreased among obese patients\u003csup\u003e(13)\u003c/sup\u003e. Elkins et al.\u003csup\u003e(14)\u003c/sup\u003e have reported the noncompliance with eating and exercise recommendations in about 40% of patients after bariatric surgery. The relationship between the behavioral recommendations and weight after surgery is an important issue \u003csup\u003e(5)\u003c/sup\u003e. In the study by Sarwer et al.\u003csup\u003e(15)\u003c/sup\u003e, the dietary adherence at 20 weeks was associated with weight loss at 40, 66, and 92 weeks positively after the surgery.\u003c/p\u003e \u003cp\u003ePsychosocial interventions improve eating behaviors after bariatric surgery\u003csup\u003e(13,16)\u003c/sup\u003e. Motivational interviewing is an effective method in persuading the patients to follow the treatment recommendations. Expressing empathy, avoiding conflict, revealing incongruity, supporting self-efficacy, and coping with resistance are clinical principles of motivational interviewing\u003csup\u003e(17)\u003c/sup\u003e. This is client-centered method used to enhance intrinsic motivation in order to establish self-efficacy to create changes in the patients\u0026rsquo; beliefs \u003csup\u003e(17, 18)\u003c/sup\u003e. The efficacy of motivational interviewing in improving a broad range of diseases and health behaviors has proved successful\u003csup\u003e(19)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis method improves dietary behaviors and eating disorders by a standard psycho-education, increases the physical activity, and improves the bariatric patients' confidence for change in eating behaviors \u003csup\u003e(20\u0026ndash;24)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAbout 25% of patients experienced a suboptimal weight loss or a significant weight regain after the surgery that might be due to physiologic processes, behavioral factors, or psychological characteristics \u003csup\u003e(25)\u003c/sup\u003e. So far, there are few studies on motivational interviewing for people who have undergone bariatric surgery \u003csup\u003e(13, 23, 24)\u003c/sup\u003e. Increasing knowledge, skills, motivation, self-confidence, self-efficacy, and self-monitoring of obese patients after surgery seems essential \u003csup\u003e(26)\u003c/sup\u003e. Therefore, the goal of this study was to evaluate eating behaviors, physical activity, and weight loss after motivational interviewing (MI) in patients who have undergone laparoscopic sleeve gastrectomy.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis is a semi-experimental study with pre-test, post-test and control group. The study population consisted of all patients (Body Mass Index:BMI\u0026thinsp;\u0026gt;\u0026thinsp;35) aged 21 to 58 years old (mean 38.23 and standard deviation 9.87) who had undergone LSG in Mother and Child Hospital in Shiraz during spring and summer of 2019. The inclusion criteria were having BMI greater than 35, receiving LSG at least the previous 12 months, failing to achieve successful weight loss, and being able to read and write in Persian. Thirty patients who had the inclusion criteria were selected as the samples by the sealed envelope site. Block sizes were 4, 6, and 8, and the patients were selected according to the patient list, and randomly divided into two groups of control and experimental, each containing 15 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eTools\u003c/h2\u003e \u003cp\u003eThe following tools were used in this study:\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e1- Bariatric Self-Management Behaviors Questionnaire (BSSQ):\u003c/h2\u003e \u003cp\u003eIn order to assess eating behaviors, supplement consumption and physical activity, the bariatric surgery self-management behaviors questionnaire (BSSQ) was used. This questionnaire was originally developed by Welch et al. \u003csup\u003e(7)\u003c/sup\u003e. The seven BSSQ behavioral domains were (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) eating behaviors (eight EB items); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) fluid intake (eight FI items); (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) protein intake (three PI items); (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) physical activity (three PA items); (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) dumping syndrome management (four DSM items); (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) fruit, vegetable, and whole grains intake (three FVW items); and (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) vitamin and mineral supplement intake (four SI items). In 2017, Sobhani et al. revised the original version of this questionnaire and used it for her research\u003csup\u003e(27)\u003c/sup\u003e. To prevent any language barrier and ensure maximum comprehension, we translated the BSSQ into Persian to avoid any kind of misinterpretation on the part of the participants. To check for the originality of the meaning of the translated version, the Persian version was back-translated into English by an expert. The congruency between the two texts was found to be about 80%. Finally, based on the comparisons, a few modifications were made in the Persian version to tailor it to the context of the study. The reliability of the Persian version was computed using Cronbach's Alpha; it was 0.78.\u003c/p\u003e \u003cp\u003eIn Sobhani et al.\u0026rsquo;s study, in order to have consistency and ease in data analysis procedure, some other changes were applied. The reliability coefficient for this questionnaire (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.90) was obtained and using the split-correlation method, the two-part correlation was 0.78, indicating the desired reliability of the self-management behavior questionnaire after bariatric surgery\u003csup\u003e(27)\u003c/sup\u003e. Based on the findings of the present study, high adherence to these behaviors was anticipated to improve the likelihood of the patient\u0026rsquo;s success after surgery in terms of excess weight loss and adequate nutritional status. All the subscales and the total scores were converted to a 0\u0026ndash;99 range for ease of interpretation, with higher scores indicating higher adherence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2- Waight and Body mass index (BMI):\u003c/h2\u003e \u003cp\u003eHeight was measured using a stadiometer (SECA, Chino CA) to the nearest 0.1 cm. Weight was measured using a medical scale to the nearest 0.1 kg (Detecto-Medic, Brooklyn NY). BMI was calculated based on this formula:\u003c/p\u003e \u003cp\u003eBMI (kg / m\u003csup\u003e2\u003c/sup\u003e) = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\text{W}\\text{e}\\text{i}\\text{g}\\text{h}\\text{t} \\left(\\text{k}\\text{g}\\right)}{\\text{H}\\text{e}\\text{i}\\text{g}\\text{h}\\text{t} \\left(\\text{m}\\right)2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eIndividuals, who were selected based on inclusion criteria, completed the bariatric BSSQ. The experimental group received motivational interviewing during 4 sessions of 90 minutes in the obesity clinic of Hospital. Three months after the pre-test, BSSQ was distributed again among all the participants. The topics of the 4 sessions of motivational interviewing sessions about the self-management behaviors after bariatric surgery were as follows: 1- Understanding the stages of change aiming at raising awareness, 2- One day of life aiming at increasing awareness about the quantity and quality of self-care behaviors and its effects, 3- Positive and negative values ​​and aspects aiming at self-reevaluation and balanced decision making, and 4) Temptation and self-esteem; goal setting and preparation for change, self-efficacy, and commitment to change behavior\u003csup\u003e(23)\u003c/sup\u003e. Using SPSS 19 software, we used descriptive statistics (mean and standard deviation) and inferential statistics (multivariate analysis of covariance) to analyze the data and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn terms of demographic variables, there was no statistically significant difference between the two groups. The mean and standard deviation of the age of the control group was 37.99\u0026thinsp;\u0026plusmn;\u0026thinsp;9.79 and the minimum and maximum age of the participants was 21 and 55 years, respectively. In the experimental group, the mean and standard deviation of age was 38.53\u0026thinsp;\u0026plusmn;\u0026thinsp;10.29 and the minimum and maximum age was 22 and 53 years, respectively. Independent t-test showed no significant difference between the two groups in terms of age (t\u0026thinsp;=\u0026thinsp;0.16, p\u0026thinsp;=\u0026thinsp;28, df\u0026thinsp;=\u0026thinsp;28). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the mean and standard deviation of the two groups in the pre-test and post-test conditions. The descriptive data illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e indicated that the mean and standard deviation of the groups in the pre-test and post-test were not the same. The scores of the experimental group at the post-test stage improved on the overall score of eating behaviors, supplement consumption, and physical activity after bariatric surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviation of the subscales of eating behaviors, supplement consumption, physical activity, weight and BMI in the experimental and control groups in two stages of pre-test and post-test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-test\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEating Behaviors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExperimental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e19.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e15.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.6792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSupplement Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExperimental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e5.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.8820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExperimental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExperimental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e92.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e81.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e92.60\u0026thinsp;\u0026plusmn;\u0026thinsp;16.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e88.20\u0026thinsp;\u0026plusmn;\u0026thinsp;14.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.4511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExperimental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e36.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e31.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e36.52\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e34.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.4762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe significant differences in the study showed by multivariate analysis of covariance. However, before proceeding to do so, it was necessary to check the preconception of the equality of covariance via the Levene\u0026rsquo;s test. The results of the Levene\u0026rsquo;s test showed that the preconception of the equality of variances held true. Therefore, covariance analysis can be used to examine the data. Multivariate analysis of covariance was used to test the hypothesis that motivational interviewing influences eating behaviors, supplement consumption, and physical activity after bariatric surgery. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of Multivariate Covariance Analysis on eating behaviors, supplement consumption, physical activity, weight, and BMI after laparoscopic sleeve gastrectomy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName of test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDf\u003c/p\u003e \u003cp\u003eHypothesis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003cp\u003eerror\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEta Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStatistical Power\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePillai\u0026rsquo;s Trace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWilk\u0026rsquo;s Lambda\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHoteling\u0026rsquo;s Trace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRoy\u0026rsquo;s largest Root\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that there is a significant difference between the experimental group and the control group in terms of the dependent variables at the level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and the explanatory power of 0.83; therefore, the hypothesis of the present study is confirmed. Accordingly, it can be stated that there is a significant difference between the two groups in at least one of the dependent variables (eating behaviors, supplement consumption and physical activity). In order to determine this difference, we used MANCOVA (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In addition, the effect size coefficient shows that the 0.83 difference between the two groups is the result of motivational interviewing intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the MANCOVA analysis on the mean scores of the post-test of eating behaviors, supplement consumption, physical activity, weight and BMI in the experimental and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChange sources\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSum of squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDegree of freedom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean of squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEta coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStatistical power\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEating Behaviors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePre-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e106.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eError\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSupplement Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePre-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eError\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePhysical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePre-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eError\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePre-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e541.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e541.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eError\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePre-test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eError\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the differences between the experimental and control groups in terms of the variables of eating behaviors (P\u0026thinsp;=\u0026thinsp;0.0001, F\u0026thinsp;=\u0026thinsp;27.06), supplement consumption (P\u0026thinsp;=\u0026thinsp;0.01, F\u0026thinsp;=\u0026thinsp;7.47), weight (P\u0026thinsp;=\u0026thinsp;0.008, F\u0026thinsp;=\u0026thinsp;8.72) and BMI (P\u0026thinsp;=\u0026thinsp;0.005, F\u0026thinsp;=\u0026thinsp;9.98) were significant, whereas the difference between the experimental and control groups in terms of physical activity (F\u0026thinsp;=\u0026thinsp;2.21, P\u0026thinsp;\u0026lt;\u0026thinsp;0.15) was not significant.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe goal of this study was to evaluate the effectiveness of motivational interviewing on eating behaviors, physical activity, and weight loss in patients who had undergone bariatric surgery. Findings showed that motivational interviewing was effective on eating behaviors, supplement consumption, weight loss, and BMI in patients who had undergone bariatric surgery; these findings are consistent with those of previous research on motivational interviewing for dietary adherence, confidence for change, and binge eating disorder (BED)\u003csup\u003e(13, 18, 20\u0026ndash;24)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAfter bariatric surgery, people are expected to abandon unhealthy habits such as: binge eating, emotional eating, eating at night, drinking high-calorie fluids, and returning to the pre-surgery lifestyle \u003csup\u003e(7)\u003c/sup\u003e. Adherence to dietary and physical guidelines following bariatric surgery is critical in reducing postoperative complications and increasing the positive outcomes of weight loss. Therefore, pre- and post-obesity counseling aimed at increasing treatment compliance, and the importance of follow-up sessions over the long term have been emphasized \u003csup\u003e(6, 7, 26)\u003c/sup\u003e. Patients who have undergone bariatric surgery usually do not adhere to healthy postoperative behavioral instruction like their behavior before bariatric surgery, despite their agreements to do so \u003csup\u003e(13)\u003c/sup\u003e. Negative weight-related effects on health are associated with dysregulated eating behaviors \u003csup\u003e(10)\u003c/sup\u003e. Changing lifestyle such as adopting healthy eating habits and physical activity is associated with weight loss and sustained postoperative improvement in quality of life \u003csup\u003e(28, 29)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMotivational interviewing significantly increased the eating behavior and supplement consumption. Since weight gain is influenced by the patients\u0026rsquo; lifestyles, motivational interviewing sessions attempt to resolve the patients\u0026rsquo; ambivalence over change or continuation of their current lifestyle in favor of change. In some studies, control of over- weight might be achieved as a result of direct control over eating habits \u003csup\u003e(13, 21)\u003c/sup\u003e. The process includes discussing different post-surgery behavioral patterns and pinpointing discrepancies between the current patient behaviors and desired behaviors, which is consistent with the findings of this study, suggesting the effectiveness of motivational interviewing on improving behavior after bariatric surgery\u003csup\u003e(23)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClark et al.\u003csup\u003e(30)\u003c/sup\u003e reported that motivational interviewing could improve and maintain the patient\u0026rsquo;s motivation and confidence levels for positive lifestyle changes. Evidence suggests that motivational interviewing helps the patients employ medical information and instructions, including adherence to a low-calorie diet, by providing the necessary motivations as fuel and energy for behavioral change. The above point is achieved by satisfying the fundamental psychological needs via implementation of the principles and techniques of motivational interviewing \u003csup\u003e(17, 31)\u003c/sup\u003e, illustrating the effectiveness of motivational interviewing on different aspects of post-surgery self-management behaviors.\u003c/p\u003e \u003cp\u003eIn a study carried out by Cassin et al.\u003csup\u003e(20)\u003c/sup\u003e, motivational interviewing was used for BED patients and they found that this method reduced the frequency of binge eating after16 weeks. Also, David et al \u003csup\u003e(24)\u003c/sup\u003e reported that the addition of one motivational interviewing session to standard post-operative bariatric care improved patient\u0026rsquo;s confidence for change, binge eating symptoms, self-efficacy for resisting overeating in tempting situations, and adhering to the postoperative guidelines. West et al. \u003csup\u003e(21)\u003c/sup\u003e found that the patients who received 5 sessions of motivational interviewing showed a significant weight loss, consistent with the results of the present study.\u003c/p\u003e \u003cp\u003ePhysical activity adherence is a behavioral predictor of weight loss\u003csup\u003e(7)\u003c/sup\u003e. Wiklund et al\u003csup\u003e(32)\u003c/sup\u003e found that the patients experienced both achievements and failures with regard to physical activity one year after the surgery and they understood the benefits of physical activities. Findings show that motivational interviewing was not effective on physical activity in patients who had undergone bariatric surgery, one possible explanation for this being that humans resist behavioral changes initiated from external pressures and thus they are more likely to adopt treatment recommendations if they feel they have an active role in their treatment process. The enhancement of self-efficacy could be one of the mechanisms that changes the physical activity behavior after motivational interviewing after a long time\u003csup\u003e(17)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe finding that motivational interviewing did not affect the physical activity subscale is accordance with the research conducted by Dalle et al.\u003csup\u003e(33)\u003c/sup\u003e. It might be argued that the lack of significant change in the level of physical activity may be due to the fact that obese patients are less active due to being overweight and consequently they are afflicted by depression, and hopelessness \u003csup\u003e(14)\u003c/sup\u003e. So, the change in diet seems an easier solution compared to physical exercise. As for people undergoing bariatric surgery, the surgery itself might be the cause of inactivity, lack of energy, and physical weakness for which supplements consumption is a possible remedy. Another possible reason might be that physical activity is a habitual behavior, and that the duration of the intervention may not have been enough to significantly increase it.\u003c/p\u003e \u003cp\u003ePatients increased long-term changes in physical activity behavior 12 months or more after interviewing compared with those who used a 12-week follow-up \u003csup\u003e(34)\u003c/sup\u003e. For greater effectiveness, the interventions need to both contain high-intensity behavioral modification (more than one person-to-person session per month for a period of three months) and include extensive ongoing contact according to a dose-response relationship between counselling sessions attended and changes in clinical motivational outcomes\u003csup\u003e(11)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e Overall, research supports the efficacy of motivational interviewing in weight loss, adherence to dietary guidelines, and supplement consumption after bariatric surgery. Adopting a new lifestyle with new eating behaviors could adjust the patients\u0026rsquo; metabolism and consequently reproduce the energy and motivation required to follow the instructions. Further research is recommended to be conducted to determine the optimal number of consultations needed to promote autonomous forms of motivation and sustainable physical activity adherence.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe patients did not volunteer to participate in the study and data gathering was too hard.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe aimed to identify the participants\u0026rsquo; perceptions throughout the course of the intervention in relation to physical activity and diet. Motivational interviewing is effective in changing the lifestyle in obese patients undergoing bariatric surgery and improves their eating behaviors and supplement consumption towards achieving optimal weight loss; however, longer-term interventions are needed to motivate the patients to increase their physical activity. Changing the lifestyle in patients who have undergone bariatric surgery is achieved by meeting their psychological needs, namely autonomy, competence, and communication with others.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e We would like to show our gratitude to the staff of the Laparoscopy Research Center \u0026nbsp;and Obesity Clinic, Shiraz Mother and Child Hospital, who helped and assisted this research. The authors also thank all the participants involved in this research study for their sincere cooperation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval Statement\u003c/strong\u003e This study was approved by the research ethics committee of University of\u0026nbsp;Medical Sciences (no. IR.SUMS.REC.1402.461).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent Statement\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThere was no founding.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability declaration:\u0026nbsp;\u003c/strong\u003eData was supporting the results that reported in the article by Mother and Child hospital in Shiraz. The Hospital dataset that provided from all patients that have surgery there.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZ.S. and H.P. designed the study, SV.H. and H.Kh. wrote the main manuscript text and prepared the tables and all the authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOgden J. The psychology of eating: From healthy to disordered behavior. Wiley; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYazdani NPC, Hosseini SM, Amini MM, Sobhani ZP, Sharif FP, Khazraei HP. Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity. Int J community based Nurs midwifery. 2018;6(2):175\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaji CA, Ho AJ, Parikshak NN, et al. Brain structure and obesity. Hum Brain Mapp. 2010;31(3):353\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026ouml;str\u0026ouml;m L. Review of the key results from the Swedish Obese Subjects (SOS) trial\u0026ndash;a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchroeder R, Harrison TD, McGraw SL. Treatment of adult obesity with bariatric surgery. Am Family Phys. 2016;93(1):31\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWelch G, Wesolowski C, Piepul B, Kuhn J, Romanelli J, Garb J. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. 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Healthy eating index and metabolically healthy obesity in US adolescents and adults. Prev Med. 2015;77:23\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStamatakis E, Chaudhury M. Temporal trends in adults\u0026rsquo; sports participation patterns in England between 1997 and 2006: the Health Survey for England. Br J Sports Med. 2008;42(11):901\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZuckoff A. Why won't my patients do what's good for them? Motivational interviewing and treatment adherence. Surg Obes Relat Dis. 2012;8(5):514\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElkins G, Whitfield P, Marcus J, Symmonds R, Rodriguez J, Cook T. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15(4):546\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNijamkin MP, Campa A, Nijamkin SS, Sosa J. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. J Nutr Educ Behav. 2013;45(6):620\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliam R. Miller and Stephen Rollnick. Motivational Interviewing: Preparing People for Change, 2nd Edition. Journal of Developmental \u0026amp; Behavioral Pediatrics. 2006;27(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeeter BS, Kavookjian J. Telephone-based motivational interviewing for medication adherence: a systematic review. Translational Behav Med. 2014;4(4):372\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCassin SE, von Ranson KM, Heng K, Brar J, Wojtowicz AE. Adapted motivational interviewing for women with binge eating disorder: a randomized controlled trial. Psychol Addict behaviors: J Soc Psychologists Addict Behav. 2008;22(3):417\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWest DS, DiLillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30(5):1081\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHardcastle S, Hagger MS. You Can\u0026rsquo;t Do It on Your Own: Experiences of a motivational interviewing intervention on physical activity and dietary behaviour. Psychol Sport Exerc. 2011;12(3):314\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobhani Z, Ahadi H, Khosravi S, Pourshrifi H, Seirafi M. The Effectiveness of Motivational Interviewing on Adherence in Obese Patients Undergoing Sleeve Gastrectomy Surgery. Armaghane danesh. 2017;21(12):1218\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid LA, Sockalingam S, Wnuk S, Cassin SE. A pilot randomized controlled trial examining the feasibility, acceptability, and efficacy of Adapted Motivational Interviewing for post-operative bariatric surgery patients. Eat Behav. 2016;22:87\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarwer DB, Allison KC, Wadden TA, et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat diseases: official J Am Soc Bariatr Surg. 2019;15(4):650\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobhani Z, Amini M, Zarnaghash M, Hosseini SV, Foroutan HR. Self-Management Behaviors in Obese Patients Undergoing Surgery Based on General and Specific Adherence Scales. World J Plast Surg. 2019;8(1):85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobhani Z, Ahadi H, Khosravi S, Poursharifi H, Seirafi M. Psychometric Indices of Post Bariatric Surgery Self-Management Behaviors Questionnaire. J Arak Univ Med Sci. 2017;20(1):84\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLivhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20(5):657\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJim\u0026eacute;nez-Loaisa A, Gonz\u0026aacute;lez-Cutre D, Beltr\u0026aacute;n-Carrillo VJ, Alcaraz-Ib\u0026aacute;\u0026ntilde;ez M. Changes in bariatric patients\u0026rsquo; physical activity levels and health-related quality of life following a postoperative motivational physical activity intervention. Obes Surg. 2020:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrothe MMCEGAHKB. Psychological assessment and motivational interviewing of patients seeking bariatric and metabolic endoscopic therapies. Techniques Innovations Gastrointest Endoscopy.22(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRollnick WRMaS. Motivational Interviewing Third Edition Helping People Change2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalin Wiklund MFO. Torsten Olbers and Carin Will\u0026eacute;n. Experiences of Physical Activity One Year after Bariatric Surgery. Open Obes J. 2014;6:25\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalle Grave R, Calugi S, Centis E, El Ghoch M, Marchesini G. Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. Journal of obesity. 2011;2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen practice: J Royal Coll Gen Practitioners. 2005;55(513):305\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Eating Behaviors, Physical Activity, weight Loss, Motivational Interviewing, Laparoscopic Sleeve Gastrectomy","lastPublishedDoi":"10.21203/rs.3.rs-4381126/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4381126/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e There is strong evidence that obesity, especially morbid obesity, is associated with serious and dangerous physical illnesses, and that weight loss in these patients can improve their social functioning, quality of life, and mental health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The goal of this study was to evaluate eating behaviors, physical activity, and weight loss after motivational interviewing (MI) in patients who have undergone laparoscopic sleeve gastrectomy (LSG).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e Mother and Child Hospital in Shiraz during spring and summer of 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The thirty obese patients (Body Mass Index:BMI ≥ 35) who had undergone LSG were selected and randomly divided into two groups of control and experimental. Data were collected using bariatric surgery self-management behaviors questionnaire. MI was conducted for the experimental group during four weeks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The results indicated that MI caused a significant difference between the two groups in at least one of the dependent variables (eating behaviors, supplement consumption and physical activity). Therefore, MI is effective and appropriate in obese patients who had undergone LSG towards achieving optimal weight loss.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Changing the lifestyle in patients that have undergone bariatric surgery is achieved by meeting the psychological needs, namely autonomy, competence, and communication with others.\u003c/p\u003e","manuscriptTitle":"Eating Behaviors, Physical Activity and Weight Loss after Motivational Interviewing in Patients who have Undergone Laparoscopic Sleeve Gastrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-23 05:39:32","doi":"10.21203/rs.3.rs-4381126/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6062c0f-fe7d-43a2-b18a-8eb69e38bd90","owner":[],"postedDate":"May 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-07T09:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-23 05:39:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4381126","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4381126","identity":"rs-4381126","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}