Introduction

Bariatric surgery (BS) is the most effective treatment for severe obesity. Modifying eating behaviors, increasing physical activity (PA), and psychological well-being might be related to different outcomes in terms of weight loss after BS. However, the precise role of these factors has not been fully addressed [1].

On March 2020, the COVID-19 pandemic was declared and the Spanish government established a lockdown from March 15 to June 21. Until May 2, every leisure activity or practicing sports was forbidden; from that date it was possible to walk for 1 h a day or practice individual sports. Limitations on personal mobility were turned down on May 22. During this period, changes in lifestyle affected the population [2] and psychological distress might have ensured affecting both healthy and diseased people, with a relevant impact on individuals with obesity undergoing BS [3].

We aimed to investigate the impact of COVID-19 lockdown on short-term weight loss 1 year after BS. Also, we analyzed the differences in food intake, PA, and anxiety between those patients operated during and before the lockdown.

Methods

This is a retrospective analysis of a prospective maintained database; for the COVID-group (study group), we selected all patients undergoing a primary BS, either laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGBP), within 6 months from the lockdown declaration. The pre-COVID group (control group) comprised patients completing 1 year of follow-up after BS before March 2020.

The study was approved by the ethical review board of our institution. Informed consent was obtained for all patients.

Validated questionnaires were used to measure 1) food intake, Food Frequency Questionnaire (FFQ); 2) physical activity, Global Physical Activity Questionnaire (GPAQ); 3) anxiety, Hamilton Anxiety Scale (HAM-A). SPSS 17 was used for statistical analysis.

Results

Between October 2019 and March 2020, 67 bariatric procedures were performed at our institution. Thirty patients were excluded: 9 revisional procedures, 5 patients with relevant morbidity after surgery, 1 patient refused to participate, 15 patients were lost during the first year of follow-up. We finally included 37 patients in the COVID-group and 37 patients in the control group. The impact of lockdown for each individual patient is shown in Fig. 1.

Fig. 1
figure 1

Postoperative time lockdown as it occurred for each individual patient. Lines represent each individual patient through follow-up. Green bar shows the period with no lockdown or restrictions. The lockdown in Madrid began on March 14th when the stay at home order was strict for all the population allowing people only to go out in case of need. No walking or practicing sports was allowed until May 2nd (red bar). By that date walking was possible 1 h a day and also individual sports practice. Finally on May 22nd the government suspended mobility restrictions (orange bar)

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No differences in mean age, gender, comorbidities, or baseline body mass index (BMI) were found between groups (Table 1).

Table 1 Baseline and follow-up characteristics of the included patients in the COVID vs pre-COVID groups
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Mean % excess weight loss (EWL) at 1 year follow-up was similar between the COVID and control groups (p = 0.828) and the mean % of total weight loss (TWL) at 1 year follow-up was also similar (Table 1). None of the patients in the COVID group was diagnosed of COVID-19 disease during the first year after the operation. A subgroup analysis, based on surgical technique, was also performed. Patients submitted to SG achieved less EWL compared to RYGBP in both the pre-COVID and COVID groups (Table 1). A similar result was found for TWL, but a difference between the pre-COVID and COVID group was found in those patients submitted to SG, showing a higher TWL in the COVID period (Table 1).

Based on what patients reported on the questionnaires, no differences were found in PA or anxiety between groups (Table 2). Oral intake did not differ except for complex carbohydrates (CCH) with a lower consumption in the COVID SG subgroup (Table 2).

Table 2 Questionnaires results: Food Frequency Questionnaire (FFQ), Global Physical Activity Questionnaire (GPAQ), and Hamilton Anxiety Scale (HAM-A)
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Conclusion

Our study shows that the lockdown during the COVID-19 pandemic did not affect short-term weight loss after BS. We did not find any significant differences in food intake, PA, or anxiety between groups using validated questionnaires.

Our results are in agreement with previously published data regarding the impact of COVID lockdown in weight loss after BS: Pereira et al. [4] in a larger study showed no differences at 1 year follow-up with patients undergoing either SG or RYGBP; a Spanish study [5] including only patients submitted to SG reported a non-significant trend for a worse outcome during the COVID lockdown, opposite to our results, but they found no significant differences in EWL and TWL 1 year after the operation.

Changes in individual PA during lockdown have been previously reported. Although it has been found that a majority of patients reported a decrease in PA, other studies showed either increased or no change in PA [6]. This may explain why after comparing groups instead of individuals PA before and during lockdown, no differences were found.

Although a worsening in healthy lifestyle habits was expected during lockdown regarding dietary habits, a previous study based on self-reported surveys showed no differences [7] in agreement with our results.

Even though the COVID-19 pandemic added another level of stress, when using objective measures of anxiety in patients undergoing BS, no differences were found compared to the pre-COVID period [8], in agreement with our present results using the HAM-A test.

The limitations of our study include the small number of patients and the retrospective information given by the control group answering the questionnaires long time after their operation.

In conclusion, lockdown during COVID-19 did not affect weight loss 1 year after BS and had no impact in food intake, physical activity, or anxiety.