Invest Clin 66(1): 49 - 62, 2025 https://doi.org/10.54817/IC.v66n1a05
Corresponding Author: Luis Carlos Oliveira Gonçalves. Federal University of Uberlandia. Amazonas Avenue. Uber-
landia, Minas Gerais, Brazil. E-mails: luis.carlos@ufu.br; luisogoncalves@yahoo.com.br
Health profile of patients subjected
to gastric bypass at Clinics Hospital
of Acre, Brazil.
Suellem Maria Bezerra de Moura Rocha1, Alanderson Alves Ramalho2,
Rachel Horta Freire3, Thiago Montes Fidale4, Dionatas Ulises de Oliveira Meneguetti1,
Luis Carlos Oliveira Gonçalves6,7, Anibal Monteiro de Magalhães Neto5,6,
Luiz Carlos de Abreu1 and Romeu Paulo Martins Silva1
1Graduate Program in Health Science in the Western Amazon – Federal University
of Acre, Brazil.
2Health and Sports Science Center - Federal University of Acre, Brazil.
3 Biochemistry and Immunology Department. Federal University of Minas Gerais, Brazil.
4Special Academic Unit of Biotechnology, Federal University of Catalao, Brazil.
5Graduate Program in Basic and Applied Immunology and Parasitology –
Federal University of Mato Grosso, Brazil.
6Graduate Program in Physical Education - Federal University of Mato Grosso, Brazil;
7Graduate Program in Genetics and Biochemistry – Federal University of Uberlandia,
Brazil.
Keywords: obesity; bariatric surgery; weight recovery; weight loss; public health
Abstract. The study aimed to analyze the health profile of women undergoing
Roux-en-Y gastric bypass according to the time elapsed since surgery. Ninety-three
women who underwent this procedure at the Clinics Hospital in Acre, Brazil, from
2008-2017, were divided into three groups according to the post-surgery period:
G1 (n = 37) up to two years; G2 (n = 20) from two to four years; G3 over four
years (n = 36) after surgery. Pre-surgery and post-surgery clinical, anthropomet-
ric, and dietary variables were analyzed through a 24-hour recall. The postoperative
time was 16.9±7.9 months (G1); 33.9±9.2 months (G2) and 75.3±19.1 months
(G3). In the postoperative period, there was a decrease in the number of patients
who practiced physical activity (35.5-33.3%). The mean percentage of excess weight
loss was 66.1±15.4%. Satisfactory results were achieved by 88.17% (% PEP ≥50%).
67% of the patients presented weight reacquisition, proportional to the postopera-
tive time (p˂0.001). The dietary survey indicated a daily energy consumption of
1262.75±424.11 kcal. The macronutrient distribution showed 59.25±8.33% for
carbohydrates, 24.26±6, 90% for lipids and 17.12±6.68% for proteins. The mean
protein intake was lower in group G1 (16.09±6.23), and lipid intake slightly in-
creased over time. Bariatric surgery had a significant impact on the reduction of
comorbidities, medication use, and the loss of excess weight. However, the nutrient
adequacy and the increasing incidence of weight regain in the post-surgery period
demonstrated that bariatric surgery does not end the obesity treatment, but it is
only a step that requires periodic monitoring.
50 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
Perfil de salud de los pacientes sometidos a bypass gástrico
en el Hospital de Clínicas de Acre, Brasil.
Invest Clin 2025; 66 (1): 49 – 62
Palabras clave: obesidad; cirugía bariátrica; recuperación de peso; pérdida de peso;
salud pública.
Resumen. El objetivo del estudio fue analizar el perfil de salud de muje-
res sometidas a bypass gástrico Roux-en-Y según el tiempo transcurrido desde
la cirugía. Noventa y tres mujeres que se sometieron a este procedimiento en
el Hospital de Clínicas en Acre, Brasil, de 2008 a 2017, se dividieron en tres
grupos según el período posoperatorio: G1 (n = 37) hasta dos años; G2 (n =
20) de dos a cuatro años; G3 más de cuatro años (n = 36) desde la cirugía.
Se analizaron variables clínicas, antropométricas y dietéticas preoperatorias y
posoperatorias a través de un recordatorio de 24 horas. El tiempo posoperato-
rio fue de 16,9 ± 7,9 meses (G1); 33,9 ± 9,2 meses (G2) y 75,3 ± 19,1 meses
(G3). En el posoperatorio, hubo una disminución en el número de pacientes
que practicaban actividad física (35,5-33,3%). El porcentaje medio de pérdida
de exceso de peso fue de 66,1±15,4%. Se obtuvieron resultados satisfactorios
en el 88,17% (% PEP ≥50%). El 67% de los pacientes presentó readquisición de
peso, proporcional al tiempo postoperatorio (p˂0,001). La encuesta dietética
indicó un consumo energético diario de 1262,75±424,11 kcal. La distribución
de macronutrientes mostró 59,25±8,33% para carbohidratos, 24,26±6,90%
para lípidos y 17,12±6,68% para proteínas. La ingesta media de proteínas fue
menor en el grupo G1 (16,09±6,23%), y la ingesta de lípidos aumentó lige-
ramente con el tiempo. La cirugía bariátrica tuvo un impacto significativo en
la reducción de comorbilidades, uso de medicamentos y pérdida de exceso de
peso. Sin embargo, la adecuación de nutrientes y la creciente incidencia de
recuperación de peso en el período postoperatorio demostraron que la cirugía
bariátrica no pone fin al tratamiento de la obesidad, sino que es sólo un paso
que requiere seguimiento periódico.
Received: 08-05-2024 Accepted: 01-02-2025
INTRODUCTION
Obesity is currently one of the biggest
public health problems in the world. Its pro-
jection, according to the World Health Orga-
nization, is that in 2025, 2.3 billion adults will
be overweight, and more than 700 million will
be obese. Being a global epidemic of chronic
conditions, a multifactorial etiology whose
treatment involves different approaches, the
main ones are dietary guidelines, physical ac-
tivity practice, and, in cases where these mea-
sures are not enough, the use of medications
and surgical intervention 1.
Conventional treatment for severe
obesity still produces unsatisfactory results
since 95% of patients regain their initial
weight in up to 2 years. Due to the need for
a more effective intervention in the clinical
management of severely obese individuals,
an indication of surgery is the most effective
treatment for obesity control 2.
Health profile of patients submitted to gastric bypass 51
Vol. 66(1): 49 - 62, 2025
In Brazil, bariatric surgery is among the
procedures of high complexity offered by the
Unified Health System (SUS), according to
the regulation established on April 21, 2001.
Its indication must be according to CFM
Resolution No. 1,766/05, which designates
the following requirements for its accom-
plishment: being over 18 years of age, pre-
senting a Body Mass Index (BMI) of 40 kg/
m2 or more or equal to or greater than 35
kg/m2 and comorbidities such as diabetes,
sleep apnea, hypertension, dyslipidemia, cor-
onary disease, osteoarthritis, and others. In
addition, the subject must have undergone
conventional methods and have psychologi-
cal conditions to follow the indications sug-
gested after surgery 2.
According to the Brazilian Society of
Bariatric and Metabolic Surgery (SBCBM),
throughout 2018, 63,969 bariatric surgeries
were performed, 49,521 of which for supple-
mentary health (health plans), according
to data from the National Supplementary
Health Agency (ANS), 11,402 surgeries by
the Unified Health System (SUS) and 3,046
private surgeries. The total number of proce-
dures performed in 2018 was 4.38% higher
than in 2017, when approximately 61.283
thousand surgeries were performed by SUS
and ANS 3.
Although bariatric surgery is an effec-
tive clinical strategy for promoting weight
loss, reducing comorbidities, and improving
quality of life, it is essential to emphasize
that it does not promote the cure of obesity
but rather its control. Therefore, although
the surgical treatment demonstrates sat-
isfactory results, some individuals present
postoperative complications related to or-
ganic and behavioral problems that damage
clinical and nutritional aspects 4,5.
The Brazilian population has extensive
demographic, social, and cultural diversity,
which is why population studies that assess
the health conditions of the Amazonian
peoples and their main conditions allow us
to broaden the understanding of the mag-
nitude of diseases, analyze their historical
trends, and observe risks of morbidity and
mortality in these population groups.
From this perspective, the objective of
this study was to analyze the clinical, nutri-
tional, and weight requirements of women
undergoing Roux-en-Y gastric bypass accord-
ing to the time elapsed post-surgery.
PATIENTS AND METHODS
Study design and data collection
The research, carried out at the Clinics
Hospital of the State of Acre from August to
December 2017, was quantitative, qualita-
tive, and retrospectively observational. The
project was submitted to the Research Eth-
ics Committee of the Clinics Hospital /HC
of the State of Acre and approved through
opinion nº 1,979,084.
Patient inclusion criteria were age 18
or older, having a BMI ≥ 35kg/m2 associated
with a disease or BMI ≥ 40kg/m2, and having
undergone bariatric surgery from 2008 to
2017. The collection took place through an
outpatient appointment, which was sched-
uled by the hospital’s Obesity and Quality
of Life Group and held every Wednesday and
Thursday afternoon in the outpatient clinic
of the Rio Branco Clinic Hospital—Acre,
Brazil. Telephone contact with the patients
and during the support group meetings were
made. The researcher and two nutritionally
trained academics collected the data. At
the time of collection, the participants were
informed about the study’s relevance, and
they voluntarily participated by signing the
Informed Consent Form (TCLE).
The evaluation consisted of a question-
naire to identify the patient with the fol-
lowing information: personal data, socio-
economic data, schooling, previous clinical
history, current clinical history, anthropo-
metric evaluation, and dietary assessment.
It was also evaluated whether or not the
patient did nutritional monitoring during
the postoperative period. All items were
self-reported by the patients, except for the
anthropometric data of the preoperative
52 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
period, which were obtained from the medi-
cal records and the current anthropometric
data collected during the outpatient care
performed by the researchers.
The study included 114 patients who
underwent Roux-en-Y gastric bypass from
2008 to 2017 at the Acre State Clinic Hos-
pital. Among these patients, ninety-three
(81.57%) were women and twenty-one
(18.42%) were men. Among the patients se-
lected, seven refused to participate, and two
died before being evaluated.
The patients were divided into three
groups, according to the postoperative pe-
riod, to compare the variables of interest
in the study: group (G1) for up to twenty-
four months, group (G2) from twenty-four
months to forty-eight months, and group 03
(G3) more than forty-eight months.
After analysis, it was decided to ex-
clude males since there was a statistically
significant difference between surgery time
and sex. 47.6% of males were in the 25 to
48-month group. Thus, the analyses were
based only on female patients.
Clinical Evaluation
The clinical evaluation was performed
in two parts: clinical history before surgery
and current clinical history. The clinical his-
tory in the pre-surgical period was based on
the presence of associated diseases, medi-
cation use, and physical activity practice.
The current clinical history was based on
the same information, adding only the use
of nutritional supplements and the presence
or absence of gastrointestinal disorders 4,5 in
the postoperative period.
Obesity is a clinical condition with a
high risk for developing other chronic dis-
eases 6, and the following comorbidities were
analyzed during the clinical evaluation of the
patients: arterial hypertension, dyslipidemia,
arthritis, hormonal changes, diabetes melli-
tus type II, apnea obstructive sleep, and ede-
ma 7. For the evaluation of drug use 6, they
were categorized into antihypertensive, anti-
diabetic, anti-lipemic, antidepressants, appe-
tite suppressants, and others 8. Patients were
asked whether or not they performed regular
activities to evaluate physical activity, what
their activities were, and how often they prac-
ticed them: once, twice, three to four times a
week, and five or more times a week.
Regarding the presence or absence of gas-
trointestinal disorders in the postoperative pe-
riod, patients were questioned if, at any time,
they had at least one of these complications:
vomiting, nausea, diarrhea, constipation, and
abdominal distension. Regarding supplementa-
tion in the postoperative period, the consump-
tion of the following supplements was evalu-
ated: polyvinyl alcohol and minerals, vitamin
B12, calcium, and ferrous sulphate.
Nutritional and Dietetic Assessment
For the anthropometric evaluation, the
following data were collected: weight (kg)
on the day of surgery; height (m); maximum
weight achieved in the preoperative period;
current weight; minimum weight achieved in
the postoperative period; waist circumference
(cm); body composition through electrical
bioimpedance; reacquisition of weight and per-
centage of the loss of excess weight (PEP).
The current body weight was measured
on a pre-calibrated digital weighing scale with
a Welkin 300 kg capacity, and the patient was
instructed 8 to remove the shoes, climb back-
wards to the equipment and remain still with
the feet in the center of the platform.
The vertical stadiometer (coupled to
the scale) was used for stature measure-
ment, with a scale of 0.5cm. The patient was
instructed to keep the arms extended along
the body, the head erect, and the stare fixed
in a horizontal plane. The body mass index
(BMI) was calculated by the weight ratio
(kg) divided by the height (m) squared. This
index was calculated using preoperative and
current weights to evaluate its classification
in both moments. The values found were
classified according to the WHO 9.
The patients’ body composition was eval-
uated through electrical bioimpedance (BIA)
using a Maltron BioScan 10 915/916 Analyzer.
Health profile of patients submitted to gastric bypass 53
Vol. 66(1): 49 - 62, 2025
The following variables were analyzed: lean
mass (kg), fat mass (kg), total body water
(L), and basal metabolic rate (Kcal).
The loss of excess weight (PEP) was cal-
culated according to the equation indicated
by Deitel11, and weight reacquisition was
evaluated by comparing the current weight
with the minimum weight reached in the
postoperative period.
The quantitative feeding evaluation was
performed through a 24-hour recall (R24h)
using the Avanutri 2.0 Nutrition Soft-
ware based on the food composition table
(TACO)12.
Nutrient intake adequacy was evaluated
according to the cut-off points of the DRIs19
(Dietary Reference Intakes), considering ad-
equate intake as 50 to 60% carbohydrates,
25 to 30% lipids, and 10 to 15% protein 12.
The weight reacquisition was evaluated
by comparing the current weight collected
with the minimum weight reached in the
postoperative period and the value in kilo-
grams (kg) when the weight was regained.
Data Analysis
Statistical Package for Social Sciences
(SPSS) 10.0 and SigmaPlot 14.5 were used to
analyze the data. For the qualitative variables,
absolute (n) and relative (%) frequencies were
described, and the Pearson chi-square test was
used to evaluate the difference in the propor-
tion of the outcomes according to the indepen-
dent variables. The mean (µ) and standard devi-
ation (SD) describe the quantitative variables.
The T/Mann-Whitney test was used to evaluate
the difference in means of the outcomes ac-
cording to the independent variables. ANOVA/
Kruskal-Wallis was used for the evaluation be-
tween two means and three or more means,
ANOVA/Kruskal-Wallis was used, according to
the Shapiro-Wilk Normality test (p-value).
RESULTS
Ninety-three women with a mean age of
41.8 ± 7.6 years, divided into three groups
were evaluated according to the postop-
erative time: group one (G1) up to twenty-
four months, group two (G2) of twenty-four
months to forty-eight months and group
three (G3) over forty-eight months. In the
first group, the mean postoperative time was
16.9 ± 7.9 months. In the second group,
33.9 ± 9.2 months, and in the third group, a
mean of 75.3 ± 19.1 months.
As described in Table 1, 29% of the pa-
tients evaluated reported having a complete
secondary level, 24.7% an incomplete upper
level, and only 22.6% a complete upper level.
The income classification showed that
17.2% up to one minimum wage 58% had a
family income of up to four minimum wages,
18.3% up to seven and 6.5% more than seven
minimum wages.
Regarding whether or not to perform
nutritional follow-up after surgery, 52.7% said
to follow up, and 47.3% did not do nutritional
monitoring. Among the groups, the G1 group
(25 to 48 months) attended most nutritional
consultations, with 42.9% of the patients.
When the groups were compared, the
lowest percentage of patients (23.3%) using
medication was found in group 2 (25 to 48
months). 98.9% of the patients reported us-
ing medications in the preoperative period,
with antihypertensives (32.3%) and anxiolyt-
ics (24.7%) being the most commonly used
medications. In the postoperative period,
this index decreased to 46.2%.
Only 35.5% of the patients reported do-
ing some physical activity before surgery, which
was the most performed: walking (22.6%) and
bodybuilding (8.6%). The frequency of physical
activity reported by the majority (21.5%) was
3 to 4 times per week. The number of patients
who practiced physical activity decreased to
33.3% in the postoperative period. The types
of exercise most performed by them were walk-
ing (20.4%) and bodybuilding (8.6%). Most pa-
tients (19.4%) reported having physical activity
3 to 4 times a week.
Regarding alcohol consumption, 61.3%
reported not consuming. However, 27.9%
reported consuming eventually, and 10.8%
weekly.
54 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
Eighty-seven percent of the patients
said they were not smokers, and 13% said
they were former smokers.
Regarding using nutritional supple-
ments in the postoperative period, 59.13%
of the patients reported taking supplemen-
tation, and 40.86% reported not using any
supplement. Comparing the groups, the G1
group (25 to 48 months) used the most sup-
plementation (52.7%).
Table 2 shows the participants’ anthro-
pometric variables (weight, height, percent-
age of fat mass, fat mass, and lean mass).
Table 1
General characterization of the study population.
Groups Total p
Variable Group 1 Group 2 Group 3
n = 37 n = 20 n = 36
n (%) n (%) n (%) n (%)
Schooling
Incomplete Elementary School 4 (66.7) 0 (0.0) 2 (33.3) 6 (6.5) 0.11
Complete Elementary School 1 (20.0) 0 (0.0) 4 (80.0) 5 (5.4)
Incomplete High School 1 (9.10) 5 (45.5) 5 (45.5) 11 (11.8)
Complete High School 12 (44.4) 4 (14.8) 11 (40.7) 27 (29.0)
Incomplete Higher Education 5 (21.7) 8 (34.8) 10 (43.5) 23 (24.7)
Complete Higher Education 14 (66.7) 3 (14.3) 4 (19.0) 21 (22.6)
Family income
Up to 1 minimum wage 8 (50,0) 2 (12.5) 6 (37.5) 16 (17.2) 0.495
From 2 to 4 minimum wages 22 (40.7) 10 (18.5) 22 (40.7) 54 (58.0)
From 5 to 7 minimum wages 5 (29.4) 5 (29.4) 7 (41.2) 17 (18.3)
More than 7 minimum wages 2 (33.3) 3 (50.0) 1 (16.7) 6 (6.5)
Nutritional monitoring
Yes 21 (42.9) 12 (24.5) 16 (32.7) 49 (52.7) 0.437
No 16 (36.4) 8 (18.2) 20 (45.5) 44 (47.3)
Use of medicines
Ye s 19(42.2) 10(23.3) 14(32.6) 43 (46.2) 0.526
No 18(36.0) 10(20.0) 22(44.0) 50 (53.8)
Physical activity practice
Ye s 13(41.9) 5(16.1) 13(41.9) 31 (33.3) 0.669
No 24(38.7) 15(24.2) 23(37.1) 62 (66.7)
Alcohol use
Never 24 (42.1) 12 (21.1) 21 (36.8) 57 (61.3) 0.229
Eventually 12 (46.2) 6 (23.1) 8 (30.8) 26 (27.9)
Weekly 1 (10.0) 2 (20.0) 7 (70.0) 10 (10.8)
Smoking
Non-smoking 31 (38.3) 17 (21.0) 33 (40,7) 81 (87.0) 0.574
Smoker 6 (50.0) 3 (25.0) 3 (25.0) 12 (13.0)
* p values (Pearson chi-square test).
Health profile of patients submitted to gastric bypass 55
Vol. 66(1): 49 - 62, 2025
Regarding the anthropometric evalua-
tion, the mean preoperative BMI was 47.2±4.9
kg/m2. Ninety-eight percent of the patients
were classified as grade III (IMC>40kg/m2),
and 2% were classified as grade II obesity. In
the postoperative period, the mean BMI was
31.1±4.0 kg/m2, the mean of group one being
31.10±4.8 kg/m2, group two 31.1±3.1 kg/m2,
and group three of 31.1±3.6 kg/m2.
The mean percentage of excess
weight loss was 66.1±15.4%, and the fol-
lowing means were found in the groups:
G1 65.64±18.1%, G2 67.22±11.6 and G3
66,19±14.6%. Satisfactory results were
achieved by 88.1% of the patients who pre-
sented PEP≥50%. There was no significant
difference between groups (p=0.05).
Table 3 contains the results obtained
in the 24-hour recall for mean daily caloric
intake, macronutrients, and micronutrients.
Concerning nutrient intake, the dietary
survey (R24hs) pointed to the average daily
energy consumption of 1262.75±424.11
kcal. There was no difference in energy con-
sumption between the groups evaluated
(p>0.05).
The distribution of the macronu-
trient percentage indicated a mean in-
take of 59.25±8.33% for carbohydrates,
24.26±6.90% for lipids, and 17.12±6.68%
for proteins. There was no significant differ-
ence between the groups regarding the in-
take of macro and micronutrients (p>0.05).
Although the macronutrient intake
was not significant between the groups, the
mean protein intake was lower in group 01
(16.09±6.23), and that of lipid showed a
slight increase over time.
Regarding the regularity of meal times,
69.89% of the patients reported not eating
regularly. Only 30.10% stated that they had
regular meals. Regarding the number of
meals performed daily, most participants had
a proper fractionation of their meals; 63.4%
stated they had 3 to 4 meals/day, while only
18.3% reported doing 1 to 2 meals/day.
Table 2
Anthropometric data of the study population.
Groups Total p
Variable Group 1 Group 2 Group 3
n = 37 n = 20 n = 36
µ ± SD µ ± SD µ ± SD µ ± SD
Pre-surgery
Weight surgery (kg) 117.71 ± 12.08 125.81* ± 15.24 124.94* ± 14.33 122.25 ± 14.04 0.037
BMI surgery (kg/m²) 46.10 ± 4.40 47.60 ± 6.12 48.17 ± 4.62 47.22 ± 4.93 0.188
Maximum weight (kg) 124.42 ± 12.76 129.86 ± 14.55 130.54 ± 13.14 128.00 ± 13.48 0.122
Overweight (kg) 20.85 ± 10.83 22.58 ± 7.55 21.68 ± 8.15 21.54 ± 9.13 0.792
Post-surgery
Current weight (kg) 78.47 ± 11.24 81.83 ± 8.27 80.40 ± 7.81 79.92 ± 9.42 0.421
Current BMI (kg/m²) 31.09 ± 4.87 31.07 ± 3.13 31.17 ± 3.62 31.12 ± 4.03 0.995
Minimum weight (kg) 76.15 ± 11.97 76.64 ± 8.89 72.66 ± 9.71 74.88 ± 10.58 0.269
Fat mass (%) 30.60 ± 5.49 31.52 ± 5.15 32.17 ± 3.64 31.40 ± 4.77 0.373
PEP**(%) 65.64 ± 18.18 67.22 ± 11.64 66.19 ± 14.61 66.19 ± 15.46 0.936
PEP** Percentage of excess weight loss. µ ± SD: average ± Standard Deviation.
The p values are determined by the ANOVA/Kruskal-Wallis test between groups according to the Shapiro-Wilk Nor-
mality test. *Different from group 1.
56 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
The evaluation of water consumption
showed that 74.2% of the patients consumed
1 to 2 liters of water/per day, 19.4% above
2 liters, and 6.5% up to 1 liter of water/per
day.
73.3% of the patients reported food in-
tolerances. The most mentioned foods were
tapioca (59.1%), açaí (49.5%), rice (43%),
fried foods (37.6%), and milk. Food intol-
erances were not reduced according to the
postoperative time (p>0.05).
Sixty-seven percent of the patients pre-
sented weight reacquisition, with a mean re-
acquisition of 14.6±10.8 kg. Among the pa-
tients who presented weight reacquisition,
27.4% were from G1 (2 to 24 months), 21%
from G2 (25 to 48 months), and 51.6% from
G3 (above 48 months). It was observed that
the reacquisition of weight was proportional
to the postoperative time (p<0.001).
Of the several factors analyzed that
could influence weight reactivity (age, pre-
operative BMI, percentage of excess weight
loss, basal metabolic rate, and caloric in-
take), none had a significant influence on
postoperative weight reactivity (p˃0.05)
(Table 4).
Ninety-nine percent of the patients
presented at least one obesity-related dis-
ease in the preoperative period. After the
surgical procedure, this index decreased to
36.7%, showing a significant reduction in
the presence of all comorbidities (p=0.01),
as shown in Fig. 1.
DISCUSSION
Currently, bariatric surgery is consid-
ered the most effective strategy for manag-
ing and treating severe obesity. However,
several studies show that the surgical proce-
dure does not end treatment, necessitating
auxiliary therapies associated with continu-
ously monitoring risk factors by a multipro-
fessional team 13.
In Brazil, the highest prevalence of se-
vere obesity is concentrated in women. The
higher prevalence of women undergoing
bariatric surgery may be justified by a so-
cial issue that involves the beauty pattern,
Table 3
Daily nutrient intake.
Groups Total p
Variable Group 1 Group 2 Group 3
n = 37 n = 20 n = 36
µ ± SD µ ± SD µ ± SD µ ± SD
Heat Transfer (kcal) 1201.5 ± 460.81 1395.4 ± 523.93 1252.0 ± 302.06 1262.7 ± 424.11 0.255
Carbohydrates (%) 58.68 ± 9.69 59.41 ± 8.58 59.74 ± 6.74 59.25 ± 8.33 0.860
Protein (%) 16.09 ± 6.23 17.30 ± 6.53 18.03 ± 7.19 17.12 ± 6.68 0.466
Lipids (%) 23.91 ± 7.42 23.78 ± 6.88 24.88 ± 6.49 24.26 ± 6.90 0.788
Calcium (mg) 480.70 ± 369.71 488.91 ± 360.42 522.51 ± 413.07 498.65 ± 381.57 0.891
Iron (mg) 9.86 ± 8.62 14.82 ± 10.10 12.98 ± 8.14 12.14 ± 8.90 0.102
Thiamine (mg) 1.43 ± 2.59 2.25 ± 5.64 1.10 ± 0.78 1.48 ± 3.10 0.414
Vitamin B12 (mcg) 2.22 ± 3.84 2.64 ± 6.59 0.72 ± 0.77 1.73 ± 3.96 0.135
Folate (mcg) 182.30 ± 311.47 203.37 ± 290.38 229.65 ± 282.99 205.16 ± 293.75 0.792
Zinc (mg) 5.48 ± 4.42 6.91 ± 5,17 8.59 ± 17.42 6.99 ± 11.43 0.512
µ ± SD: average ± Standard Deviation. The p values were determined by the ANOVA/Kruskal-Wallis test between
groups according to the Shapiro-Wilk Normality test.
Health profile of patients submitted to gastric bypass 57
Vol. 66(1): 49 - 62, 2025
the appreciation of leanness, and the social
pressure for weight loss to be greater in this
public. In addition, women seek more health
services than men 14-16.
According to information published by
the Brazil Agency website, 70% of bariatric
surgeries are performed by women17. Re-
search carried out in different sociocultural
contexts has shown that women are the ma-
jority of patients who seek a surgical proce-
dure to treat obesity18,19.
Comparing data from the pre-and post-
operative periods of the population evalu-
ated in this study showed improvement in all
obesity-related comorbidities. Several stud-
ies 20-22 described the reduction of the pres-
ence of comorbidities.
In this study, most patients reported
the use of drugs in the preoperative period,
and in the postoperative period, there was
a significant reduction. Possibly, this result
is directly related to the reduction of co-
morbidities diagnosed before surgery. Ac-
cording to Ceneviva et al. 23, the reduction
of comorbidities and the use of medications
is proportional to weight reduction in the
postoperative period of bariatric surgery. A
meta-analysis investigated the impact of sur-
gery on weight and reduction of significant
comorbidities in more than 136 studies, to-
talling 22,094 patients (72.6% women) with
a mean age of 39. The results found that the
reduction of comorbidities was proportional
to the loss of excess weight, similar to that
found in this research 24.
A study of 342 patients (261 women
and 81 men) who underwent Roux-en-Y gas-
tric bypass showed that, as the mean BMI
decreased in a postoperative period of 1,2,5
and 10 years, the associated comorbidities
Table 4
Analysis of factors associated with weight re-acquisition.
Total weight re-acquisition p
Variable (n = 93) Ye s No
n = 62 n = 31
µ ± SD µ ± SD µ ± SD
Surgery time 43.19 ± 29.68 52.32 ± 29.07 24.94 ± 21.60 0.001
Age 41.86 ± 7.68 42.84 ± 7.40 39.90 ± 7.98 0.82
Preoperative BMI 47.22 ± 4.93 47.33 ± 4.75 47.00 ± 5.36 0.759
Percentage of Excessive
Weight Loss
4.17 ± 0.65
4.21 ± 0.58
4.10 ± 0.79
0.435
Basal Metabolic Rate 1463.56 ± 166.27 1456.45 ± 148.60 1477.76 ± 198.92 0.563
Fat Mass (Percentage) 31.40 ± 4.77 31.55 ± 4.10 30.50 ± 5.86 0.199
Caloric intake 1262.75 ± 424.12 1302.46 ± 410.52 1183.33 ± 446.28 0.203
µ ± SD: average ± Standard Deviation. The p values are determined by the T/Mann-Whitney test between groups
according to the Shapiro-Wilk Normality test.
Fig. 1. Comorbidities associated with obesity befo-
re and after operation.
Percentage of patients (%)
Comorbidities associated with obesity
58 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
were also reduced in the short, medium, and
long term 25.
Regarding the practice of physical ac-
tivity, we observed in this study that there
was a reduction in the postoperative period,
which may contribute to the reacquisition
of weight. Bariatric surgery, combined with
guided physical exercise, potentiates the
reduction of comorbidities and contributes
to a better quality of life for the patient 26.
Although no significant result was found
between the association of physical activity
practice and weight reactivity in this study,
it is known that those who become more
active present better weight control post-
operatively compared to people who do not
exercise physically 27. Weich et al. identified
that 30% of the patients who adhered to
regular physical activity had better weight
control in the postoperative period of bar-
iatric surgery 28.
Regarding using nutritional supple-
ments in the postoperative period, most
patients evaluated in this study did not use
any supplementation. When comparing the
groups, it was observed that group 02 was
the least medication user. This result may
be related to the non-attendance of these
patients in the health unit for nutritional
follow-up since it was the group that less
frequently attended consultations with nu-
tritionists. Regarding whether or not to at-
tend the nutritional consultation, 49% of
the patients stated that they did not attend
the consultations. Similar results were de-
scribed by Magro et al. and Souza JMB 27,29,
evidencing that periodic nutritional moni-
toring greatly influences dietary habits and
adherence to supplementation.
Regarding the anthropometric evalua-
tion, this study did not observe a significant
difference in BMI values between the groups
evaluated in the postoperative period. This
study confirmed that satisfactory results
were achieved by 88.17% of the patients (%
PEP ≥50%), with similar results 24.
The dietary survey (R24h) indicated an
average daily energy consumption of 1262.7
± 424.1 kcal. There was no significant dif-
ference between groups in terms of nutrient
intake. A similar result was described by Bro-
lin RE et al. 30.
Carbohydrate intake was 57±6.4%, the
only macronutrient that presented intakes
compatible with current nutritional recom-
mendations. In this study, we found similar
results since the percentage of carbohydrate
intake was also the only one that showed
adequacy of the current daily recommenda-
tions 31.
Although the macronutrient intake
was not significant between the groups, the
mean protein intake was lower in group 01
(16.09 ± 6.23), and that of lipids showed a
discrete increase over time. The average pro-
tein intake in grams was shown to be inad-
equate since the minimum recommendation
is 60 to 70 grams per day. A study showed
similar results when citing the average pro-
tein intake performed by most patients in
the postoperative period 13.
Compared to the DRIs-recommended
Daily Intake Means, inadequacy was observed
in all micronutrients analyzed: calcium, iron,
thiamine, vitamin B12, folate, and zinc. Oth-
er studies 30-32 also reported low vitamin B12,
iron, zinc, iron, calcium, and folate intake.
In patients over 18 years of both gen-
ders submitted to Roux-en-Y gastric bypass
gastroplasty, it was evidenced that 30.83%
of subjects had vitamin B12 deficiency, 29.1%
had iron deficiency, and 14.1% had calcium
deficiency 30-32.
The majority of patients adequately
fractionated their meals. Thirty-five report-
ed similar results, identifying that 62.1% of
the individuals evaluated consumed four or
five meals daily.
Food intolerances were reported by
73.3% of the patients, similar to that found
by other authors 30-35, who also identified that
the foods that caused the most discomfort
were rice, sweets, and meat. In this study,
the most mentioned foods were tapioca
(59.1%), açaí (49.5%), rice (43%), fried foods
(37.6%), milk (32.3%), and sweet (31,2%).
Health profile of patients submitted to gastric bypass 59
Vol. 66(1): 49 - 62, 2025
Foods such as tapioca and açaí have not yet
been cited in other studies because they are
regional foods.
Regarding weight reacquisition, 67% of
the patients regained weight, with a mean
reacquisition of 14.6 ± 10.8 kg. 27, finding
that 46% of the patients regained weight in
two years postoperatively and 63.6% in four
years.
In this study, most patients who pre-
sented reacquisition were in G3 (above 48
months). Thus, reacquisition was signifi-
cantly proportional to postoperative time,
although no significant relationship was
found with income, daily caloric intake, bas-
al metabolic rate, body composition, physi-
cal exercise, and nutritional monitoring.
As observed in this study, the litera-
ture 30-35 points out a greater incidence of
weight reacquisition after two years of sur-
gery, which is attributed to the longer time
elapsed after surgery.
The occurrence of weight relapse, espe-
cially in patients with a more extended post-
operative period, is associated with worsen-
ing comorbidities. There is little data on
patients with more than 10 years of postop-
erative, which increases the concern and the
need for more research in the area 31.
In the last five years, the scientific
literature has pointed out that so far, bar-
iatric surgery is the most effective method
to treat obesity and can play an essential
role in reducing the direct and indirect
costs of obesity treatment 36. The proce-
dure increases fertility rates and improves
breastfeeding, providing benefits to infant
and maternal health37 However, it pointed
out that issues associated with bone min-
eralization 38, digestive motility 39, and nu-
tritional deficiencies should be carefully
observed 40.
The results found in this study evi-
denced that the public that most demanded
bariatric surgery in the Western Amazon is
the female population.
Among the individuals evaluated, there
was a significant reduction in comorbidities
associated with obesity and, consequently, a
decrease in medication use. The loss of ex-
cess weight was satisfactory concerning the
surgical procedure adopted (Roux-en-Y gas-
tric bypass), and daily caloric intake, as well
as protein, vitamin, and mineral intake, es-
pecially in the first two postoperative years,
presented inadequacies compared to the
current recommended nutrient recommen-
dations.
Most patients did not perform periodic
nutritional monitoring, which can demon-
strate non-attendance to consultations with
other health professionals since the answer-
ing service is integrated. In addition, most
of the patients did not adequately use nu-
tritional supplementation. The foods with
the most significant potential for food in-
tolerances in the region were tapioca, açaí,
sweets, and milk.
Regarding weight reacquisition, the
higher the postoperative period of the pa-
tients, the greater the weight reacquisition
was found. This fact did not present signifi-
cant relevance when compared to variables
such as income, physical activity practice,
nutritional monitoring, basal metabolic rate
and daily energy intake. This result is worri-
some and must be investigated in other re-
search, seeking to describe the determining
factors for the reality found.
Bariatric surgery significantly reduced
comorbidities, medication use, and excess
weight loss. However, the adequacy of nutri-
ents and the increasing incidence of weight
reactivity in the postoperative period dem-
onstrated that bariatric surgery does not end
the treatment of obesity; on the contrary, it
is only a step that requires periodic monitor-
ing by health professionals.
ACKNOWLEDGMENTS
We thank the Clinics Hospital of the
State of Acre, Brazil, for allowing and sup-
porting the study, all the professionals for
their support, and the patients for agreeing
to participate in the experiment.
60 Bezerra de Moura Rocha et al.
Investigación Clínica 66(1): 2025
Funding
No funds, grants, or other support was
received.
Conflicts of interest
Authors declare that they have no con-
flicts of interest.
Ethical approval
The project was submitted to the Re-
search Ethics Committee of the Clinics Hos-
pital /HC of the State of Acre and approved
through opinion nº 1,979,084.
Author’s ORCID numbers
• Suellem M. Bezerra de Moura Rocha:
0000-0001-8060-2746
• Alanderson Alves Ramalho:
0000-0002-7503-1376
• Rachel Horta Freire:
0000-0001-7020-4402
• Thiago Montes Fidale:
0000-0002-6137-1687
• Dionatas U. de Oliveira Meneguetti:
0000-0002-1417-7275
• Luis Carlos Oliveira Gonçalves:
0000-0001-5368-1194
• Anibal Monteiro de Magalhães Neto:
0000-0002-4887-5936
• Luiz Carlos de Abreu:
0000-0002-7618-2109
• Romeu Paulo Martins Silva:
0000-0002-8368-158X
Participation in the development
and Writing of the paper
SMBMR, AAR, and RPMS Conceptu-
alization; SMBMR, AAR, RHF, TMF, DUOM,
and RPMS Data curation; SMBMR, AAR,
LCOG, AMMN, LCA and RPMS Formal analy-
sis; SMBMR, AAR, RHF, TMF, DUOM and
RPMS Investigation; SMBMR, AAR, and
RPMS Methodology; RPMS Project adminis-
tration; All authors Resources; Software; Su-
pervision; Validation; Visualization; Writing -
original draft; and Writing - review & editing.
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