Feasibility of ecological momentary assessment to characterize adolescent postoperative diet and activity patterns after weight loss surgery

Background: Adherence to postoperative lifestyle recommendations may be associated with weight outcomes among weight loss surgery (WLS) patients, but it is difficult to objectively assess and has not been reported among adolescents. Methods of assessment that are ecologically valid and provide important contextual information related to adherence are needed. The objective of this pilot study was to demonstrate the feasibility of using a form of ecological momentary assessment (i.e., daily phone diaries; DPD) to assess postoperative diet and activity patterns among a sample of adolescent WLS patients to determine adherence to best-practice lifestyle recommendations. Setting: University Hospital. Methods: Eight adolescent WLS patients completed 3 consecutive DPDs at 12 and 18 months postsurgery. Results: Ninety-four percent of DPD's were completed with an average 20.9 +/- 5.0 activities/day. Although adolescents engaged in recommended lifestyle behaviors (e.g., >= 30 min moderate physical activity/d; duration of meals/snacks >= 20 min) some of the time, few were adherent to postoperative physical activity and dietary recommendations the majority of the time. Conclusion: The DPD provides a feasible and informative methodology for assessing adherence behaviors among adolescent WLS patients. It is a relatively low burden method that may be useful in identifying behavioral targets for postoperative intervention. Adherence to postoperative lifestyle recommendations may be a serious concern among this cohort. These preliminary data shed light on potential targets for postoperative intervention. Targeting nonadherence is essential in not only improving health outcomes but in deciphering the true potential effectiveness of WLS in this at-risk population. (C) 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.