Risk factors for non-adherence to nutritional treatment in patients after bariatric surgery A single-center observational study.

Abstract

Introduction: Bariatric surgery has expanded rapidly to fight obesity, but despite its benefits, it is estimated that between 20% and 50% of patients fail to adhere to postoperative nutritional follow-up, which affects long-term outcomes.

Methodology: A prospective, observational study was conducted at the "Medical Center for Metabolism and Obesity" in Guayaquil, Ecuador, from January to April 2025. The probabilistic sample included adults under 65 years old who had undergone bariatric surgery in the past two years and was divided into two groups based on adherence to nutritional controls. Demographic, clinical, habit, perception, and treatment barrier variables were recorded.

Results: There were 20 cases in the adherence group and 30 in the non-adherence group. The adherence group included 4 men (20%), while the non-adherence group included 20 men (66.7%) (P = 0.0012). No significant differences were seen in age, marital status, social status, smoking or alcohol habits, comorbidities, or type of surgery. Difficulty accessing a nutritionist (OR 6.0; 95% CI 1.69-21.26; P = 0.0055) and a lack of family support (OR 3.5; 95% CI 1.05-11.66; P = 0.0413) were identified as risk factors. Female gender (P=0.0022) served as a protective factor.

Conclusion: Adherence to nutritional follow-up after bariatric surgery is primarily affected by psychosocial and logistical barriers, with the strongest risk factors being male sex, difficulty accessing a nutritionist, and lack of family support. These findings highlight the need for multidisciplinary teams to develop and implement personalized, urgent intervention protocols to reduce abandonment and the long-term risk of serious nutritional deficiencies.