The purpose of the study was to perform a comparison about how the quality of life, food tolerance and eating disorder behavior varied according to different bariatric surgeries such as gastric sleeve and gastric band surgeries. After approval was obtained from the institutional research and ethics committee, a retrospective chart review was completed for all patients who had undergone laparoscopic gastric banding and sleeve gastrectomy at the Bahrain Defense Force Hospital between 2011 and 2014. In 2015, we telephoned all patients who had at least 1 year of postoperative duration and invited them to join the follow-up survey. Those who responded to our phone call were invited to participate in the follow-up questionnaire survey at the hospital. We scheduled the survey on 2 different days so that the patients could come and complete the survey on any of those 2 days according to their convenience. All patients were assessed through face-to-face interviews with a dietitian. We included gastric sleeve participants those that had both pre and post-operative QOL evaluations. As the gastric band patients preoperative assessments were not available for comparison, we included all the eligible gastric band patients for the post-operative comparison in the study.
A total of 84 bariatric patients, each of whom had undergone a gastric sleeve or gastric band procedure that a single surgeon conducted, were included in the study. Of these, 48 were gastric sleeve patients, and 36 were gastric band patients. After they completed psychiatric evaluations, we sent them for further clinical assessment. The changes in BMI were evaluated and compared between the surgical groups by using the Mann-Whitney U test. Patients were asked to complete 3 questionnaires: the Medical Outcomes Study Short-Form Questionnaire (SF-36), the Quality of Alimentation questionnaire, and the Eating Disorder Examination Questionnaire (version 6; EDE-Q).
The SF-36 is a 36-item questionnaire that evaluates eight different aspects of quality of life: physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health . The responses to this self-reported questionnaire were eventually grouped into a physical health category and a mental health category.
The Quality of Alimentation questionnaire  was developed to assess food tolerance after bariatric surgery. It consists of 4 components, including overall patient satisfaction with alimentation, the timing and content of meals and snacks, the tolerance of different types of foods, and the frequency of vomiting. A Mann-Whitney U test was conducted to assess the food tolerance between the 2 groups.
The EDE-Q  was used to assess eating-disorder psychopathology in a self-reported manner, such that patients described their eating behaviors during a 28-day period immediately before the administration of the questionnaire. This questionnaire was distributed to the patients before they were interviewed individually. The questions asked were related to the following 4 categories: restraint, eating concerns, shape concerns, and weight concerns. This questionnaire differentiates objective bulimic episodes from subjective bulimic episodes and objective overeating.
The Statistical Package for Social Science (SPSS Version 19.0) was used to analyze the data. The results are presented as a mean ± standard deviation (SD) or percentage of patients. The pre- and postoperative comparisons were calculated to evaluate the changes of the quality of life of gastric sleeve patients. The Shapiro-Wilk test was used for testing the normality. The data did not follow the parametric assumptions but were positively skewed. Thus, we used non-parametric tests. Both groups were compared using the Mann-Whitney U test. To assess the differences in the participants’ quality of life before and after their gastric sleeve procedures, the Wilcoxon Signed-Rank Test was used. Qualitative data were compared using the chi-square test or Fisher’s exact test as appropriate. The correlation between excess weight loss (EWL) and postoperative quality of life, food tolerance, and eating disorder scores were assessed by using the Spearman rank correlation coefficient. The percent of excess weight loss (%EWL) was calculated as follows: [(operative weight–follow-up weight) / (operative weight–ideal weight)] × 100, with the ideal weight being based on a BMI of 25 kg/m2. A P value of < 0.05 was considered significant.