Study finds rural patients do as well after weight loss surgery as urban patients

A new University of Florida study finds that patients living in rural areas who undergo bariatric weight loss surgery have similar outcomes to patients in urban areas. Given the known barriers to weight loss and weight maintenance in rural areas, including limited access to healthy foods and recreational facilities, this is good news for rural patients considering the surgery, the researchers say.

people posing in front of research poster
Dr. Kathryn Ross, Andreana Apostolopoulos and Vivian Bauman pose in front of Apostolopoulos’ poster at PHHP Research Day 2019.

The study, published in Obesity Science and Practice, began as an honors thesis project by Andreana Apostolopoulos, then a student in the Bachelor of Public Health degree program at the UF College of Public Health and Health Professions.

As an intern working under her first research mentor, Lisa Clifford, Ph.D., a faculty member in the college’s department of clinical and health psychology, Apostolopoulos’ duties included helping patients undergoing bariatric surgery check-in for their pre-operative psychology appointments and to calculate their caloric intake through food journals.

“When learning about the stringent and permanent diet guidelines bariatric patients must adopt to avoid health complications and relapse, I was surprised by the lack of research investigating how other outside factors could impact a patient’s ability to sustain a healthy lifestyle post-operatively,” Apostolopoulos said. “I wondered if one’s food, built environment or demographics correlated to their success or failure after surgery and if any health-related disparities existed.”

After Clifford left UF for another position, Apostolopoulos began working with Kathryn Ross, Ph.D., M.P.H., an associate professor of clinical and health psychology who studies the prevention and treatment of adult obesity. Vivian Bauman, a doctoral student in clinical psychology with experience in bariatrics, joined the team as Apostolopoulos’ secondary mentor.

“Dr. Ross provides excellent guidance in research design and manuscript preparation, and in this case, she provided great guidance to me when engaging in my own mentorship of an undergraduate student,” Bauman said.

Finding only one other published research article that examined bariatric surgery outcomes in rural vs. urban patients, the team decided to focus on exploring differences between the two populations.

Gwendolyn Hasse, R.N., M.S.N., a bariatric nurse coordinator at UF Health Shands Hospital, worked alongside Apostolopoulos to perform retrospective chart reviews and data extraction from records of 170 patients who underwent bariatric surgery for weight loss. She also provided valuable feedback throughout the development of the manuscript.

After Apostolopoulos presented the research at PHHP Research Day and graduated in 2019, Bauman led additional analysis and finalization of the manuscript for journal submission with support from Thomas Parkman, a doctoral student in the clinical and health psychology’s internship program.

While the team’s findings are encouraging for people living in rural areas who undergo bariatric surgery, there are substantial barriers to the surgery for rural residents, Bauman said.

“One study found that eligible residents of rural areas are 23% less likely to undergo bariatric surgery compared to their urban counterparts,” Bauman said. “Thus, my hope is that these findings may enhance initiatives designed to reduce health disparities faced by patients undergoing bariatric surgery.”

Added Apostolopoulos: “It’s important to consider all aspects of a patient’s life, from hospital to home, when developing comprehensive care.”

Following graduation, Apostolopoulos accepted a position as a health policy specialist for the Tobacco Prevention Program at the Alachua County Department of Health, where she developed a passion for communications. She is now pursuing a master’s degree in mass communications at UF. Seeing her undergraduate honors thesis evolve from an idea to an important contribution to the literature on bariatric surgery health disparities has been a source of immense pride.

“I will forever be thankful for this once-in-a-lifetime experience as a student, and hope for many others to continue finding those gaps in research by questioning the unquestioned within public health,” Apostolopoulos said.