Avoid judgement when making prediction of patient’s weight loss outcomes

NEW ORLEANS — Because clinicians are poor predictors of weight-loss outcomes after gastric banding, it is imperative that physicians take a nonjudgmental approach when interacting with their patients preoperatively and postoperatively, according to a presenter here.

“‘I knew he wouldn’t do well at all.’ ‘They just aren’t complying’ are not valid observations for predicting,” John Dixon, MBBS, MD, PhD, Baker IDI Heart and Diabetes Institute, said.

Dixon presented a litany of data sets from band bypass studies, and none revealed a clear predictor of success in weight loss. Instead, Dixon said the consultant aspect of patient interaction is a heavy influencer over the success rate.

“If people don’t talk to a patient ... ask about their appetite, seek out symptoms of restriction, then they are not going to have success,” he said. “It takes time and effort. And great practices around this country, in Australia and Europe do it and have very great success. But remember they [patients who get bands} are getting 20% on average weight loss, not 25, 40 or 30 you get with gastric bypass. ... It is a terrific treatment for those who want a very safe procedure.”

“The practices that do best are the practices that tend to steer away from surgeons managing postoperatively unless they are trained to talk to patients,” he said. “What we need to do is put the resources around the surgeons or, in fact, the bariatric physicians to actually give our patients the best chance.”

“Be it lifestyle, pharmacotherapy or surgical procedures, the patients who lost the most weight in the first couple of months went on to lose the most weight in the long term,” said Carel le Roux, FRCP, FRCPath, PhD, from University College, Dublin, another symposium presenter during the question and answer session. However, “the people who fail our consultation route are the people who do not respond to our favorite treatment. And what we need to do as clinicians in the wicked world where we are limited is we are then judgmental or beat these people with sticks, and we say ‘you must try harder. It’s your fault for not responding to my favorite treatment.’”

Le Roux said clinicians need to know there are limits due to the current available treatments, and for those patients who do not respond, a clinician should try another treatment and not place blame on either oneself or the patient.

Dixon said to throw out “the idea that I can predict or you can predict who is going to do well when we haven’t got the tools to measure their physiology. Predicting appears to be physiological rather psychological — age, insulin, poor physical function.” – by Joan-Marie Stiglich, ELS

Reference:

Dixon J. Predicting weight loss after gastric banding. Presented at: ObesityWeek 2016; Oct. 31-Nov. 4, 2016; New Orleans.

Disclosure: Dixon reports serving as an advisor to Novo Nordisk and as a consultant for Apollo Endosurgery, Bariatric Advantage, iNova, Nestle and Novartis. Le Roux reports no financial disclosures.