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Weight loss 1 month before bariatric surgery improves 1-year outcomes
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Patients who lost at least 8% of excess body weight in the 4 weeks before undergoing bariatric surgery had a shorter mean hospital stay and experienced greater excess weight loss at 12 months vs. patients who lost less than 8% of body weight before the procedure, according to findings published in the Journal of the American College of Surgeons.
“Currently, controversy exists for the optimal preoperative dietary optimization of patients prior to bariatric surgery,” John David Scott, MD, FACS, FASMBS, associate professor of surgery, University of South Carolina School of Medicine, Greenville, and the metabolic and bariatric surgery director of Greenville Health System, South Carolina, said in a press release. “On one side, insurance policies often mandate 6- or 12-month weight-management programs. This mandate is in direct contrast to many bariatric surgeons, who prefer to use short-term, calorie-restricted diets several weeks prior to surgery in order to optimize outcomes.”
Scott and colleagues analyzed data from 355 patients who completed a program-recommended, preoperative low-calorie diet for 4 weeks before undergoing sleeve gastrectomy (n = 167) or Roux-en-Y gastric bypass surgery (n = 188) between January 2014 and January 2016. Patients were asked to lose at least 8% of excess body weight while following a 1,200 kcal per day diet and participating in at least 30 minutes of moderate- to vigorous-intensity exercise per day. Patients completed diet and exercise logs that were reviewed by a program nutritionist at weekly group education classes. Patients were stratified by the achievement of at least 8% excess weight loss during the low-calorie intervention. Primary endpoints included rate of follow-up (at 1, 3, 6 and 12 months) and percent of excess weight loss at 1, 3, 6 and 12 months after surgery.
Within the cohort, 224 patients achieved the goal of at least 8% excess weight loss (mean age, 46 years; 74.6% women; 84.8% white) and 131 did not (mean age, 44 years; 86.3% women; 74.1% white).
Researchers found that patients who lost at least 8% excess body weight before surgery had a shorter postoperative length of stay (mean, 1.8 days vs. 2.1 days; P = .006). The median operative duration did not differ between groups; however, mean surgery time for the group that lost at least 8% body weight was 8 minutes faster (mean, 117 minutes vs. 124 minutes; P = .061), according to researchers. Analysis by type of surgery did not change results.
Patients who lost at least 8% excess weight before surgery saw greater weight loss at 3, 6 and 12 months after surgery vs. patients who lost less weight before surgery. Mean excess weight loss for the two groups was 42.3% vs. 36.1% at month 3, 56% vs. 47.5% at month 6 and 65.1% vs. 55.7% at month 12. There were no between-group differences in excess weight loss at month 1; however, the absolute amount change in postoperative BMI was different between groups at month 1 (mean BMI change, 3.7 kg/m² vs. 2.3 kg/m²).
In multiple linear regression analysis, researchers found that at least 8% excess body weight loss before surgery was associated with superior percentage weight loss at 12 months after surgery (beta = 7.6; P < .001), with results persisting after adjustment for insurance status, 12-month diet compliance and surgery type.
“These findings suggest that surgeons and clinical care teams should encourage patients to lose weight through diet and exercise prior to surgery to support improved outcomes during and following surgery,” study author Deborah Hutcheon, DCN, RD, LD, a clinical nutrition specialist with Greenville Health System in Greenville, South Carolina, told Endocrine Today. “However, the achievement of weight loss prior to surgery should not be used as a mandate, since patients who do not achieve significant weight loss prior to surgery can still experience successful postoperative outcomes, including clinically meaningful weight loss.”
Hutcheon said that more research is needed to examine the role of preoperative weight loss in long-term outcomes following surgery.
“Additionally, future research is needed to further understand how the timing of weight loss (ie, when it occurs prior to surgery), the total amount of weight loss and other weight-loss interventions affect patient outcomes, including resolution of comorbidities, such as diabetes, hypertension and sleep apnea,” Hutcheon said.
– by Regina Schaffer
For more information:
Deborah Hutcheon, DCN, RD, LD, can be reached at the Department of Surgery, Division of Bariatric and Minimal Access Surgery, Greenville Health System, 2104 Woodruff Rd, Greenville, SC 29607; email: dhutcheon@ghs.org.
Disclosures: The authors report no relevant financial disclosures.
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