Adding weight management to NAFLD care boosts bariatric surgery referrals 25-fold
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WASHINGTON — Adding weight management care into a multidisciplinary nonalcoholic fatty liver disease program improved referrals for bariatric surgery at a rate of 25 times higher than the national average, according to Yale study results.
“Losing at least 10% of your body weight is the treatment for fatty liver disease, and there are many ways to lose weight on the market, including new medications and bariatric surgery,” Ysabel Ilagan-Ying, MD, a hospital resident at Yale University School of Medicine and West Haven Veterans Medical Center, said during The Liver Meeting media briefing. “However, only an estimated 1% of eligible patients are appropriately referred to bariatric surgery.”
She noted: “We believe that this clinic model is the way of the future, which will enhance connections to nutritionists, new weight loss medication therapies and weight loss surgery referrals while considering each patient’s unique medical and metabolic profile.”
Ilagan-Ying and colleagues retrospectively reviewed charts of 1,166 patients in the Yale Fatty Liver Disease Program from October 2015 to May 2022, of whom 596 were bariatric surgery eligible and 570 were non-eligible. Patients with a BMI greater than 40 kg/m2 or greater than 35 kg/m2 with an obesity-associated comorbidity were considered eligible for surgery.
Researchers collected data on bariatric surgery referrals and follow-up, including type of surgery performed, and compared clinical and demographic characteristics between surgery eligible and non-eligible groups.
Significant differences were noted between groups related to sex, age, race, insurance status and presence of a non-NAFLD chronic liver disease, while ethnicity and rate of anti-obesity medication prescriptions were not significantly different.
Of surgery eligible patients, 150 were referred for evaluation and 29 underwent bariatric surgery. According to researchers, referred patients were more often younger, female, white, privately insured and of middle class.
Significant differences in sex, age, race, ethnicity, median household income and anti- obesity prescriptions also were observed between surgery eligible patients who did or did not undergo bariatric surgery.
“We found that patients with fatty liver in our novel program successfully achieved weight loss in a very short period of time; over half saw some degree of weight loss by 12 months,” Ilagan-Ying said, “Our patients receive bariatric surgery referrals at a rate 25 times higher than the national average, and those who underwent surgery lost over 20% of their body weight, which is twice the amount needed to show liver health improvement.”
Additionally, the researchers noted that patients were able to successfully lose weight even if they had poorly controlled diabetes, and those patients being treated for anxiety and mood disorders did not exhibit any significant difference in weight loss compared with those without a psychiatric comorbidity.
“Weight loss is not one size or one treatment fits all,” she said. “Combining weight management within multidisciplinary liver clinics is the next step in helping treat fatty liver disease, because it takes a village to fight obesity.”
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Ilagan-Ying Y, et al. Abstract 2535. Integration of weight management care for nonalcoholic fatty liver disease improves referrals to bariatric surgery. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid).
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