Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?

Sara Monfared, Dimitrios I. Athanasiadis, Alvin Furiya, Annabelle Butler, Don Selzer, William Hilgendorf, Ambar Banerjee, Dimitrios Stefanidis

Research output: Contribution to journalArticle

Abstract

Background: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. Methods: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35–45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. Results: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43–45 vs 45.01–47) were compared. Conclusion: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.

Original languageEnglish (US)
JournalObesity Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Bariatric Surgery
Weight Loss
Body Mass Index
Length of Stay
Gastric Bypass
Gastrectomy
Morbidity
Type 2 Diabetes Mellitus
Comorbidity
Hypertension
Weights and Measures
Proxy
Obstructive Sleep Apnea
Hyperlipidemias
Multicenter Studies

Keywords

  • Bariatric surgery
  • Goal setting
  • Medically supervised weight loss
  • Outcomes
  • Preoperative weight loss

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Monfared, S., Athanasiadis, D. I., Furiya, A., Butler, A., Selzer, D., Hilgendorf, W., ... Stefanidis, D. (Accepted/In press). Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes? Obesity Surgery. https://doi.org/10.1007/s11695-019-04275-8

Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes? / Monfared, Sara; Athanasiadis, Dimitrios I.; Furiya, Alvin; Butler, Annabelle; Selzer, Don; Hilgendorf, William; Banerjee, Ambar; Stefanidis, Dimitrios.

In: Obesity Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Monfared, S, Athanasiadis, DI, Furiya, A, Butler, A, Selzer, D, Hilgendorf, W, Banerjee, A & Stefanidis, D 2019, 'Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?', Obesity Surgery. https://doi.org/10.1007/s11695-019-04275-8
Monfared, Sara ; Athanasiadis, Dimitrios I. ; Furiya, Alvin ; Butler, Annabelle ; Selzer, Don ; Hilgendorf, William ; Banerjee, Ambar ; Stefanidis, Dimitrios. / Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?. In: Obesity Surgery. 2019.
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abstract = "Background: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. Methods: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35–45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. Results: A total of 776 patients, 81.4{\%} LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in {\%}ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43–45 vs 45.01–47) were compared. Conclusion: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.",
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AU - Athanasiadis, Dimitrios I.

AU - Furiya, Alvin

AU - Butler, Annabelle

AU - Selzer, Don

AU - Hilgendorf, William

AU - Banerjee, Ambar

AU - Stefanidis, Dimitrios

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N2 - Background: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. Methods: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35–45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. Results: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43–45 vs 45.01–47) were compared. Conclusion: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.

AB - Background: Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities. Methods: Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35–45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity. Results: A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43–45 vs 45.01–47) were compared. Conclusion: WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.

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KW - Goal setting

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KW - Outcomes

KW - Preoperative weight loss

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