Does Dietary Weight Loss Predict Surgical Outcomes?
Although most patients do, a substantial number struggle with post-surgical complications or simply fail to lose adequate amounts of weight.
Now a study by Mirna Azar and colleagues from the University of Ottawa, published in OBESITY, suggests that weight loss over six weeks on a low-calorie liquid diet as part of a behavioural weight-loss program may predict subsequent weight loss with laparoscopic Roux-en-Y gastric bypass (RYGB).
The observational studied looked at data from over 200 patients, who underwent RYGB following a previous dietary and behavioural intervention.
Overall there did appear to be a relationship between weight loss on six weeks of the low-calorie diet and the weight loss response at 26 weeks post surgery.
However, despite statistical significance, this relationship hardly meets the criteria of a “clinically predictive” test and probably performs dismally on an ROC curve in terms of both sensitivity and specificity.
Nevertheless, the fact that there was any relationship at all is intriguing and one can only speculate as to why this may be the case.
I can indeed think of a number of reasons ranging from genetic differences (susceptibly to weight loss) to differences in behaviour such as adherence and compliance with the dietary recommendations that may explain this relationship.
Overall however, predicting who does well with surgery and who does not continues to be a mystery even if many clinicians often kid themselves when they think they can tell.
This is unfortunate, as identifying patients most likely to do well (or perhaps more importantly, identifying those who will not) remains an important challenge in the field of bariatric surgery.