Arya M. Sharma, MD

Yesterday I had the privilege of speaking to around 400 dietitians (and other health professionals) at Capital Health’s 12th Annual Regional Nutrition and Food Services symposium.

After my presentation, many of the attendees came up to personally thank me for such an “eye opening” take on obesity.

This of course is surprising, given that you’d think that, if anyone, dietitians would be the ones with the greatest knowledge and understanding of the issues around obesity management.

So I asked the folks who came up to me about what exactly they found so “eye opening”.

The answers were pretty much the issues that I have so often blogged about:

- The problems with clinically defining exactly what obesity is and who really needs treatment (no, BMI is not the best criterium!).

- The fact that obesity is a chronic disease that requires life-long treatment - a condition for which we have no cure (with a few rare exceptions).

- The rather limited long-term success of lifestyle (3-5% sustained weight loss), pharmacological (5-15% sustained weight loss) and even surgical (20-30% sustained weight loss) treatments (and even these results only if you continue the treatments!).

- The fact that while maintaining energy balance appears simple (energy in must equal energy out), energy regulation is highly complex.

- The concept that pharmacotherapy and surgery are not a “substitute” for lifestyle change but in fact only work when patients really do make substantial changes to their lifestyle (click here for a previous entry on this topic).

So, to readers of my blog, nothing really new or enlightening - yet, “eye opening” to many in the audience.

I guess we have a long way to go before all health professionals (especially physcians!) understand these basic concepts of obesity management.

If only I could speak to 400 health professionals everyday!

AMS

There is no question that with improved results, patients and physicians are beginning to look at bariatric surgery as a realistic and definitive option for the treatment of morbid obesity.

However, do even well-informed patients have the right expectations? This issue was recently addressed by Andrea Bauchowitz and colleagues from the University of Virginia, who examined weight loss expectations of 217 consecutive preoperative patients.

It turns out that over two-thirds of patients (65%) had misconceptions about the amount of weight they would lose after surgery. On average, patients thought that they would lose around 80% of excess weight, when in fact a good response to surgery is probably anything greater than 50% of excess weight.

Almost one-third of patients did not look at surgery as a tool to help make dietary changes and increase physical activity - rather, they thought that surgery would merely prevent overeating.

There were likewise misconceptions regarding length of hospital stay and the importance of post-surgical depression.

Overall, the results of this study show that many patients have misconceptions about the amount of weight loss they can expect from surgery and do not appreciate the need for lifestyle changes after surgery.

Therefore, implementing a thorough patient education program that fosters adequate knowledge about the nutritional and behavioural aspects of surgery as well as the amount of weight loss to be expected may be an important part of preparing patients for surgery.

A previous paper by Bauchowitz, where she examined how bariatric programs evaluate and interpret the psychosocial situation of patients with regard to surgery is available online (click here for full-text). While this study does not tell us whether centres which demand more of their patients have better outcomes, it does provide a list of common practices and things to think about when preparing patients for surgery.

AMS