Does Presurgical Weight Loss Predict Outcomes?Tuesday, May 6, 2008
Contrary to popular belief, patients who undergo obesity surgery do indeed have to make substantial lifestyle changes to be successful – obesity surgery is therefore never a “quick fix”.
Therefore, many bariatric programs, including ours, often use modest presurgical weight loss as a screening tool to determine whether patients can indeed make lifestyle changes that would help them be successful after obesity surgery.
The theory is that if someone is unable to make even modest changes to their lifestyles before surgery, they will have difficulty making those changes after surgery, thereby limiting their chances for success.
But does presurgical weight loss truly predict outcomes?
This question was examined by Bushr Mrad and colleagues who performed a retrospective chart review of 562 patients who underwent surgery in our program. The results of this study were just published in the American Journal of Surgery.
One hundred forty-six patients met the inclusion criteria (23 men and 123 women). The mean age was 39.5 years, and the mean body mass index (BMI) was 52.6 kg/m(2). Comorbid disease includes diabetes (15.7%), hypertension (30.8%), mental illness (38.4%), and musculoskeletal disease (56.8%). Procedures performed were 16 vertical band gastroplasties, 43 open gastric bypasses, 52 laparoscopic gastric bypasses, and 35 laparoscopic adjustable gastric bands.
Preoperative weight change was as follows: 31 patients gained weight (21.2%), 56 patients lost weight (38.3%), and 59 patients maintained their weight (40.4%).
While in women, there was no relationship between pre- and postoperative weight loss, men who gained weight preoperatively had significantly worse outcomes.
This study shows that while in women, ability to achieve a modest presurgical weight loss may not matter, in men inability to lose weight may predict poorer success.
Obviously, this study has methodological limitations and only included 23 men – perhaps not enough to make ruling statements about how men do with surgery.
Nevertheless, for now, our program continues to expect patients to demonstrate compliance with lifestyle changes including self-monitoring before considering anyone for bariatric surgery.