Mixed Signals on Pre-Bariatric Surgery Weight Loss Regimens

While many physicians recommend weight loss in advance of bariatric surgery, and many insurance provides require it, a wide-ranging study suggests that the benefits of such preparatory dieting may actually be negligible.

Surgeons often advise patients to lose weight loss before they undergo bariatric surgery, but impending surgery seems no greater motivation for patients to do so. The advice surprises many patients, as the very purpose of the surgery is to help them address a life-long inability to lose weight. Patients' success varies, even when the healthcare teams explains the many reasons to lose weight before surgery—it's often an insurance company requirement, it may prepare the patient for the trauma of surgery, and some studies suggest it improves recovery time. This issue is controversial.

Researchers from NorthShore University HealthSystem, in Evanston, IL, wondered if a mandatory medically supervised preoperative weight loss (MPWL) could improve success rates. The results of their observational study appear in the Journal of Gastrointestinal Surgery, and indicate that MPWL may offer no advantages.

They compared patients undergoing primary bariatric surgery (N = 717) with and without a compulsory preoperative weight loss regimen directing them to shed at least 10% of baseline body weight. They tracked weight loss, comorbidity resolution, and hospital readmissions.

The researchers placed patients into cohorts, with cohort 1 being patients who enrolled in a MPWL program (n=252) and cohort 2 being those who had no MPWL requirements (n=465).

At one year post-surgery, 62.5% of MPWL participants and 67.1% non-participants had resolved at least one of five obesity-associated comorbidities.

Excess weight loss was similar between non-participants and MPWL participants (58.6% and 59.1%, respectively).

Readmission rates were also similar.

With no apparent advantages in terms of excess weight loss, comorbidity resolution one year after surgery, or 30- or 90-day readmission rates for these patients, the researchers question MPWL's value. MPWL may discourage some patients who need bariatric surgery from pursuing it, and prevent some from undergoing the procedure if their insurance requires it.