New research shows that patients who lost at least 8 percent of their excess weight one month before their surgeries had overall better results. The study, in the Journal of the American College of Surgeons, suggests that losing weight directly impacts a person’s ability to shed even more pounds in the year following surgery.
For the study, 355 patients followed a four-week, low-calorie diet before undergoing a bariatric operation. They had either sleeve gastrectomy or Roux-en-Y gastric bypass.
“Our ultimate goal was to see what makes postoperative outcomes better for our patients undergoing this lifesaving procedure,” said study coauthor Dr. John David Scott, the metabolic and bariatric surgery director of Greenville Health System, South Carolina.
Patients were asked to lose at least 8 percent of their excess weight by following a 1,200 calorie diet for four weeks immediately preceding their operations. Those who lost at least 8 percent of their excess weight achieved a 7.5 percent greater weight loss at the 12-month post-surgery mark, compared with those who did not achieve that weight loss goal. This finding held true even when other factors such as age, gender, ethnicity, and health problems including high blood pressure and diabetes were considered.
According to Dr. Deborah A. Hutcheon, a clinical nutrition specialist at GHS who led the study, there’s a key window of opportunity after bariatric surgery, up to 18 months, when many physical and metabolic changes occur that help facilitate weight loss.
“After that time point, patients will have to rely on diet and exercise and lifestyle management to maintain that weight loss,” she said. “We call it the honeymoon period of bariatric surgery.”
Hutcheon said after that time period, the body starts to figure out what it can and can’t do. The odds of losing a significant amount of weight after that time period are definitely decreased.
“Therefore, the more weight you can lose during that honeymoon period, the better, because that effort will help establish a set point, in terms of where your steady weight is going to be further down the road,” she said.
It could also mean a shorter hospital stay, too. Patients who managed to lose 8 percent or greater of their excess weight before surgery stayed two fewer days in the hospital.
“Ultimately, we believe that preoperative preparation for bariatric surgery should be mediated by individual surgeons taking care of their patients,” Dr. Scott said. “And this 8 percent target should not be used as a hard set point to qualify patients for bariatric surgery. Because patients with obesity who weren’t able to achieve that 8 percent goal still had dramatic effects in terms of how much weight they lost and comorbidity resolutions.”
The most important aspect of this study is that it adds to the body of research data showing that it is beneficial for bariatric surgery programs to encourage and counsel patients to follow a short-term diet or aim to achieve weight loss prior to bariatric surgery.
“One of the things we often say is bariatric surgery is a tool; it’s not the end-all-be-all for weight loss,” Dr. Hutcheon said. “So it’s really about making sure this tool is used wisely and proactively by our patients and having it work most effectively in the long run.”
Source: American College of Surgeons