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Do mandated weight loss goals prior to bariatric surgery improve patient outcomes?

Sara Monfared, MD, Alvin Furiya, RD, Annabelle Butler, MD, Don Selzer, MD, William Hilgendorf, PhD, Ambar Banerjee, MD, Dimitrios Stefanidis, MD. Indiana University

Background: Most obese patients pursuing bariatric surgery have to complete insurance mandated preoperative weight loss programs. This approach has been criticized as arbitrary and not supported by scientific data, and it contributes to patient attrition, poor resource utilization, and unnecessary delays in the care of patients. The purpose of this study was to assess whether preoperative mandated weight loss goals (WLG) lead to improved postoperative weight loss and resolution of comorbidities.

Methods: After Institutional Review Board approval, data prospectively collected from patients who underwent primary laparoscopic gastric bypass at a center of excellence between January 2010 and April 2013 were reviewed. Patients were divided in two groups: those with BMI between 35 and 45 were not required to achieve a weight loss goal prior to surgery (no WLG group), while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). To assess postoperative weight loss and comorbidity resolution body mass index (BMI), hemoglobin A1c (HbA1C), low density lipid protein (LDL), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at baseline and 6 and 12 months after surgery. Patients with missing data were not included in the analysis. A p-value<0.05 was considered significant.

Results: A total of 377 patients were included in the study (age 50.9 ± 10.6). Besides BMI, there were no demographic or comorbidity differences between the groups at baseline. While BMI decrease was significantly higher in the WLG group at 6 months (p <0.05), it was similar at 12 months. No significant difference was found between groups in the level of LDL, SBP and DBP at 6 and 12 months postoperatively. HgA1c normalized in both groups but was slightly lower in the WLG group at 12 months (0.3). (table 1)

Conclusion: In this study mandated preoperative WLG did not lead to improved weight loss and comorbidity resolution 1 year after laparoscopic gastric bypass.  While these findings should also be confirmed by longer-term outcome studies, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.

Keywords: Gastric bypass; Weight loss; Health care insurance; Bariatric surgery program


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88088

Program Number: S036

Presentation Session: Bariatrics 2 Session

Presentation Type: Podium

41

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