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Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study

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Abstract

Background

Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population.

Methods

This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively).

Results

A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital’s bariatric surgery program. Data analysis included both intention-to-treat and completers’ analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively.

Conclusion

MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.

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References

  1. Jamal MK, DeMaria EJ, Johnson JM et al (2006) Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 2:122–127

    Article  PubMed  Google Scholar 

  2. Gastrointestinal surgery for severe obesity (1991) NIH Consensus Statement, March 25–27 1991 9(1):1–20

  3. Ren CJ, Fielding GA (2003) Laparoscopic adjustable gastric banding: Surgical technique. J Laparoendosc Adv Surg Tech A 13:257–263

    Article  PubMed  Google Scholar 

  4. Gulkarov I, Wetterau M, Ren CJ, Fielding GA (2008) Hiatal hernia repair at the initial laparoscopic adjustable gastric band operation reduces the need for reoperation. Surg Endosc 22:1035–1041

    Article  PubMed  Google Scholar 

  5. Robinson J, Lupkiewicz S, Palenik L et al (1983) Determination of ideal body weight for drug dosage calculations. Am J Hosp Pharm 40:1016–1019

    PubMed  CAS  Google Scholar 

  6. Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74

    Article  PubMed  CAS  Google Scholar 

  7. Chevallier JM, Paita M, Rodde-Dunet MH et al (2007) Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg 246:1034–1039

    Article  PubMed  Google Scholar 

  8. Hibbard JH, Mahoney ER, Stockard J, Tusler M (2005) Development and testing of a short form of the patient activation measure. Health Serv Res 40:1918–1930

    Article  PubMed  Google Scholar 

  9. Hibbard JH, Mahoney ER, Stock R, Tusler M (2007) Do increases in patient activation result in improved self-management behaviors? Health Serv Res 42:1443–1463

    Article  PubMed  Google Scholar 

  10. Jeffrey RW, Wing RR, Sherwood NE, Tate DF (2003) Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr 78:684–689

    Google Scholar 

  11. University of Maryland Medical Center (2008) Medically supervised diet documentation. Available at http://www.umm.edu/weightloss/supervised_diet.htm. Accessed 17 June 2011

  12. Jantz E, Larson C, Mathiason M, Kallies K, Kothari S (2009) Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss. Surg Obes Relat Dis 5(2):208–211

    Article  PubMed  Google Scholar 

  13. Williams B, Melvin W, Torquati A, Richards W (2008) Impact of insurance mandated weight loss before bariatric surgery. Surg Obes Relat Dis 4:354–355

    Article  Google Scholar 

  14. Madan A (2006) Insurance mandated preoperative dietary counseling does not improve outcome and increases drop-out rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 2:417–418

    Article  PubMed  Google Scholar 

  15. Ochner C, Puma L, Raevuori A, Teixeira J, Geliebter A (2010) Effectiveness of a prebariatric surgery insurance-required weight loss regimen and relation to postsurgical weight loss. Obesity 18:287–292

    Article  PubMed  Google Scholar 

  16. Alami RS, Morton JM, Schuster R et al (2007) Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis 3:141–145; discussion 145–146

    Google Scholar 

  17. Livhits M, Mercado C, Yermilov I, Parikh J, Duston E, Mehran A, Ko C, Gibbons M (2009) Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis 5:713–721

    Article  PubMed  Google Scholar 

  18. Talarico J, Torquati A, McCarthy E et al (2010) Pre-Lap-Band group education in Medicaid population: does it really make a difference? Surg Obes Relat Dis 6:356–360

    Article  PubMed  Google Scholar 

  19. El Chaar M, McDeavitt K, Richardson S et al (2010) Does patient compliance with preoperative bariatric office visits affect postoperative excess weight loss? Surg Obes Relat Dis 6(3 Suppl):S11

    Article  Google Scholar 

  20. Martin M, Beekley A, Kjorstad R, Sebesta J (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based study. Surg Obes Relat Dis 6:8–15

    Article  PubMed  Google Scholar 

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Disclosures

Drs. Ren and Fielding are on the Medical Advisory Board for Allergan. They receive research grant funding from Allergan; however, none of the research in the present report was supported by Allergan. Drs. Parikh, Dasari, McMacken, and Ogedegbe have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Bellevue Center for Obesity and Weight Management, Bellevue Hospital Center, Department of Surgery, New York University School of Medicine, New Bellevue 15 South 7, 550 First Avenue, New York, NY, 10016, USA

    Manish Parikh & Meena Dasari

  2. Department of Medicine, Bellevue Hospital/NYU School of Medicine, New York, NY, USA

    Michelle McMacken & Gbenga Ogedegbe

  3. NYU Langone Weight Management Program, Department of Surgery, New York University School of Medicine, 530 First Avenue, New York, NY, 10016, USA

    Christine Ren & George Fielding

Authors
  1. Manish Parikh
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  2. Meena Dasari
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  3. Michelle McMacken
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  4. Christine Ren
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  5. George Fielding
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  6. Gbenga Ogedegbe
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Corresponding author

Correspondence to Manish Parikh.

Additional information

Funded by 2009 SAGES Research Grant Award.

Presented at SAGES 2011 Annual Meeting; El Paso, TX.

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Parikh, M., Dasari, M., McMacken, M. et al. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc 26, 853–861 (2012). https://doi.org/10.1007/s00464-011-1966-9

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  • DOI: https://doi.org/10.1007/s00464-011-1966-9

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