Skip to main content
Log in

Preoperative Interventions for Patients Being Considered for Bariatric Surgery: Separating the Fact from Fiction

  • Review Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Preoperative interventions aimed at patients referred for bariatric surgery continue to divide funders, commissioners, and practitioners alike. A number of preoperative interventions and variables have been used to influence patient selection. Many of these are believed to lead to better postoperative outcomes by helping target a limited resource (bariatric surgery) at those most likely to benefit. Inevitably, this leads to competition amongst patients and some being denied benefits of surgery. There is a risk that these strategies for resource allocation may actually deprive the most vulnerable and those most in need. This review examines evidence and justification behind popular preoperative interventions for patients being considered for bariatric surgery patients in the light of published English language scientific literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

UK:

United Kingdom

NICE:

National Institute for Health and Care Excellence

NHS:

National Health Service

BOMSS:

British Obesity and Metabolic Surgery Society

References

  1. NICE Guideline CG189. Obesity: identification, assessment and management of overweight and obesity in children, young people and adults (CG189). http://www.nice.org.uk/guidance/cg189/resources/guidance-obesity-identification-assessment-and-management-of-overweight-and-obesity-in-children-young-people-and-adults-pdf.

  2. Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7(6):760–7.

    Article  PubMed  Google Scholar 

  3. Ochner CN, Dambkowski CL, Yeomans BL, et al. Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome. Int J Obes. 2012;36(11):1380–7.

    Article  CAS  Google Scholar 

  4. Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21.

    Article  PubMed  Google Scholar 

  5. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91.

    Article  PubMed  Google Scholar 

  6. A05/P/a Clinical commissioning policy: complex and specialised obesity surgery. http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2013/08/a05-p-a.pdf.

  7. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5.

    Article  PubMed  Google Scholar 

  8. Gerber P, Anderin C, Thorell A. Weight loss prior to bariatric surgery: an updated review of the literature. Scand J Surg. 2015;104(1):33–9.

    Article  CAS  PubMed  Google Scholar 

  9. BOMSS commissioning guide: weight assessment and management clinics (Tier 3). http://www.bomss.org.uk/wp-content/uploads/2014/04/Commissioning-guide-weight-assessment-and-management-clinics-published.pdf.

  10. Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1282–6.

    Article  CAS  PubMed  Google Scholar 

  11. Ochner CN, Puma LM, Raevuori A, et al. Effectiveness of a prebariatric surgery insurance—required weight loss regimen and relation to postsurgical weight loss. Obesity (Silver Spring). 2010;18(2):287–92.

    Article  Google Scholar 

  12. Harnisch MC, Portenier DD, Pryor AD, et al. Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4(3):445–50.

    Article  PubMed  Google Scholar 

  13. Istfan NW, Anderson WA, Apovian CM, et al. Preoperative weight gain might increase risk of gastric bypass surgery. Surg Obes Relat Dis. 2011;7(2):157–64.

    Article  PubMed Central  PubMed  Google Scholar 

  14. de Witt Hamer PC, Tuinebreijer WE. Preoperative weight gain in bariatric surgery. Obes Surg. 1998;8(3):300–1.

    Article  PubMed  Google Scholar 

  15. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  16. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Joined up clinical pathways for obesity: report of the working group. http://www.england.nhs.uk/wp-content/uploads/2014/03/owg-join-clinc-path.pdf.

  18. Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery: initial results from a randomized, controlled trial. Obesity (Silver Spring). 2013;21(2):254–60.

    Article  CAS  Google Scholar 

  19. Goldberg RF, Parker M, Stauffer JA, et al. Surgeon’s requirement for obesity reduction: its influence on weight loss. Am Surg. 2012;78(3):325–8.

    PubMed  Google Scholar 

  20. Gibbons LM, Sarwer DB, Crerand CE, et al. Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery? Surg Obes Relat Dis. 2006;2(2):159–64.

    Article  PubMed  Google Scholar 

  21. 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. 2012;26(3):853–61.

    Article  PubMed  Google Scholar 

  22. Orth WS, Madan AK, Ternovits CA, et al. Effect of preoperative knowledge on weight loss after laparoscopic gastric bypass. Obes Surg. 2008;18(7):768–71.

    Article  PubMed  Google Scholar 

  23. Jantz EJ, Larson CJ, Mathiason MA, et al. 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. 2009;5(2):208–11.

    Article  PubMed  Google Scholar 

  24. Leahey TM, Bond DS, Irwin SR, et al. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Surg Obes Relat Dis. 2009;5(1):99–102.

    Article  PubMed  Google Scholar 

  25. Madan AK, Dhawan N, Coday M, et al. Patients who are delayed from undergoing bariatric surgery do not have improved weight loss. Obes Surg. 2008;18(3):278–81.

    Article  PubMed  Google Scholar 

  26. Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013;368(4):351–64.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Haskins IN, Amdur R, Vaziri K. The effect of smoking on bariatric surgical outcomes. Surg Endosc. 2014;28(11):3074–80.

    Article  PubMed  Google Scholar 

  28. Coblijn UK, Goucham AB, Lagarde SM, et al. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors, and patient presentation: a systematic review. Obes Surg. 2014;24(2):299–309.

    Article  PubMed  Google Scholar 

  29. Lent MR, Hayes SM, Wood GC, et al. Smoking and alcohol use in gastric bypass patients. Eat Behav. 2013;14(4):460–3.

    Article  PubMed  Google Scholar 

  30. Adams CE, Gabriele JM, Baillie LE, et al. Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery. J Behav Health Serv Res. 2012;39(4):462–71.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Statement of Informed Consent

This statement does not apply.

Author Contribution

KM conceived the idea for the topic and wrote the manuscript. All authors participated in discussions on the topic. All authors have seen the final version and approve of it.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kamal K. Mahawar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahawar, K.K., Parmar, C., Carr, W.R.J. et al. Preoperative Interventions for Patients Being Considered for Bariatric Surgery: Separating the Fact from Fiction. OBES SURG 25, 1527–1533 (2015). https://doi.org/10.1007/s11695-015-1738-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1738-z

Keywords

Navigation