Skip to main content
SpringerLink
Log in

A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

We designed an assessment and education program which was delivered to patients prior to first outpatient appointment for bariatric surgery. We hypothesised that this program would streamline care and would lead to improved weight loss following bariatric surgery.

Methods

The program incorporates a structured general practitioners (GP) review, a patient information evening and an on-line learning package. It was introduced in September 2012. Patient flow through the program was recorded. Outcomes of the new program were compared with contemporaneously treated patients who did not undertake the pre-hospital program.

Results

All 636 patients on the waiting list for first appointment at the Alfred Health bariatric surgery clinic were invited to participate. There were 400 patients ultimately removed from the waiting list for first appointment. Of the remaining 236 patients, 229 consented to participate in the new program. The mean BMI was 47.8 ± 9.2. The fail to attend first appointment rate dropped from 12 to 2.1 %. At 12 months post-bariatric surgery, patients who undertook the new program (n = 82) had a mean excess weight loss (EWL) of 41.1 ± 20.3 % where as those treated on the standard pathway (n = 61) had a mean EWL 32 ± 18.0 % (p = 0.012).

Conclusions

The introduction of a pre-hospital education program has led to an improvement in attendance rates and early weight loss post-bariatric surgery.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity (Review). Cochrane Rev. 2009.

  2. Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman JL, Magnus A, et al. Assessing cost-effectiveness in prevention (ACE–Prevention): final report. University of Queensland and Deakin University; 2010.

  3. Peeters A, O’Brien PE, Laurie C, et al. Substantial intentional weight loss and mortality in the severely obese. Ann Surg. 2007;246(6):1028–33.

    Article  PubMed  Google Scholar 

  4. Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32(4):567–74.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Neff KJH, le Roux C. Bariatric surgery: a best practice article. J Clin Pathol. 2013;66(2):90–8.

    Article  PubMed  Google Scholar 

  6. Aronne LJ, Wadden T, Isoldi KK, et al. When prevention fails: obesity treatment strategies. Am J Med. 2009;122(4, Supplement 1):I-CO4.

    Article  Google Scholar 

  7. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S–5.

    CAS  PubMed  Google Scholar 

  8. Balduf L, Kohn G, Galanko J, et al. The impact of socioeconomic factors on patient preparation for bariatric surgery. Obes Surg. 2009;19(8):1089–95.

    Article  PubMed  Google Scholar 

  9. Apovian C, Cummings S, Anderson W, et al. Best practice updates for multidisciplinary care in weight loss surgery. Obesity. 2009;17(5):871–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dixon JB, Laurie CP, Anderson ML, et al. Motivation, readiness to change, and weight loss following adjustable gastric band surgery. Obesity (Silver Spring). 2009;17(4):698–705.

    Article  Google Scholar 

  11. Kim HJ, Madan A, Fenton-Lee D. Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg. 2014;24(4):647–51.

    Article  PubMed  Google Scholar 

  12. Shen R, Dugay G, Rajaram K, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9.

    Article  PubMed  Google Scholar 

  13. Edye M, Talbot ML. Inequalities of access to bariatric surgery in Australia. Med J Aust. 2014;201(9):502–3.

    Article  PubMed  Google Scholar 

  14. Sharman MJ, Hensher M, Wilkinson S, Campbell JA, Venn AJ. Review of publicly-funded bariatric surgery policy in Australia—lessons for more comprehensive policy making. Obes Surg. 2015.

  15. Gearon E, Backholer K, Stevenson C, et al. Trends in body mass index according to educational attainment for urban Australian adults between 1980 and 2007. Int J Obes (Lond). 2015;39(6):1019–26.

    Article  CAS  Google Scholar 

  16. Keating C, Backholer K, Gearon E, Stevenson C, Swinburn B, Moodie M, et al. Prevalence of class-I, class-II and class-III obesity in Australian adults between 1995 and 2011–12. Obes Res Clin Pract. 2015.

  17. Burton P, Brown W, Chen R, Shaw K, Packiyanathan A, Bringmann I, et al. Outcomes of high-volume bariatric surgery in the public system. ANZ J Surg. 2015.

  18. Wadden TA, Neiberg RH, Wing RR, et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity. 2011;19(10):1987–98.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lewis VJ. Approaches to permanent weight control. Appetite. 1991;17(2):162.

    Article  CAS  PubMed  Google Scholar 

  20. Tate D, Finkelstein E, Khavjou O, et al. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38(1):40–5.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. Jama. 2003;289(14):1833–6.

    Article  PubMed  Google Scholar 

  22. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. Jama. 2001;285(9):1172–7.

    Article  CAS  PubMed  Google Scholar 

  23. Richardson C, Buis L, Janney A, et al. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12(4):e71-e.

    Article  Google Scholar 

  24. Johnson F, Wardle J. The association between weight loss and engagement with a web-based food and exercise diary in a commercial weight loss program: a retrospective analysis. Int J Behav Nutr Phys Act. 2011;8(83):1–7.

    Google Scholar 

  25. O’Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94.

    Article  PubMed  Google Scholar 

  26. Dolan K, Hatzifotis M, Newbury L, et al. A comparison of laparoscopic adjustable gastric banding and biliopancreatic diversion in superobesity. Obes Surg. 2004;14(2):165–9.

    Article  PubMed  Google Scholar 

  27. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  PubMed  Google Scholar 

  28. Moroshko I, Brennan L, O’Brien P. Predictors of attrition in bariatric aftercare: a systematic review of the literature. Obes Surg. 2012;22(10):1640–7.

    Article  PubMed  Google Scholar 

  29. Whitty JA, Ratcliffe J, Kendall E, et al. Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy. BMJ Open. 2015;5(10), e008919.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Brown WA, Moszkowicz J, Brennan L, et al. Pre-operative weight loss does not predict weight loss following laparoscopic adjustable gastric banding. Obes Surg. 2013;2:2.

    Google Scholar 

  31. Chevallier JM, Zinzindohoue F, Elian N, et al. Adjustable gastric banding in a public university hospital: prospective analysis of 400 patients. Obes Surg. 2002;12(1):93–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Upper Gastrointestinal Surgical Service, The Alfred, Commercial Road, Melbourne, 3004, Australia

    Wendy A. Brown, Paul R. Burton, Kalai Shaw, Shelley Maffescioni & Peter Nottle

  2. Centre for Obesity Research and Education, Monash University School of Public Health and Preventative Medicine, Level 6, 99 Commercial Road, Melbourne, 3004, Australia

    Wendy A. Brown, Paul R. Burton, Brittany Smith & Cheryl Laurie

  3. Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3004, Australia

    Wendy A. Brown & Paul R. Burton

  4. CEO’s office/Surgical Services, The Alfred, Commercial Road, Melbourne, 3004, Australia

    Bernadette Comitti & Andrew Way

  5. Monash Obesity and Diabetes Institute, Monash University, Wellington Road, Clayton, 3800, Australia

    Michael A. Cowley

Authors
  1. Wendy A. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul R. Burton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kalai Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brittany Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shelley Maffescioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernadette Comitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael A. Cowley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cheryl Laurie
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrew Way
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Peter Nottle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wendy A. Brown.

Ethics declarations

Conflict of Interest

Professor Wendy Brown declared that her research group (Centre for Obesity Research and Education) receives funding from the manufacturer of the LapBand™ (Allergan and Apollo Endosurgical) as well as from Applied Medical. None of the funding for this study came from these sources; this study was internally funded by the Alfred Hospital through the Alfred Foundation and a Monash University small grant.

Professor Cowley reports grants and personal fees from Novo Nordisk, personal fees and other from Orexigen Therapeutics. None of these relationships are associated with the submitted work.

Dr. Paul Burton reports an honorarium from Covidien which does not apply to the submitted work.

A/Prof Andrew Way, A/Prof Peter Nottle, Ms. Kalai Shaw, Ms. Bernadette Comitti, Ms. Brittany Smith, Ms. Cheryl Laurie and Ms. Shelley Maffescioni have no interests to declare.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown, W.A., Burton, P.R., Shaw, K. et al. A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery. OBES SURG 26, 2074–2081 (2016). https://doi.org/10.1007/s11695-016-2075-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2075-6

Keywords

Search

Navigation