The Efficacy of Energy-Restricted Diets in Achieving Preoperative Weight Loss for Bariatric Patients: a Systematic Review

Abstract

In bariatric practice, a preoperative weight loss of at least 5% is recommended. However, the hypocaloric diets prescribed vary and no consensus exists. This study examined the efficacy of preoperative diets in achieving 5% weight loss. From a systematic literature search, eight randomised controlled trials (n = 862) were identified. Half of the trials used a “very-low-calorie diet” whilst the rest employed a “low-calorie diet”. Only five diets achieved ≥ 5% weight loss over varying durations and energy intakes. By inference, compliance with a 700–1050 kcal (2929–4393 kJ) diet, consisting of moderate carbohydrate, high protein and low/moderate fat, for 3 weeks is likely to achieve 5% weight loss. A low-carbohydrate diet (< 20 g/day) may achieve this target within a shorter duration. Additional research is required to validate these conclusions.

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References

  1. 1.

    Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, et al. Foresight tackling obesities: future choices – project report. Government Office for Science. 2007.

  2. 2.

    Kim JJ, Rogers AM, Ballem N, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955–9.

    Article  PubMed  Google Scholar 

  3. 3.

    Ng M, Fleming T, Robinson M, et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: a systematic analysis. Lancet. 2014;384(9945):766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Pasco JA, Nicholson GC, Brennan SL, et al. Prevalence of obesity and the relationship between the body mass index and body fat: cross-sectional, population-based data. PLoS One. 2012;7(1):e29580.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    World Health Organisation. Obesity and overweight [Internet]. 2017. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/

  6. 6.

    American Diabetes Association. Standards of medical care in diabetes 2016 abridged for primary care providers. Clin Diabetes. 2016;34(1):3–21.

    Article  PubMed Central  Google Scholar 

  7. 7.

    National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia [Internet]. Commonwealth of Australia 2013. Canberra. 2013. Available from: https://www.nhmrc.gov.au/guidelines-publications/n57

  8. 8.

    National Institute for Health and Care Execellence. Obesity: identification, assessment and management - clinical guideline [CG189] [Internet]. 2014. Available from: https://www.nice.org.uk/guidance/cg189

  9. 9.

    Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.

    Article  PubMed  Google Scholar 

  10. 10.

    Schmidt JB, Pedersen SD, Gregersen NT, et al. Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial. Int J Obes. 2013;40(2):1–10.

    Google Scholar 

  11. 11.

    Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357, iii–iv

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Runkel N, Colombo-Benkmann M, Hüttl TP, et al. Evidence-based German guidelines for surgery for obesity. Int J Color Dis. 2011;26(4):397–404.

    Article  Google Scholar 

  13. 13.

    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. Surg Obes Relat Dis. 2013;9(2):159–91.

    Article  PubMed  Google Scholar 

  14. 14.

    Remedios C, Bhasker AG, Dhulla N, et al. Bariatric nutrition guidelines for the Indian population. Obes Surg. 2016;26(5):1057–68.

    Article  PubMed  Google Scholar 

  15. 15.

    Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065–83.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14(9):1165–70.

    Article  PubMed  Google Scholar 

  18. 18.

    van Wissen J, Bakker N, Doodeman HJ, et al. Preoperative methods to reduce liver volume in bariatric surgery: a systematic review. Obes Surg. 2016;26(2):251–6.

    Article  PubMed  Google Scholar 

  19. 19.

    Schwartz ML, Drew RL, Chazin-Caldie M. Factors determining conversion from laparoscopic to open Roux-en-Y gastric bypass. Obes Surg. 2004;14(9):1193–7.

    Article  PubMed  Google Scholar 

  20. 20.

    Schwartz ML, Drew RL, Chazin-Caldie M. Laparoscopic Roux-en-Y gastric bypass: preoperative determinants of prolonged operative times, conversion to open gastric bypasses, and postoperative complications. Obes Surg. 2003;13(5):734–8.

    Article  PubMed  Google Scholar 

  21. 21.

    Brody F, Vaziri K, Garey C, et al. Preoperative liver reduction utilizing a novel nutritional supplement. J Laparoendosc Adv Surg Tech. 2011;21(6):491–5.

    Article  Google Scholar 

  22. 22.

    Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast® very low calorie diet. Obes Surg. 2006;16(6):697–701.

    Article  PubMed  Google Scholar 

  23. 23.

    Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345–50.

    Article  PubMed  Google Scholar 

  24. 24.

    Ross LJ, Wallin S, Osland EJ, et al. Commercial very low energy meal replacements for preoperative weight loss in obese patients: a systematic review. Obes Surg. 2016;26(6):1343–51.

    Article  PubMed  Google Scholar 

  25. 25.

    Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for comprehensive medical care of patients with obesity – executive summary. Endocr Pract. 2016;22(7):842–84.

    Article  PubMed  Google Scholar 

  26. 26.

    Lu Y, Hajifathalian K, Ezzati M, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. Lancet. 2014;383(9921):970–83.

    Article  PubMed  Google Scholar 

  27. 27.

    Hanazaki K, Maeda H, Okabayashi T. Relationship between perioperative glycemic control and postoperative infections. World J Gastroenterol. 2009;15(33):4122–5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Nomikos IN, Sidiropoulos A, Vamvakopoulou DN, et al. Surgical complications of hyperglycaemia. Curr Diabetes Rev. 2009;5(2):145–50.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    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 

  30. 30.

    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 

  31. 31.

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

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Kadeli DK, Sczepaniak JP, Kumar K, Youssef C, Mahdavi A, Owens M. The effect of preoperative weight loss before gastric bypass: a systematic review. J Obes. 2012;2012(Article ID 867540).

  33. 33.

    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.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Adrianzén Vargas M, Cassinello Fernández N, Ortega Serrano J. Preoperative weight loss in patients with indication of bariatric surgery: which is the best method? Nutr Hosp. 2011;26:1227–30.

    PubMed  Google Scholar 

  35. 35.

    Baldry EL, Leeder PC, Idris IR. Pre-operative dietary restriction for patients undergoing bariatric surgery in the UK: observational study of current practice and dietary effects. Obes Surg. 2014;24(3):416–21.

    Article  PubMed  Google Scholar 

  36. 36.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1).

  37. 37.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Vol. 6, PLoS Med. 2009.

  38. 38.

    Miller S, Forrest J. Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. J Evid Based Dent Pract. 2001;1(2):136–41.

    Article  Google Scholar 

  39. 39.

    Clarivate Analytics. EndNote [Internet]. 2017. Available from: http://endnote.com/

  40. 40.

    Centre for Reviews and Dissemination. Systematic reviews: CRD’s guidance for undertaking systematic reviews in health care [Internet]. University of York. 2009. Available from: https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf

  41. 41.

    Downs S, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Katrak P, Bialocerkowski AE, Massy-Westropp N, et al. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol. 2004;4(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Schutz T, Peter V, Garnov N, et al. Effect of two preoperative low energy diets on liver volume in bariatric patients: a randomized trial. Obes Facts. 2014;7:83.

    Google Scholar 

  44. 44.

    Chakravartty S, Sidhu P, Vivian G, et al. Randomised controlled trial on pre-operative liver shrinking diet on peri-operative outcomes in patients undergoing gastric bypass: is it time to change our practice? Obes Surg. 2014;24(8):1141.

    Google Scholar 

  45. 45.

    Baldry E, Aithal G, Kaye P, et al. Effects of short-term energy restriction on liver lipid content and inflammatory status in severely obese adults: results of a randomised controlled trial (RCT) using two dietary approaches. Diabetes Obes Metab. 2017;19(8):1179–83.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Nielsen LV, Nielsen MS, Schmidt JB, et al. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery. J Nutr Sci. 2016;5:e22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Schouten R, van der Kaaden I, van’t Hof G, et al. Comparison of preoperative diets before bariatric surgery: a randomized, single-blinded, non-inferiority trial. Obes Surg. 2016;26(8):1743–9.

    Article  PubMed  Google Scholar 

  48. 48.

    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.

    CAS  Article  Google Scholar 

  49. 49.

    Heinberg LJ, Schauer PR. Pilot testing of a portion-controlled, commercially available diet on presurgical weight loss and metabolic outcomes in patients undergoing bariatric surgery. Obes Surg. 2014;24(10):1817–20.

    Article  PubMed  Google Scholar 

  50. 50.

    Faria SL, Faria OP, Cardeal MDA, et al. Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial. Surg Obes Relat Dis. 2015;11(1):230–7.

    Article  PubMed  Google Scholar 

  51. 51.

    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.

    CAS  Article  Google Scholar 

  52. 52.

    Mulholland Y, Nicokavoura E, Broom J, et al. Very-low-energy diets and morbidity: a systematic review of longer-term evidence. Br J Nutr. 2012;108(5):832–51.

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity. 2006;14(8):1283–93.

    Article  PubMed  Google Scholar 

  54. 54.

    Disease NI of D and D and K. Very low calorie diets [Internet]. 2012. Available from: https://www.niddk.nih.gov/health-information/weight-management/very-low-calorie-diets

  55. 55.

    Mendez MA, Wynter S, Wilks R, et al. Under- and overreporting of energy is related to obesity, lifestyle factors and food group intakes in Jamaican adults. Public Health Nutr. 2004;7(1):9–19.

    Article  PubMed  Google Scholar 

  56. 56.

    Ferrari P, Slimani N, Ciampi A, et al. Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European prospective investigation into cancer and nutrition (EPIC). Public Health Nutr. 2002;5(6b):1329–45.

    CAS  Article  PubMed  Google Scholar 

  57. 57.

    Joo NS, Lee DJ, Kim KM, et al. Ketonuria after fasting may be related to the metabolic superiority. J Korean Med Sci. 2010;25(12):1771–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Brinkworth GD, Buckley JD, Noakes M, et al. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Arch Intern Med. 2009;169(20):1873–80.

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    Martin CK, Rosenbaum D, Han H, et al. Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet. Obesity. 2011;19(10):1963–70.

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Westerterp-Plantenga MS, Lemmens SG, Westerterp KR. Dietary protein - its role in satiety, energetics, weight loss and health. Br J Nutr. 2012;108(SUPPL. 2):S105–12.

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    British Dietetic Association. BDA Dietary Fat Consumption in the Management of Type 2 Diabetes Policy Statement [Internet]. 2015. Available from: https://www.bda.uk.com/news/view?id=95

  62. 62.

    Colica C, Merra G, Gasbarrini A, et al. Efficacy and safety of very-low-calorie ketogenic diet: a double blind randomized crossover study. Eur Rev Med Pharmacol Sci. 2017;21(9):2274–89.

    CAS  PubMed  Google Scholar 

  63. 63.

    Pogozelski W, Arpaia N, Priore S. The metabolic effects of low-carbohydrate diets and incorporation into a biochemistry course. Biochem Mol Biol Educ. 2005;33(2):91–100.

    CAS  Article  PubMed  Google Scholar 

  64. 64.

    Thibault R, Pichard C. Overview on nutritional issues in bariatric surgery. Curr Opin Clin Nutr Metab Care. 2016;19(6):484–90.

    CAS  Article  PubMed  Google Scholar 

  65. 65.

    Nutrition SAC on. Carbohydrates and health. London; 2015.

  66. 66.

    Egger M, Smith GD. Meta-analysis bias in location and selection of studies. BMJ. 1998;316(7124):61–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Haldar S, Chia SC, Henry CJ. Body composition in Asians and Caucasians: comparative analyses and influences on cardiometabolic outcomes. Adv Food Nutr Res. 2015;75:97–154.

    Article  PubMed  Google Scholar 

  68. 68.

    Delbridge E, Proietto J. State of the science: VLED (very low energy diet) for obesity. Asia Pac J Clin Nutr. 2006;15(SUPPL. 1):49–54.

    CAS  PubMed  Google Scholar 

  69. 69.

    Dickersin K. The existence of publication bias and risk factors for its occurrence. JAMA. 1990;263(10):1385–9.

    CAS  Article  PubMed  Google Scholar 

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Naseer, F., Shabbir, A., Livingstone, B. et al. The Efficacy of Energy-Restricted Diets in Achieving Preoperative Weight Loss for Bariatric Patients: a Systematic Review. OBES SURG 28, 3678–3690 (2018). https://doi.org/10.1007/s11695-018-3451-1

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Keywords

  • Obesity
  • Bariatric surgery
  • Metabolic surgery
  • Low-calorie diet
  • Very-low-calorie diet