Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in a more effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss.
All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1 year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL.
Total weight loss after 1, 6, and 12 months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001).
Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12 months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
Collaboration NRF. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377-96.
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.
Watanabe A, Seki Y, Haruta H, et al. Preoperative weight loss and operative outcome after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(10):2515–21.
Giordano S, Victorzon M. The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg. 2014;24(5):669–74.
Gerber P, Anderin C, Gustafsson UO, et al. Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian Obesity Registry (SOReg). Surgery for Obesity and Related Diseases. 2016;12(3):556–62.
Al-Khyatt W, Ryall R, Leeder P, et al. Predictors of inadequate weight loss after laparoscopic gastric bypass for morbid obesity. Obes Surg. 2017;27(6):1446–52.
Hutcheon DA, Hale AL, Ewing JA, et al. Short-term preoperative weight loss and postoperative outcomes in bariatric surgery. J Am Coll Surg. 2018;226(4):514–24.
Kraus R, Stekhoven DJ, Leupold U, et al. Linear mixed effects analysis reveals the significant impact of preoperative diet success on postoperative weight loss in gastric bypass surgery. Obes Surg. 2018;28(8):2473–80.
Lodewijks Y, Akpinar E, van Montfort G, Nienhuijs S. Impact of Preoperative Weight Loss on Postoperative Weight Loss Revealed from a Large Nationwide Quality Registry. Obes Surg. 2022;32(1):26-32.
Ruiz-Tovar J, Boix E, Bonete JM, et al. Effect of preoperative eating patterns and preoperative weight loss on the short- and mid-term weight loss results of sleeve gastrectomy. Cir Esp. 2015;93(4):241–7.
Steinbeisser M, McCracken J, Kharbutli B. Laparoscopic sleeve gastrectomy: preoperative weight loss and other factors as predictors of postoperative success. Obes Surg. 2017;27(6):1508–13.
Anderin C, Gustafsson UO, Heijbel N, et al. Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Ann Surg. 2015;261(5):909–13.
Benotti PN, Still CD, Wood GC, et al. Preoperative weight loss before bariatric surgery. Arch Surg. 2009;144(12):1150–5.
Gilbertson NM, Paisley AS, Kranz S, et al. Bariatric surgery resistance: using preoperative lifestyle medicine and/or pharmacology for metabolic responsiveness. Obes Surg. 2017;27(12):3281–91.
Holderbaum MS, Buss C. Dietary management in the immediate preoperative period of bariatric surgery: a national overview : bariatric preoperative diets. Obes Surg. 2018;28(6):1688–96.
Hutcheon DA, Byham-Gray LD, Marcus AF, et al. Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks. Surg Obes Relat Dis. 2017;13(6):1041–51.
Holderbaum M, Casagrande DS, Sussenbach S, et al. Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review. Surg Obes Relat Dis. 2018;14(2):237–44.
Schiavo L, Pilone V, Rossetti G, et al. A 4-week preoperative ketogenic micronutrient-enriched diet is effective in reducing body weight, left hepatic lobe volume, and micronutrient deficiencies in patients undergoing bariatric surgery: a prospective pilot study. Obes Surg. 2018;28(8):2215–24.
Pilone V, Tramontano S, Renzulli M, et al. Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery. Surg Obes Relat Dis. 2018;14(7):1013–9.
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. 2018;28(11):3678–90.
Gils Contreras A, BonadaSanjaume A, Montero Jaime M, et al. Effects of two preoperatory weight loss diets on hepatic volume, metabolic parameters, and surgical complications in morbid obese bariatric surgery candidates: a randomized clinical trial. Obes Surg. 2018;28(12):3756–68.
Jacobs A, Liem RSL, Janssen IMC, et al. Weight loss after bariatric surgery: a comparison between delayed and immediate qualification according to the last resort criterion. Surg Obes Relat Dis. 2021;17(4):718–25.
Tewksbury C, Williams NN, Dumon KR, et al. Preoperative medical weight management in bariatric surgery: a review and reconsideration. Obes Surg. 2017;27(1):208–14.
Sun Y, Liu B, Smith JK, et al. Association of preoperative body weight and weight loss with risk of death after bariatric surgery. JAMA Netw Open. 2020;3(5): e204803.
Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1):42–55.
Poelemeijer YQM, Liem RSL, Nienhuijs SW. A Dutch nationwide bariatric quality registry: DATO. Obes Surg. 2018;28(6):1602–10.
Lodewijks Y, Akpinar E, van Montfort G, Nienhuijs S. Impact of Preoperative Weight Loss on Postoperative Weight Loss Revealed from a Large Nationwide Quality Registry. Obes Surg. 2021.
Tan SYT, Loi PL, Lim CH, et al. Preoperative weight loss via very low caloric diet (VLCD) and its effect on outcomes after bariatric surgery. Obes Surg. 2020;30(6):2099–107.
Kuwada TS, Richardson S, El Chaar M, et al. Insurance-mandated medical programs before bariatric surgery: do good things come to those who wait? Surg Obes Relat Dis. 2011;7(4):526–30.
Blackledge C, Graham LA, Gullick AA, et al. Outcomes associated with preoperative weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2016;30(11):5077–83.
Eisenberg D, Duffy AJ, Bell RL. Does Preoperative Weight Change Predict Postoperative Weight Loss after Laparoscopic Roux-en-Y Gastric Bypass in the Short Term? J Obes. 2010;2010:907097.
McNickle AG, Bonomo SR. Predictability of first-year weight loss in laparoscopic sleeve gastrectomy. Surg Endosc. 2017;31(10):4145–9.
Parmar AD, Drosdeck JM, Mattar SG, et al. Impact of preoperative weight loss on postoperative weight loss after sleeve gastrectomy. Bariatric Surgical Practice and Patient Care. 2018;13(2):69–74.
Parri A, Benaiges D, Schröder H, et al. Preoperative predictors of weight loss at 4 years following bariatric surgery. Nutr Clin Pract. 2015;30(3):420–4.
Sherman WE, Lane AE, Mangieri CW, et al. Does preoperative weight change predict postoperative weight loss after laparoscopic sleeve gastrectomy? Bariatr Surg Pract Patient Care. 2015;10(3):126–9.
Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.
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.
Herzog K, Berggren J, Al Majdoub M, et al. Metabolic effects of gastric bypass surgery: is it all about calories? Diabetes. 2020;69(9):2027.
Zhang L, Tan WH, Chang R, et al. Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1316–20.
Sarela AI, Dexter SP, McMahon MJ. Use of the obesity surgery mortality risk score to predict complications of laparoscopic bariatric surgery. Obes Surg. 2011;21(11):1698–703.
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.
Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146(11):1300–5.
For this type of study, formal consent is not required. This study was approved by the Institutional Review Board of the Zuyderland Medical Center.
Statement of Informed Consent
Informed Consent does not apply.
Conflict of Interest
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
• Higher preoperative weight loss is associated with greater weight loss.
• Extra preoperative support for younger and diabetic patients is recommended.
• Nutritional counseling and weight measurement in the weeks before surgery is advised.
Below is the link to the electronic supplementary material.
About this article
Cite this article
Romaen, I.F.L., Jense, M.T.F., Palm-Meinders, I.H. et al. Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery. OBES SURG 32, 2860–2868 (2022). https://doi.org/10.1007/s11695-022-06176-9