Pre-Op weight loss improves WLS outcomes

[Creekimp13 5,838]

https://www.hospimedica.com/surgical-techniques/articles/294773291/pre-op-weight-loss-improves-bariatric-surgery-outcomes.html

[Losingit2018 1,170]

That study was conducted by my group of Drs. that did my surgery and is the regimen that I followed pre op.

Cool.

[brightfaith 187]

Thank you for sharing this. I lost about 25% of my body weight in the 8 months prior to surgery and this makes me hopeful that I’ll continue to do well now that I’ve had surgery. I do think that my recovery was much better because of this weight loss and as a result of daily exercise since November. My recovery has been amazingly smooth so far; I’m fortunate.

[blizair09 3,250]

Good article.

I lost 99 of my 227 pounds during the six month pre-op diet program. It set me on the right path, helped me to get to goal within one year post-op, and helped me to redefine my relationship with food before the surgery.

It was the best thing I did for myself.

[MistyAlli 8]

Good article! So glad to hear all of the hard work leading up tho the surgery is sooo beneficial in more ways than one! Thanks for posting!

[RickM 1,747]

I'm not so sure that they are drawing a valid conclusion from their study (or at least the headline isn't.) By giving their population a common diet (1200 calories, etc.) and dividing them into those who lost more than 8%EW and those who lost less than 8%, they are effectively grouping their patients into those who lose weight more or less easily (implicitly by differing metabolic rates), and it doesn't seem like a profound conclusion that those who lose more easily pre-op will lose more easily post-op. Further evidence of this is that their male patients did better than their female patients, which also isn't overly profound as men typically have higher metabolic rates than women, so they do tend to lose more on a given diet plan.

The implied headline conclusion that dieting and losing weight pre-op leads to better post-op loss really doesn't follow. For that, you need to look at two randomly chosen groups, one of which follows some prescribed diet program and the other that does nothing special, and then look at the post-op results. Another question not answered is whether the imposed diet provides any long term benefit toward maintaining a healthy weight once the weight is lost

I'm not saying that there are not benefits to getting one's head together and establishing good habits ahead of time, but that imposing yet another diet on people who have an established pattern of failing at diets is of questionable value.

I had to do the common six month insurance program, but the focus was on developing good dietary and lifestyle habits rather than any particular weight loss goals, and the loss followed with the improved habits - which flowed through the post-op period and into the long term maintenance period. Learning long term weight control is much more valuable than a dubious improvement in short term loss rate.

[Creekimp13 5,838]

The study was published in the April 2018 issue of the Journal of the American College of Surgeons (JACS).

[Losingit2018 1,170]

2 hours ago, RickM said:

I'm not so sure that they are drawing a valid conclusion from their study (or at least the headline isn't.) By giving their population a common diet (1200 calories, etc.) and dividing them into those who lost more than 8%EW and those who lost less than 8%, they are effectively grouping their patients into those who lose weight more or less easily (implicitly by differing metabolic rates), and it doesn't seem like a profound conclusion that those who lose more easily pre-op will lose more easily post-op. Further evidence of this is that their male patients did better than their female patients, which also isn't overly profound as men typically have higher metabolic rates than women, so they do tend to lose more on a given diet plan.

The implied headline conclusion that dieting and losing weight pre-op leads to better post-op loss really doesn't follow. For that, you need to look at two randomly chosen groups, one of which follows some prescribed diet program and the other that does nothing special, and then look at the post-op results. Another question not answered is whether the imposed diet provides any long term benefit toward maintaining a healthy weight once the weight is lost

I'm not saying that there are not benefits to getting one's head together and establishing good habits ahead of time, but that imposing yet another diet on people who have an established pattern of failing at diets is of questionable value.

I had to do the common six month insurance program, but the focus was on developing good dietary and lifestyle habits rather than any particular weight loss goals, and the loss followed with the improved habits - which flowed through the post-op period and into the long term maintenance period. Learning long term weight control is much more valuable than a dubious improvement in short term loss rate.

I get what you are saying but, this group does teach good nutrition and lifelong skills needed to succeed as well as requiring the 4 week pre op diet. My thinking is that it speaks more about the fact that people that actually follow the pre op diet are more likely to follow the post op diet/instructions. As for having a better outcome when losing weight pre op, the surgery is safer and not as many complications if the patient loses weight pre op.

I could be wrong. I will have to take another look at it tomorrow.

Edited May 8, 2018 by Yoyogirl

[Apple203 1,314]

Nice! Especially since I lost 15%, haha.

[FluffyChix 17,409]

7 hours ago, RickM said:

I'm not so sure that they are drawing a valid conclusion from their study (or at least the headline isn't.) By giving their population a common diet (1200 calories, etc.) and dividing them into those who lost more than 8%EW and those who lost less than 8%, they are effectively grouping their patients into those who lose weight more or less easily (implicitly by differing metabolic rates), and it doesn't seem like a profound conclusion that those who lose more easily pre-op will lose more easily post-op. Further evidence of this is that their male patients did better than their female patients, which also isn't overly profound as men typically have higher metabolic rates than women, so they do tend to lose more on a given diet plan.

The implied headline conclusion that dieting and losing weight pre-op leads to better post-op loss really doesn't follow. For that, you need to look at two randomly chosen groups, one of which follows some prescribed diet program and the other that does nothing special, and then look at the post-op results. Another question not answered is whether the imposed diet provides any long term benefit toward maintaining a healthy weight once the weight is lost

I'm not saying that there are not benefits to getting one's head together and establishing good habits ahead of time, but that imposing yet another diet on people who have an established pattern of failing at diets is of questionable value.

I had to do the common six month insurance program, but the focus was on developing good dietary and lifestyle habits rather than any particular weight loss goals, and the loss followed with the improved habits - which flowed through the post-op period and into the long term maintenance period. Learning long term weight control is much more valuable than a dubious improvement in short term loss rate.

Yep, you make VERY valid points! And how would you sort this for confounding factors like that? Think it's a poorly designed study.

It also assumes that everyone can lose weight on 1200 cals. Some can't.

[GreenTealael 24,864]

Hmmm interesting

I lost weight prior to surgery , developed healthier habits , increased Water intake, I'm at about 1200 cals daily

yet my post op weight loss is slow, where would I fall in this study ?

HW 270

SW 238

CW 188

VSG 11/7

[emoji471][emoji471][emoji471]

[jess9395 5,448]

Correlation is not causation. Random assignment is necessary in experimental design to determine cause.

Hopefully they will continue to research whether pre op weight loss does improve outcomes.

I didn’t have a pre op diet. I lost more than 100% of my weight and have kept it off. I know others with pre op success have as well.

[FluffyChix 17,409]

^^^^THIS! Maybe my favorite quote evs! "Correlation is not causation."

[Kay07 734]

It also assumes that everyone can lose weight on 1200 cals. Some can't.

^^ this is very important. I notice that pre-op, if my calories fall below 1300 my weight STALLS hardcore. If I manage to get 1500-1600 I lose quicker. My metabolism is shot. It’s one of the reasons both my doctor and I believe my weight loss will be on the slower side and so I’ve mentally prepared myself for a cross country race to the healthy line instead of a sprint

[RickM 1,747]

7 hours ago, Losingit2018 said:

I get what you are saying but, this group does teach good nutrition and lifelong skills needed to succeed as well as requiring the 4 week pre op diet. My thinking is that it speaks more about the fact that people that actually follow the pre op diet are more likely to follow the post op diet/instructions. As for having a better outcome when losing weight pre op, the surgery is safer and not as many complications if the patient loses weight pre op.

I could be wrong. I will have to take another look at it tomorrow.

Teaching nutrition and sustainable weight control is great, and I really hope that they are doing that - not just the "diet of the day". Compliance is a factor as well, and that is, I believe, one of the issues that this study can point to - those that are non-compliant with the pre-op program will likely have compliance problems post-op.

This can be a good tool in identifying potential problems. Compliance is an issue, and can can point to the need for either additional psych or nutritional therapy or counseling. depending upon where the compliance problem is. If the diet is overly restrictive, that's a problem, but a good RD should be able to tailor a diet around a patient's preferences and aversions. This is not to say that they should allow a 1200 calorie Twinkie diet, but there are a lot of healthy ways to craft a low calorie diet - a Mediterranean diet, as good as it may be, won't work with our family, for instance, due to its' inherent fishiness, but that's ok because there are other approaches that work well, too.

It can also point to metabolic problems - as others have noted, some do better on a 1200 calorie diets than others. Some, particularly shorter women who inherently have less muscle mass to drive their metabolism, will ultimately be maintaining at 1200 calories (and sometimes less) which can make sustainable maintenance a problem for many - they can't keep it that low and the weight creeps back up again. This factor can help drive a decision as to which procedure may be most appropriate for a particular patient - the DS, for instance, is a stronger metabolic tool and typically has better regain resistance than the VSG or RNY, so is often a better choice for those with significant metabolic problems or a long history of yo-yo dieting. There isn't a one-size-fits-all solution.

On the flip side, over the years that I have been involved in this, I haven't seen much evidence that pre-op diets have much of an influence over long term success in weight control (as in 5-10 years out and beyond.) Many programs include pre-op diets of some kind, while many others don't, and many patients will struggle with regain problems after a couple or years or so, and observationally at least, it is real hard to pre-op dieting or lack thereof as being a factor. I am familiar with several programs that don't do any such dieting yet they have very good long term results. It would be real hard to craft a study to evaluate this while isolating the multitude of confounders,

In short, there is a lot of benefit to good nutritional counseling and education as part of a good WLS program, and helping patients learn new and better lifestyle habits, but I remain skeptical of the value of imposed pre-op dieting in regard to long term success.