Can morbidly obese patients safely lose weight preoperatively?

Martin, Louis F.; Tan, Tjiauw Ling; Holmes, Pamela A.; Backer, Dolores A.; Horn, John R.; Bixler, Edward O.

doi:10.1016/s0002-9610(99)80145-7

Cited by 62 publications

(57 citation statements)

References 32 publications

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“…Below we summarize and discuss studies of preoperative weight loss requirements imposed by insurance carriers [10][11][12][13] and surgery centers. 2,[10][11][12][13][14][15][16][17][18][19][20] Few studies have evaluated the effect of current insurancemandated preoperative requirements, irrespective of actual preoperative weight change. The only relevant prospective study 10 found no benefit from a X6-month-mandated preoperative medical weight loss program.…”

Section: Resultsmentioning

confidence: 99%

“…Particularly under the supervision of a physician, nonsurgical weight loss has been shown to be safe. 14,17,[19][20][21][22]42 Therefore, it could be argued that preoperative weight loss poses little risk to patients, and is likely to improve their health preoperatively, regardless of whether it leads to improved postoperative outcome.…”

Section: Retrospectivementioning

confidence: 99%

“…This effect did not persist at 24-month follow-up; however, power may have been limited in 24-month analyses due to attrition. 27 There are also a number of studies reporting no relationship between pre-and postoperative weight change, 11,13,14,26,[27][28][29][30][31][32][33][34] including a prospective analysis 14 reporting no difference in weight loss outcome between preoperative dieters (n ¼ 47; losing an average of 7.8 kg) and non-dieters (n ¼ 53; no significant weight loss) across a 4-year follow-up. Several of the studies reporting no relationship do appear to be underpowered but do not provide adequate detail to conduct post-hoc power analyses.…”

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confidence: 99%

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Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies420 years old and studies that utilized selfreported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.

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Section: Resultsmentioning

confidence: 99%

Section: Retrospectivementioning

confidence: 99%

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confidence: 99%

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Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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“…Weight loss by obesity surgery (12,13), low-calorie diets (14), and very-lowenergy diets (VLEDs) (15,16) can reduce weight, liver steatosis, necroinflammatory change, and fibrosis. In the presurgical setting, a VLED provides the benefit of rapid weight loss (17), with no compromise to immune function (18) or wound healing (19), and few side effects (20).…”

Section: Introductionmentioning

confidence: 99%

Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging

Colles

Dixon

Marks

et al. 2006

The American Journal of Clinical Nutrition

289

153

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Background: A very-low-energy diet (VLED) can result in substantial, rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity. Despite its growing popularity, a VLED in this setting has received little attention. Objective: The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED. Design: In a prospective observational study, 32 subjects (n ҃ 19 men and 13 women) with a mean (ȀSD) age of 47.5 Ȁ 8.3 y and a body mass index (in kg/m 2 ) of 47.3 Ȁ 5.3 consumed a VLED for 12 wk. Primary outcomes included changes in liver volume (LV) and in visceral and subcutaneous adipose tissue (VAT/SAT). Changes in body weight, anthropometric measures, and biochemical variables were also recorded, and compliance with, acceptability of, and side effects of treatment were assessed. Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2, 4, 8, and 12. Results: Mean (ȀSD) LV, VAT/SAT, and body weight decreased significantly (P 0.001 for all). The degree of LV reduction was directly related to the reduction in relative body weight (r ҃ 0.54, P ҃ 0.001) and initial LV (r ҃ 0.43, P ҃ 0.015). Eighty percent of the reduction in LV occurred between weeks 0 and 2 (P 0.001). Reductions in body weight and VAT were uniform over the 12-wk period. Attrition was 14%. Acceptability was adequate but waned over time, and mild transitory side effects occurred. Conclusions: Given the observed early reduction in LV and the progressive reduction in VAT, we suggest that the minimum duration for a preoperative VLED be 2 wk. Ideally, the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability.Am J Clin Nutr 2006;84:304 -11.

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“…Again, some authors reported improved weight loss at time points varying between 6 and 24 months postoperatively (15,32,33). In other, no benefit in terms of postoperative weight development could be demonstrated in patients who were submitted to mandatory weight loss prior to bariatric surgery (30,34,35). In one of very few rCTs, Alami et al (18) reported no difference in excess body weight loss (EBWL) at 6 months postoperatively in patients assigned to 10% preoperative weight loss requirement compared to patients with no weight loss requirement.…”

Section: Postoperative Weight Lossmentioning

confidence: 99%

Weight loss prior to bariatric surgery: An updated review of the literature

2014

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Background and Aims: prior to bariatric surgery, a preoperative weight-reducing regimen is usually adhered to in most centers. the clinical effects of such a regimen are yet to be determined.Material and Methods: We reviewed the current literature by searching in pubMed for publications reporting clinical effects resulting from a preoperative weight loss regimen prior to bariatric surgery published from January 1, 1995 to april 30, 2014.Results: in total, we identified 23 original publications and 2 review articles which met all inclusion criteria. these were included and fully analyzed with regard to effects of preoperative weight loss. in general, for parameters such as operating time and intraoperative complications including blood loss and recovery, inconsistent data were reported. Most studies included low number of patients and with heterogenic designs, and the results could not form the base for recommendations. however, for outcomes such as postoperative complications and weight development over time, data from large-scale studies and randomized controlled trials suggest beneficial effects following adherence to weight loss prior to bariatric surgery.Conclusion: although a large amount of data in the current literature on the effects of weight loss prior to bariatric surgery are inconsistent for many outcome parameters, recently published results regarding effects on postoperative complications and weight development over time strongly suggest that such a regimen should be recommended. Whether a certain degree of weight loss should be mandatory before being accepted for bariatric surgery is, however, still controversial.

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Can morbidly obese patients safely lose weight preoperatively?

Cited by 62 publications

References 32 publications

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging

Weight loss prior to bariatric surgery: An updated review of the literature

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