Aim
To date there is no standardised pre-bariatric surgery management in Australian tertiary centres. The goal of this study was to evaluate the pre- and post-bariatric surgery weight loss outcomes in intensive versus lifestyle weight loss management clinics at a tertiary referral hospital.
Method
Retrospective analysis was conducted on 192 patients (49.8±10y, 70.8% female) who had bariatric surgery between 1/12/2009 (when the bariatric surgery service began) and 31/5/19. 166 patients attended a lifestyle programme (for those with BMI 35-55 kg/m2and living within 2 hours of clinic) and 26 patients attended an intensive diet modification clinic (BMI > 55 kg/m2or out of area). The lifestyle programme initially involved group education on diet, exercise and behaviour modification. In the Intensive programme patients were prescribed a very low-energy diet initially and followed fortnightly as a group. On completion of either program all subjects had individual reviews with a therapist. Weight was measured at all clinic visits, and post-operatively 3 monthly for the first 12 months.
Results
Pre-operatively, those at the intensive clinic had a higher average BMI 60.5 vs 50.3kg/m2(p<0.001) more comorbidities (2 vs 4, p<0.001) and were on more medications (4 vs 8, p=0.001). Pre-surgical %weight loss was greater in the intensively managed group, -11.1 ±7.6% versus -4.1 ±8.2% (p<0.0005). Post-operatively there was no significant difference in %weight loss from the surgery date to 12 months post-surgery (lifestyle vs intensive -24.6±9.4% vs -27.2±7.2%). However, there was greater weight loss from clinic entry to 12 months post-surgery in the intensively managed group (-36.40 ± 6.2% vs -27.76 ±1 0.8%, p=0.04).
Conclusion
Despite having a greater degree of obesity and more comorbidities, individuals in the intensive group achieved greater weight loss both pre-operatively and overall. Thus patients may be better managed before bariatric surgery with intensive dietary modification.