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S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric
Panagiotis Drakos1, Panagiotis Volteas2, Kevin Seeras2,3
1Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA. panagiotis.drakos@stonybrookmedicine.edu.
Insights
A structured support program did not improve bariatric surgery outcomes for patients with early suboptimal weight loss. Adherence to interventions was low, even when patients were aware of their poor progress in excess body weight loss.
Area of Science:
- Bariatric Surgery Outcomes
- Weight Management Interventions
- Postoperative Care
Background:
- Early postoperative weight loss is a key predictor of long-term bariatric surgery success.
- The potential for improvement in patients with initially poor weight loss through targeted support remains unclear.
Purpose of the Study:
- To assess the efficacy of a structured support program for bariatric surgery patients with below-average early weight loss.
- To determine the impact of this intervention on one-year outcomes, including excess body weight loss (%EWL), excess body mass index loss (%EBMIL), and total weight loss (%TWL).
Main Methods:
- A prospective randomized study involving 128 bariatric surgery patients with <50th percentile excess body weight loss (%EWL) at 3 weeks.
- Patients with EWL < 18% were randomized to either an intervention (IV) group receiving 7 weekly behavioral support sessions or a control (NI) group receiving routine care.
- Adherence to the intervention was tracked, with varying levels of participation observed in the IV group.
Main Results:
- No statistically significant differences in %EWL, %EBMIL, or %TWL were observed between the intervention and control groups at one year.
- Subgroup analysis of patients who fully adhered to all intervention sessions also showed no significant improvement in weight loss outcomes.
- Patient adherence to the structured support program was notably low, despite awareness of their suboptimal early weight loss.
Conclusions:
- A structured behavioral support program does not significantly enhance weight loss outcomes for bariatric surgery patients experiencing suboptimal early results.
- Poor patient adherence to interventions, even when informed about their insufficient weight loss, limits the effectiveness of such programs.
- Future strategies may need to address adherence barriers to improve outcomes for this patient population.
Background:
Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education.
Purpose:
To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes.
Methods:
This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care.
Results:
A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results.
Conclusion:
Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.
