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Risk factors for multimodal conservative approach failure before bariatric surgery.

Pia Jaeger1,2, Marie Mortier2, Ahmad Alhazmi1

  • 1Department of General and Visceral Surgery, Marien Hospital Witten, Teaching Hospital of the Ruhr-University Bochum, Marienplatz 2, 58452 Witten, Germany.

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Summary

Preoperative multimodal conservative approaches (MCA) before bariatric surgery often fail to achieve weight loss goals. Improved physical well-being correlated with BMI loss, but overall trends showed BMI gain, necessitating a revised pre-bariatric program.

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Area of Science:

  • Obesity Medicine
  • Bariatric Surgery Preoperative Care
  • Behavioral Health in Weight Management

Background:

  • Multimodal conservative approach (MCA) is standard preoperative care for bariatric surgery.
  • This study investigated risk factors for MCA therapy failure.

Purpose of the Study:

  • To identify risk factors associated with therapy failure in the preoperative multimodal conservative approach (MCA) for bariatric surgery.
  • To evaluate the effectiveness of current MCA in achieving weight loss prior to bariatric procedures.

Main Methods:

  • Prospective analysis of 209 patients undergoing 3-6 month preoperative MCA at a German bariatric center.
  • MCA included diet, exercise, psychological/endocrinological referrals, and support groups.
  • Body Mass Index (BMI) change was the primary outcome; SF-36, DASS-21, and SOEP assessed well-being, stress, and socioeconomic factors.

Main Results:

  • Patients gained an average of 0.23 kg/m² BMI during MCA, indicating a failure to achieve weight loss.
  • No significant influence of social, demographic, economic, or diverse health properties on therapy course.
  • Positive correlation between BMI loss and physical well-being; negative correlation with mental well-being and perceived stress, though effects were small.

Conclusions:

  • Current preoperative conservative treatment within bariatric surgery's multimodal concept is ineffective for weight loss.
  • A revised conservative weight loss program focused on surgical preparation is recommended for the pre-bariatric setting.