Risk factors for multimodal conservative approach failure before bariatric surgery

A multimodal conservative approach (MCA) is internationally recommended prior to bariatric surgery for the majority of patients. This research aimed to identify risk factors for therapy failure within the MCA.

This study was conducted in a German bariatric obesity centre. Patients who underwent a 3- to 6-month preoperative MCA from November 2019 to October 2020 were prospectively recorded and analysed. MCA included dietary and movement therapy, psychological and endocrinological referral and connection to a patient support group. The change in BMI was considered the main parameter for therapeutic success. Explanatory factors were evaluated for this outcome of interest and included physical and mental well-being (SF-36), perceived stress (DASS-21), social and economic situation and educational background (SOEP).

Out of 413 eligible patients, 209 were analysed. Overall, patients gained BMI (average gain 0.23 kg/m² (s.d. 1.44 kg/m²)) during the preoperative MCA. Diverse social, demographic and economic and health properties did not influence the course of the therapy. There was a significant positive correlation between successful loss of BMI and physical well-being (β = 0.03, 95% c.i. 0.01 to 0.04, P < 0.0001) and a negative correlation between mental well-being (β = -0.02, 95% c.i. -0.004 to -0.001, P = 0.001) as well as self-perceived stress (β = -0.05, 95% c.i. -0.09 to -0.01, P = 0.019), although these effects were small and did not affect the overall trend of gaining BMI during MCA.

The current therapeutic approach of preoperative conservative treatment within the multimodal concept of bariatric treatment fails to achieve its intended outcome. A different conservative weight loss programme from the pre-bariatric setting, which should focus on a surgical preparation, is therefore recommended.