Highlights
- •Patients who immediately qualified for surgery had more weight loss during the MWP
- •Most weight lost during the MWP is regained before surgery
- •Mandatory weight loss programs lead to a significant delay in surgical treatment
- •Postoperative weight loss is comparable for immediate and delayed qualification
Abstract
Background
In the Netherlands, patients only qualify for bariatric surgery when they have followed
a 6-month mandatory weight loss program (MWP), also called the “last resort” criterion.
One of the rationales for this is that MWPs result in greater weight loss.
Objectives
To determine weight loss during MWPs and the effect of delayed versus immediate qualification
on weight loss 3 years after bariatric surgery.
Setting
Outpatient clinic.
Methods
This is a nationwide, retrospective study with prospectively collected data. All patients
who underwent a primary bariatric procedure in 2016 were included. We compared weight
loss between patients who did not qualify according to the last resort criterion at
screening (delayed group) with patients that qualified (immediate group).
Results
In total 2628 patients were included. Mean age was 44.4 years, 81.3% were female,
and baseline BMI was 42.3 kg/m2. Roux-en-Y gastric bypass (RYGB) was the most frequently performed surgery (77.0%),
followed by sleeve gastrectomy (15.8%) and banded RYGB (7.3%). The delayed group (n
= 831; 32%) compared with immediate group (n = 1797; 68%), showed less percentage
of total weight loss (%TWL) during the MWP (1.7% versus 3.9%, P < .001) and time between screening and surgery was longer (42.3 versus 17.5 wk, P < .001). Linear mixed model analysis showed no significant difference in %TWL at
18- (P = .291, n = 2077), 24- (P = .580, n = 1993) and 36-month (P = .325, n = 1743) follow-up.
Conclusion
This study shows that delayed qualification for bariatric surgery compared with immediate
qualification does not have a clinically relevant impact on postoperative weight loss
3 years after bariatric surgery.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Interdisciplinary European guidelines on metabolic and bariatric surgery.Obes Surg. 2014; 24: 42-55
- Bariatrische chirurgie [Bariatric surgery]. c2020 [accessed 2020 May 13].(Available from:)
- Obesity: identification, assessment and management of overweight and obesity in children, young people and adults: partial update of CG43.National Institute for Health and Care Excellence (UK), London2014
- Bariatric surgery and procedures.Cigna Companies, 2019
- Preoperative medical weight management in bariatric surgery: a review and reconsideration.Obes Surg. 2017; 27: 208-214
- Postoperative outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program.Surg Obes Relat Dis. 2018; 14: 623-630
- Insurance-mandated medical programs before bariatric surgery: do good things come to those who wait?.Surg Obes Relat Dis. 2011; 7: 526-530
- Insurance-mandated medical weight management before bariatric surgery.Surg Obes Relat Dis. 2016; 12: 496-499
- Insurance-mandated preoperative diet and outcomes after bariatric surgery.Surg Obes Relat Dis. 2018; 14: 631-636
- Increase in physical activity after bariatric surgery demonstrates improvement in weight loss and cardiorespiratory fitness.Obes Surg. 2018; 28: 3950-3957
- Justification report 2019.CZ-groep, 2019
- ASMBS updated position statement on insurance mandated preoperative weight loss requirements.Surg Obes Relat Dis. 2016; 12: 955-959
- Insurance-mandated medical weight management programs in sleeve gastrectomy patients do not improve postoperative weight loss outcomes at 1 year.Obes Surg. 2020; 30: 3333-3340
- NHG-standard obesity. Dutch General Practitioner Society, 2019
- Reduced survival in bariatric surgery candidates delayed or denied by lack of insurance approval.Am Surg. 2016; 82: 166-170
- What is the impact on the healthcare system if access to bariatric surgery is delayed?.Surg Obes Relat Dis. 2017; 13: 1619-1627
- Bariatric surgery insurance requirements independently predict surgery dropout.Surg Obes Relat Dis. 2017; 13: 871-876
- Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity.Surg Obes Relat Dis. 2006; 2: 122-127
- Predictors of attrition in bariatric aftercare: a systematic review of the literature.Obes Surg. 2012; 22: 1640-1647
- Predictors of postoperative aftercare attrition among gastric bypass patients.Bariatr Surg Pract Patient Care. 2015; 10: 79-83
- Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery.Surg Obes Relat Dis. 2016; 12: 350-356
- Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg).Ann Surg. 2015; 261: 909-913
- Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian Obesity Registry (SOReg).Surg Obes Relat Dis. 2016; 12: 556-562
- Contributing of cognitive-behavioral therapy in the context of bariatric surgery: a review of the literature.Obes Surg. 2020; 30: 3154-3166
Article info
Publication history
Published online: December 09, 2020
Accepted:
November 26,
2020
Received:
September 9,
2020
Footnotes
All members of the NOK Research Group: Ahmet Demirkiran, Ruben van Veen, Eric Hazebroek, Jan Willem Greve, René M. Wiezer, Dingeman Swank, Mireille Knook, Dashti Faraj, Larissa Tseng, Steve de Castro, Hendrik Marsman, Willem van Tets, Huib Cense, Evert Jan Boerma, Sophie Fransen, Niels Wijffels, Wouter te Riele, Wouter Derksen, Marijn Takkenberg, Theo Aufenacker, Wouter Vening, Bart Witteman, Willem den Hengst.
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Abandon mandatory preoperative weight management programs!Surgery for Obesity and Related DiseasesVol. 17Issue 4
