S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study

• Published in: Surgical endoscopy Vol. 36; no. 9; pp. 6903 - 6914
• Main Authors: Drakos, Panagiotis, Volteas, Panagiotis, Seeras, Kevin, Humayon, Shabana, Flink, Benjamin, Yang, Jie, Zhu, Chencan, Spaniolas, Konstantinos, Talamini, Mark, Pryor, Aurora
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2022; Springer Nature B.V
• Subjects: 2021 SAGES Oral; Abdominal Surgery; Bariatric Surgery; Body Mass Index; Curricula; Early intervention; Early Medical Intervention; Endoscopy; Exercise; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Humans; Medicine; Medicine & Public Health; Metabolism; Obesity; Obesity, Morbid - surgery; Physical fitness; Proctology; Prospective Studies; Retrospective Studies; Surgery; Treatment Outcome; Weight control; Weight Loss; Long-term outcomes; Follow-up adherence; Behavioral support; Bariatric surgery; Weight loss
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-022-09029-9

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.