PREOPERATIVE WEIGHT LOSS AS A PREDICTOR OF LONG-TERM SUCCESS FOLLOWING BARIATRIC SURGERY

Transcription

1 ESPEN Congress Gothenburg 2011 Educational Session - Dietetic session PREOPERATIVE WEIGHT LOSS AS A PREDICTOR OF LONG-TERM SUCCESS FOLLOWING BARIATRIC SURGERY Alejandra Parri Bonet

2 EDUCATIONAL SESSION - DIETETIC SESSION PREOPERATIVE WEIGHT LOSS AS A PREDICTOR OF LONG-TERM SUCCESS FOLLOWING BARIATRIC SURGERY Alejandra Parri Bonet Nutritionist Endocrinology and Nutrition Department Universitary Hospital Mar of Barcelona

3 INTRODUCTION Bariatric surgery is the most effective treatment for weight loss in morbidly obese patients Surgical techniques currently in use allow a 60% of excess body weight loss one year after surgery but Between 10 and 15% of patients do not reach the goal of weight loss (losing less than 40% of excess weight) 30% of patients regain part of the weight lost at long term because These limitations are attributed to the lack of change in eating behavior before the surgery

4 Caloric restriction and changing eating habits and lifestyle play an essential role

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8 What if we act on some of its main features?

9 BENEFITS OF A 10% OF PREOPERATIVE WEIGHT LOSS Surgical Benefits: Reducing the size of liver Abordage surgical facility and less surgical time Increased chance of choosing a laparoscopic versus open surgery Reducing the risk of surgical complications and recovery time Restrictive thecnique Dietetic benefits: Greater weight loss after surgery Mix thecnique Increasing patient adherence to nutritional changes and lifestyle after surgery

10 IMPORTANCE OF AN EDUCATION PROGRAM AND CHANGING FOOD HABITS BEFORE SURGERY FOR OBESITY Assessment of dietary habits Better patient management Assess preoperative nutritional behavior Adapt nutrition education after surgery Optimize weight loss and quality of life of patients

11 Changes in Eating behavior Eat slowly Meal Planning Enhance the chewing of food Avoid eating and drinking at the same time Food group education Serving size WHAT WE DO? Educational material Serving size post surgery Protein foods Comparative size of food portions Tools Cognitivebehavioral sesions Dietary records Physical activity records Using a measure of physical activity Food and nutrition education

12 INDIVIDUAL OR GROUP NUTRITION EDUCATION? Individual Group The creation of support groups combined with individualized treatment (to respond to the specific characteristics of each patient) is a recommended strategy

13 Our study: PREOPERATIVE WEIGHT LOSS AS A PREDICTOR OF LONG-TERM SUCCESS FOLLOWING BARIATRIC SURGERY --> 146 patients were conducted prospectively --> Objective: Determine whether percentage of excess weight loss (%EWL) preoperatively was associated with higher %EWL after BS. --> The %EWL was measured preoperatively and at 3, 6, 12, 18, 24 and 36 months after the surgery. --> Statistical analysis: Pearson correlation coefficient considering signification in p < 0,05.

14 PATIENTS CHARACTERISTICS BEFORE THE SURGERY Mean ± SD % Male/% Female 15,9/84,1 Age (years) 44,8 ± 8,9 Body Mass Index (kg/m 2 ) 45,4 ± 4,9 Abdominal circumference (cm) 127,3 ± 12,2 Diabetes (%) 21,9 Hypertension (%) 39 Dyslipidemia (%) 23,1 Smoking history (yes/no) 116/40 n= 146

15 Beggining Before surgery 3months 6months 12months 18months 2years 3years BMI EVOLUTION BEFORE AND AFTER THE SURGERY BMI ,2 42,4 34,7 31, ,6 29,1 30,1

16 BMI AFTER 1 YEAR OF BARIATRIC SURGERY % Patients , Normal weight Overweight 31, Obesity I BMI 5, Obesity II 0, Morbid Obesity

17 RESULTS %EWL Bariatric surgery Preop 3m 6m 12m 18m 2a 3a % EWL (Mean ± SD) Correlation with preoperative % EWL r p Before Surgery 15,4 ± 12,5 3 53,8 ± 13,5 0,54 <0, ,1 ± 15,6 0,35 <0, ,9 ± 17,9 0,13 0, ,2 ± 19,3 0,23 0, ,1 ± 18,7 0,008 0, ,9 ± 18,2 0,79 0,493

18 TAKE-HOME MESSAGE We have studied a large group of patients in a referral center Nutrition education prior to surgery is possible, desirable and useful A greater weight loss prior to surgery was statistically associated with greater weight loss at 6 months after bariatric surgery. The dietitian's role will be key to the success of the overall treatment of patients with morbid obesity

19 THANK YOU