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Weight Loss Expectations of Patients Awaiting Bariatric Surgery

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					Predictors of Unrealistic Weight Loss
 Expectations of Patients Awaiting
          Bariatric Surgery


                             KA Edmiston;
                             E Efthimiou; P Tekkis; F Davison;
                             C Shannon; G. Bonanomi



 Chelsea and Westminster Hospital, London, United Kingdom
     Predictors of Unrealistic Weight Loss
   Expectations of Patients Awaiting Bariatric
                    Surgery


Presenter Name: Kelli Edmiston BSc(Hons)RD


As previously disclosed, these are the companies
with which I have a financial or other relationship(s):


None
Introduction

   Chelsea and Westminster Hospital based in London UK.

   Providing bariatric surgery to NHS patients from a large referral
    base (London, The South East and the East of England).

   Team of 4 surgeons, 3 anaesthetists, 3 psychologists, 2
    dietitians, 1 nurse specialist
Background
   The treatment seeking overweight and obese population are
    known to have unrealistic weight loss expectations (6).
   This is also true of the bariatric surgery patient population (2, 4,
    5, 7, 9).
   However, factors associated with unrealistic weight loss
    expectations differs in the published literature (1, 2, 4).
   Whether unrealistic weight loss expectations are related to
    improved weight loss post operatively remains inconclusive (3,
    9).
   Most of this research comes out of the US.
Aims

   To assess weight loss expectations of
    patients awaiting bariatric surgery in our
    patients.

   Identify preoperative factors associated with
    unrealistic expectations.
Methods

   Retrospective study.

   Prospectively completed detailed dietetic
    assessment prior to surgery from October
    2002 to October 2009.

   All patients are asked about their expected /
    ideal weight after surgery.
Methods

   Realistic weight loss expectations was defined as:
    a target weight that was within 5kg of calculated
    predicted EBWL, compared with their ideal
    weight obtained from interview
    –   RYGB 65-75% EBWL,
    –   LAGB 50-60% EBWL,
    –   Anything outside these parameters defined as ‘unrealistic’.

   Univariate and Multiple logistic regression analysis
    was conducted.
Results – Patient Characteristics

   731 dietetic record cards.

   310 contained complete information and were
    included in the analyses.

   Patient characteristics were as follows:
    –   Female 221 (71.3%); Male 89 (28.7%)
    –   Age = 43.4 ± 11.4 years
    –   BMI = 47.0 ± 7.8 kg/m2
Results – Patient Characteristics

            BMI (kg/m2)

                4%

                       20%
          22%                < 40
                             40-50
                             50-60
                             60+
                 54%
Results – Patient Characteristics

                     Race
   250
          214
   200

   150

   100

    50          28    25
                            13    13
    0
         White Black Asian Mixed Other
Results – Patient Characteristics

  Self reported patient characteristics   Classification   Number and %

  Previous diet attempts                  0-3              193 (63%)
                                          4+               112 (37%)
  Successful Weight Loss                  Yes              204 (77%)
                                          No               60 (23%)
  Sweet Eater                             Yes              154 (51%)
                                          No               148 (49%)
  Comfort Eater                           Yes              195 (65%)
                                          No               103 (35%)
  Binge Eater                             Yes              88 (30%)
                                          No               206 (70%)
  Procedure                               LAGB             164 (53%)
                                          RYGB             140 (45%)
                                           Realistic Expectations

                                     n=    Yes                       No           p-value

                          < 40      102   26.5% (27)                73.5% (75)

Age group                 40 – 49   99    32.3% (32)                67.7% (67)    0.660

                          50 +      109   29.4% (32)                70.6% (77)


  Results – Statistical Analysis
Gender
                          Female

                          Male
                                    221

                                    89
                                          24.4% (54)

                                          41.6% (37)
                                                                    75.6% (167)

                                                                    58.4% (52)
                                                                                  *0.004


                          White     214   28.5% (61)                71.5% (153)

                          Black     28    25.0% (7)                 75.0% (21)

Race                      Asian     25    36.0% (9)                 64.0% (16)    0.425

                          Mixed     13    46.2% (6)                 53.8% (7)

                          Other     13    15.4% (2)                 84.6% (11)
                         < 40       61    27.9% (17)                72.1% (44)
                         40 – 50    167   31.1% (52)                68.9% (115)
BMI                                                                               0.876
                         50 – 60    69    26.1% (18)                73.4% (51)
                         60 +       13    30.8% (4)                 69.2% (9)
                          0–3       193   30.6% (59)                69.4% (134)
Previous diet attempts                                                            0.483
                          4+        112   26.8% (30)                73.2% (82)

                          Yes       204   28.9% (59)                71.1% (145)
Successful weight loss                                                            0.734
                          No        60    26.7% (16)                73.3% (44)

                          Yes       154   27.3% (42)                72.7% (112)
Sweet eater                                                                       0.393
                          No        148   31.8% (47)                68.2% (101)

                          Yes       195   27.2% (53)                72.8% (142)
Comfort eater                                                                     0.292
                          No        103   33.0% (34)                67.0% (69)

                          Yes       88    21.6% (19)                78.4% (69)
Binge eater                                                                       *0.039
                          No        206   32.5% (67)                67.5% (139)

                          LAGB      164   28.3% (39)                76.2% (125)
Procedure                                                                         *0.031
                          RGYB      140   35.0% (49)                65.0% (91)
Results

   Multivariate analysis, the only factor that remained
    significant was gender:
    –   OR = 0.42; 95% CI = 0.25 – 73; p = 0.002
Study            n=    %        %      Age (y)   Wt       BMI           Study          Qn          WL Expectations          Significance
              Results  Female   Cauc             (kg)     (kg/m2)       Design


Heinberg et al   114   81.6     80.7   48.1 ±    135.0    48.9 ±        Prospective    GRWQ        Unrealistic   106%       F gender;
2010                                   12        ± 37.4   11.3                                                   EBWL       Caucasians;
                                                                                                                            BMI;
                                                                                                                             Age
Karmali et al    45    88.9     -      43.4      -        44.4          Prospective    GRWQ        Unrealistic   85%
2010                                                                                                             EBWL


Kaly et al       284   81.0     -      45.0 ±    -        50.0 ± 8.0    Prospective    GRWQ        Unrealistic   67-89%     F gender;
2008                                   10                                                                        EBWL       BMI;
                                                                                                                             Age
Bauchowitz et    217   82.3     89.0   42.0      -        53.7 ±        Retrospecti    BIPASS      Unrealistic   78%         BMI;
al                                                        10.9          ve             database                  EBWL
2007
White et al      139   88.5     71.9   42.4 ±    -        51.8 ± 8.0    Prospective    GRWQ        Unrealistic   BMI  25
2007                                   10
Walfish et al    250   100.0    77.2   40.3      131.6    48.2          Prospective    WALI        Unrealistic   BMI 25.3
2007                                   (19-64)   (86-     (27.4-76.7)
                                                 216)
Wee et al        44    95.5     65.9   42.6      -        47.1          Prospective    Telo. int   Unrealistic   81%
2006                                                                    /                                        EBWL
                                                                        Longitudinal
Edmiston et      310   71.0     73.0   43.4 ±    131.8    47.0 ± 7.8    Retrospecti    -           Unrealistic   -          F gender;
al                                     11        ± 25.5                 ve                                                  Binge Eating;
unpublished                                                                                                                 Surgery type
Limitations

   Observational, non-random assignment, lack of
    control group.

   < ½ complete data
    –   Only in the last 3 years – compulsory preoperative dietetic
        consult; structured assessment form.

   Used structured dietetic interview rather than a
    validated questionnaire for assessing weight loss
    expectations

   Patient’s expected %EBWL was not calculated.
Implications to current practice

   We gave implemented an additional
    educational component to our program:
    “Getting Ready for Surgery Group”
    –   2 x 150 min group sessions for preoperative
        patients

    –   Facilitated by our team Psychologists and
        Dietitians
Conclusions

   Patients, especially females have unrealistic weight
    loss expectations, consistent with published
    literature.

   In our study patients were more likely to have
    unrealistic weight loss expectations if they:
    –   Reported a history of binge eating
    –   Were awaiting gastric bypass surgery
References
1.   Bauchowitz A, Azarbad L, Day K, et al. Evaluation of expectations and knowledge in bariatric surgery
     patients. Surg Obes Rel Dis. 2007;3:554-558.
2.   Heinberg LJ, Keating K, Simonelli L. Discrepancy between ideal and realistic goal weights in three
     bariatric procedures: who is likely to be unrealistic? Obes Surg. 2001;20:148-153.
3.   van Hout GCM, Verschure SKM, van Heck GL. Psychological predictors of success following bariatric
     surgery. Obes Surg. 2005;15:552-560.
4.   Kaly P, Orellana S, Torrella BA, et al. Unrealistic weight loss expectations in candidates for bariatric
     surgery. Surg Obes Rel Dis. 2008;4:6-10.
5.   Karmali S, Kadikpy H, Brandt ML, et al. What ids my goal? Expected weight loss and comorbidity
     outcomes among bariatric surgery patients. Obes Surg. 2010. Published online.
6.   Wadden et al. Comparison of psychological status in treatment-seeking women with class III vs. class I-
     II obesity. Surg Obes Relat Dis. 2006;2/2:138-145.
7.   Walfish S, Brown TA. Patient expectations of weight loss from bariatric surgery. Bariatric Nurs Surg
     Patient Care. 2006;1(3):205-210.
8.   Wee CC, Jones DB, Davis RB, et al. Understanding patients’ value of weight loss and expectations for
     bariatric surgery. Obes Surg. 2006;16:496-500.
9.   White MA, Masheb RM, Rothschild BS, et al. Do patients’ unrealistic weight goals have prognostic
     significance for bariatric surgery? Obes Surg. 2007;17:74-81.

				
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