Effectiveness, Compliance, and Acceptability of Preoperative Weight Loss with a Liquid Very Low-Calorie Diet Before Bariatric Surgery in Real Practice.

OBJECTIVE: A preoperative very low-calorie diet (VLCD) is a common method to reduce weight before bariatric surgery. However, patient compliance and acceptability are not always known. The aim of this study is to evaluate the effectiveness, compliance, and acceptability of our regimen in a metropolitan academic quaternary care center. METHODS: Patients with a BMI < 50 kg/m2 and a BMI ≥ 50 kg/m2 were instructed to be on a liquid VLCD for 1 week and 2 weeks, respectively. The primary outcome was the amount of weight loss. Secondary outcomes were patient compliance and acceptability of either regimen using a questionnaire for hunger, satisfaction, desire, and deviation for solids. RESULTS: The study included 128 patients. Ninety-four patients were in the BMI < 50 kg/m2 group, and 34 patients were in the BMI ≥ 50 kg/m2 group. The BMI ≥ 50 kg/m2 group had a greater percentage of total weight loss (mean ± SD) than that of the BMI < 50 kg/m2 group without statistical differences (4.4 ± 1.3% vs. 3.8 ± 1.6%, p = 0.072). There were no statistical differences between the groups in terms of hunger, satisfaction with a liquid diet, or satisfaction of eating over drinking. However, hunger sensation (median [IQR]) tended to be higher in the BMI < 50 kg/m2 group than that in the BMI ≥ 50 kg/m2 group (2 [2] vs. 2 [2, 3]; p = 0.06). There was no statistical difference in the percentage of patient compliance between the groups (75.5% [n = 71] vs. 61.8% [n = 21], p = 0.18). CONCLUSIONS: Preoperative liquid VLCD provided a modest amount of weight loss and showed a high rate of patient compliance and acceptability.

Inpatient Glycemic Protocol for Patients with Diabetes Undergoing Bariatric Surgery.

BACKGROUND: Bariatric surgery is a recommended treatment for diabetes in severely obese patients. Their immediate post-operative anti-hyperglycemic requirements differ from other hospitalized diabetics, yet no standardized protocols addressing glycemic control for this group exist. OBJECTIVE: We aimed to create a safe, easily implemented protocol for immediate post-operative glycemic control, which we defined as the first 30 days. METHODS: The protocol was designed by an interdisciplinary workgroup using review of available literature, approved institutional glycemic guidelines, and team members' experience with caring for bariatric surgery patients. RESULTS: Patients are offered post-discharge recommendations using the inpatient glycemic protocol. CONCLUSION: We designed a protocol with low risk of hypoglycemia that addresses the unique glycemic needs of diabetic bariatric population in the immediate post-operative period.

Behavioral transitions and weight change patterns within the PREMIER trial.

Little is known about the transition in behaviors from short-term weight loss to maintenance of weight loss. We wanted to determine how short-term and long-term weight loss and patterns of weight change were associated with intervention behavioral targets. This analysis includes overweight/obese participants in active treatment (n = 507) from the previously published PREMIER trial, an 18-month, multicomponent lifestyle intervention for blood pressure reduction, including 33 intervention sessions and recommendations to self-monitor food intake and physical activity daily. Associations between behaviors (attendance, recorded days/week of physical activity, food records/week) and weight loss of ≥5% at 6 and 18 months were examined using logistic regression. We characterized the sample using 5 weight change categories (weight gained, weight stable, weight loss then relapse, late weight loss, and weight loss then maintenance) and analyzed adherence to the behaviors for each category, comparing means with ANOVA. Participants lost an average of 5.3 ± 5.6 kg at 6 months and 4.0 ± 6.7 kg (4.96% of body weight) by 18 months. Higher levels of attendance, food record completion, and recorded days/week of physical activity were associated with increasing odds of achieving 5% weight loss. All weight change groups had declines in the behaviors over time; however, compared to the other four groups, the weight loss/maintenance group (n = 154) had statistically less significant decline in number of food records/week (48%), recorded days/week of physical activity (41.7%), and intervention sessions attended (12.8%) through 18 months. Behaviors associated with short-term weight loss continue to be associated with long-term weight loss, albeit at lower frequencies. Minimizing the decline in these behaviors may be important in achieving long-term weight loss.

Preferences and self-efficacy for diet modification among primary care patients.

Limited data exist about patient preferences and self-efficacy for different diets. We explored the preferences and self-efficacy of primary care patients for reducing fat, reducing carbohydrates, or reducing calories. We conducted a self-administered survey study of 71 primary care patients (response rate of 52%). Of patients, 59%, 53%, and 60% had high self-efficacy for reducing fat, reducing carbohydrates, and reducing calories from their diet, respectively. Preferences were comparable, with 76% highly willing to reduce fat, 76% highly willing to reduce carbohydrates, and 72% of patients highly willing to reduce calories/portions. Female sex and higher BMI were associated with high self-efficacy for all three dietary changes. A significantly higher proportion of nonwhites than whites had high self-efficacy for reducing fat and reducing carbohydrates (P < 0.05). Obese patients in our study have similarly high willingness and self-efficacy and comparable preferences for adopting changes consistent with three popular diets.