Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

doi:10.1007/s11695-021-05573-w

Review

. 2021 Oct;31(10):4585-4591.

doi: 10.1007/s11695-021-05573-w. Epub 2021 Jul 23.

Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

John Brazil^{1

2

3}, Francis Finucane^{4

5

6}

Affiliations

¹ Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland.
² HRB Clinical Research Facility, NUIG and Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland.
³ Department of Medicine, School of Medicine, CMNHS, NUI Galway, Galway, Ireland.
⁴ Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland. francis.finucane@nuigalway.ie.
⁵ HRB Clinical Research Facility, NUIG and Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland. francis.finucane@nuigalway.ie.
⁶ Department of Medicine, School of Medicine, CMNHS, NUI Galway, Galway, Ireland. francis.finucane@nuigalway.ie.

PMID: 34297255
PMCID: PMC8458190
DOI: 10.1007/s11695-021-05573-w

Review

Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

John Brazil et al. Obes Surg. 2021 Oct.

. 2021 Oct;31(10):4585-4591.

doi: 10.1007/s11695-021-05573-w. Epub 2021 Jul 23.

Authors

John Brazil^{1

2

3}, Francis Finucane^{4

5

6}

Affiliations

¹ Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland.
² HRB Clinical Research Facility, NUIG and Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland.
³ Department of Medicine, School of Medicine, CMNHS, NUI Galway, Galway, Ireland.
⁴ Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland. francis.finucane@nuigalway.ie.
⁵ HRB Clinical Research Facility, NUIG and Galway University Hospitals, Saolta University Health Care Group, Galway, Ireland. francis.finucane@nuigalway.ie.
⁶ Department of Medicine, School of Medicine, CMNHS, NUI Galway, Galway, Ireland. francis.finucane@nuigalway.ie.

PMID: 34297255
PMCID: PMC8458190
DOI: 10.1007/s11695-021-05573-w

Abstract

Many healthcare systems require patients to participate in a structured lifestyle modification programme prior to bariatric surgery, even though bariatric consensus guidelines do not recommend this. While there is good evidence that such programmes improve health in other conditions such as metabolic and cardiovascular diseases, there is no evidence that they improve outcomes after bariatric surgery. The distinction needs to be drawn between the well-established need for individualised multidisciplinary dietetic and physical activity care for bariatric surgical patients and the potential harms from mandating participation in compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery, reinforce obesity stigma, or both. Large clinical trials might help to address some of the uncertainty and provide an evidence base for clinicians and policymakers.

Keywords: Bariatric surgery; Obesity; Structured lifestyle modification.

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Conflict of interest statement

JB has no conflicts of interest to declare. FMF is funded by a Saolta Group Clinical Research Career Development Award and has in the past (until 2017) received honoraria and travel grants and has served on advisory boards for Novo Nordisk, Eli Lilly, Ethicon, Pfizer Inc., Sanofi-Aventis, Astra Zeneca, Merck-Serono, Boehringer Ingelheim, Janssen, and Novartis.

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References

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1. Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020;28(4):O1–O58. doi: 10.1002/oby.22719. - DOI - PubMed

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[1] Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, Long MW, Gortmaker SL. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440–2450. doi: 10.1056/NEJMsa1909301. - DOI - PubMed

[2] Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, Long MW, Gortmaker SL. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440–2450. doi: 10.1056/NEJMsa1909301. - DOI - PubMed

[3] Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–752. doi: 10.1056/NEJMoa066254. - DOI - PubMed

[4] Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–752. doi: 10.1056/NEJMoa066254. - DOI - PubMed

[5] Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–1576. doi: 10.1056/NEJMoa1200225. - DOI - PMC - PubMed

[6] Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–1576. doi: 10.1056/NEJMoa1200225. - DOI - PMC - PubMed

[7] Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641. - PMC - PubMed

[8] Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641. - PMC - PubMed

[9] Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020;28(4):O1–O58. doi: 10.1002/oby.22719. - DOI - PubMed

[10] Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020;28(4):O1–O58. doi: 10.1002/oby.22719. - DOI - PubMed

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Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

Affiliations

Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough?

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Affiliations

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Conflict of interest statement

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