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. 2024 Feb:151:155739.
doi: 10.1016/j.metabol.2023.155739. Epub 2023 Nov 18.

Addressing uncertainty about the role of structured lifestyle modification for metabolic surgery patients

Enda Murphy  1 , Francis M Finucane  2
Affiliations
Free article

Addressing uncertainty about the role of structured lifestyle modification for metabolic surgery patients

Enda Murphy et al. Metabolism. 2024 Feb.
Free article

Abstract

There is good evidence that structured lifestyle modification programmes improve health in patients with metabolic and cardiovascular disorders, but there is no specific evidence that they improve outcomes in patients undergoing metabolic or obesity surgery. Despite expert consensus guidelines stating this fact, some healthcare systems still compel patients to participate in a structured lifestyle modification programme prior to metabolic or obesity surgery. There is a well-established need for individualised multidisciplinary dietetic and physical activity care for metabolic and obesity surgery patients, and the benefits of intentional weight loss prior to surgery are well proven, but these are distinct from potentially harmful requirements for patients to undertake compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery and reinforce obesity stigma. A critical step in rejuvenating metabolic surgery is to reframe patient participation in structured lifestyle modification programmes as an opportunity for education and empowerment, not as an indicator of motivation or suitability for metabolic surgery. Large, well-designed and adequately powered clinical trials are needed to address uncertainties in the evidence base for these programmes. Given genuine equipoise, they will need to determine whether "surgery plus lifestyle" is superior to "surgery plus placebo". Moreover, they will need to determine the cost-effectiveness of these programmes and identify some of the factors giving rise to the substantial heterogeneity in responses to structured lifestyle modification.

Keywords: Metabolic surgery; Obesity; Structured lifestyle modification.

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Conflict of interest statement

Declaration of competing interest EM has no conflicts of interest to declare. EM and FMF are both funded by a CÚRAM/Science Foundation Ireland Project Grant (ref 13/RC/2073-P2). FMF has served on Data Safety Monitoring Boards for the LEAP and LEGEND randomised controlled trials (run by the University of Michigan), and as a paid grant reviewer for the Danish Diabetes Academy.

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