Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study

Manish Parikh, Meena Dasari, Michelle McMacken, Christine Ren, George Fielding, Gbenga Ogedegbe

Research output: Contribution to journalArticle

Abstract

Background: Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. Methods: This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). Results: A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. Conclusion: MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.

Original languageEnglish (US)
Pages (from-to)853-861
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Weight Reduction Programs
Bariatric Surgery
Weights and Measures
Weight Loss
Stomach
Insurance
Demography
Exercise
Patient Participation
Insurance Carriers
Intention to Treat Analysis
Public Hospitals
Urban Hospitals
Medicaid
Feeding Behavior
Patient Compliance
Population
Consensus
Randomized Controlled Trials

Keywords

  • Bariatric surgery
  • Gastric band
  • Insurance
  • Medicaid
  • Medically supervised weight loss
  • Outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. / Parikh, Manish; Dasari, Meena; McMacken, Michelle; Ren, Christine; Fielding, George; Ogedegbe, Gbenga.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 26, No. 3, 03.2012, p. 853-861.

Research output: Contribution to journalArticle

Parikh, Manish ; Dasari, Meena ; McMacken, Michelle ; Ren, Christine ; Fielding, George ; Ogedegbe, Gbenga. / Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. In: Surgical Endoscopy and Other Interventional Techniques. 2012 ; Vol. 26, No. 3. pp. 853-861.
@article{2d1d600b339644028eeed8833bdc55b8,
title = "Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study",
abstract = "Background: Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. Methods: This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). Results: A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. Conclusion: MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.",
keywords = "Bariatric surgery, Gastric band, Insurance, Medicaid, Medically supervised weight loss, Outcomes",
author = "Manish Parikh and Meena Dasari and Michelle McMacken and Christine Ren and George Fielding and Gbenga Ogedegbe",
year = "2012",
month = "3",
doi = "10.1007/s00464-011-1966-9",
language = "English (US)",
volume = "26",
pages = "853--861",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study

AU - Parikh, Manish

AU - Dasari, Meena

AU - McMacken, Michelle

AU - Ren, Christine

AU - Fielding, George

AU - Ogedegbe, Gbenga

PY - 2012/3

Y1 - 2012/3

N2 - Background: Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. Methods: This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). Results: A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. Conclusion: MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.

AB - Background: Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. Methods: This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). Results: A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. Conclusion: MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.

KW - Bariatric surgery

KW - Gastric band

KW - Insurance

KW - Medicaid

KW - Medically supervised weight loss

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=84857059002&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857059002&partnerID=8YFLogxK

U2 - 10.1007/s00464-011-1966-9

DO - 10.1007/s00464-011-1966-9

M3 - Article

C2 - 22011946

AN - SCOPUS:84857059002

VL - 26

SP - 853

EP - 861

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

IS - 3

ER -