Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

Marco Aurelio Santo, Daniel Riccioppo, Denis Pajecki, Roberto de Cleva, Flavio Kawamoto, Ivan Cecconello, Marco Aurelio Santo, Daniel Riccioppo, Denis Pajecki, Roberto de Cleva, Flavio Kawamoto, Ivan Cecconello

Abstract

Objectives: The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients.

Methods: Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery.

Results: The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days.

Conclusion: In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Weekly curve of weight loss during hospitalization (kg x time in weeks).
Figure 2
Figure 2
Curve of relative effects of treatment. The impact of each of the consecutive weekly weight variations on the final treatment result is shown. The abscissae axis shows the time of treatment in weeks and the ordinate axis shows statistical significance of the weight variation. After the 14th week, the weekly weight variation lost statistical significance.

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