Published Data

Identification of appropriate bariatric surgery candidates using a pre-surgery telephonic behavior change program

Presented at the American Society for Bariatric Surgery Annual Conference June 2007, San Diego CA

Steven Bock, Marie Gahler, Debie McSperitt, Judith Malmgren

Group Health Cooperative, Seattle WA, Free and Clear Inc., Seattle WA, University of Washington, Seattle WA, HealthSTAT Consulting Inc., Seattle WA

Background: A pre-surgery telephonic nutritional/behavioral support program was developed to aid patients in achieving moderate weight loss and to demonstrate willingness to adopt coaching support. Behavioral compliance and achieving weight loss goals was included as a determining factor for surgical appropriateness and a possible indicator of post surgery outcomes.

Methods:  Patients undergoing bariatric surgery at a staff model HMO are required to participate in a pre-surgery program in the 8 weeks immediately preceding surgery. During this time they receive 4 calls (30 minutes in length) from a Registered Dietitian, addressing caloric reduction and exercise strategies; additional calls are available when needed. Height, weight, diet, food records, meal replacement use and physical activity are recorded.  Goals are 5-10% EWL and completion of scheduled phone appointments. At the end of the 8 weeks a participation report summarizing weight loss and phone call completion rate is prepared by the R.D. for the surgeon’s evaluation in determining final approval for surgery.

Results:  In 2005-2006, 186 patients with a median age of 48 years and 77% female were enrolled in the study.  Two patients (1%) were identified as non-compliant because of 1) weight gain and inability to follow a diet plan and 2) missed calls and failure to keep food records; these patients were denied surgery at that time.  Seven patients (4%) had comorbid conditions arise during the pre-surgical period, with two cancelled surgeries and five postponed.  The remaining 177 patients completed an average of 4 phone calls (range 2-8) during the 8 week period. Starting body mass index ranged from 35 to 86, averaging 49.86 and weight loss ranged from 0 to 48 pounds with an average of 12.83 pounds lost or 8.37% EWL. 

Conclusions:  The telephonic counseling program was able to identify patients with behavioral compliance issues prior to surgery indicating possible post surgery dietary adherence issues and decreased outcomes. Utilizing this information, additional support can be implemented or surgery postponed or cancelled. Effectiveness of phone counseling to achieve desired 5-10% EWL was shown to be successful.

Improving weight-loss through a post bariatric surgery telephonic nutrition and lifestyle support program

Presented at the North American Association for the Study of Obesity (Obesity Society) annual meeting October 2006, Boston MA

Gahler, Marie, Judith Malmgren, Steven Bock, Susan Zbikowski, Kathy Edris,

Free and Clear Inc., Seattle WA, University of Washington, Seattle WA, HealthSTAT Consulting Inc., Seattle WA, Group Health Cooperative, Seattle WA.

 

Background: Over 9 million adult Americans are morbidly obese with serious adverse health conditions as a direct result.  Bariatric surgical procedures are proving to be an effective treatment option to reduce weight and comorbid conditions. Nutritional and behavioral support programs may improve the long-term success of surgery related weight loss. 

Methods: Patients undergoing bariatric surgery at a staff-model HMO in Seattle WA participated in a required behavioral support program. We conducted a prospective cohort study of 219 patients undergoing RYGB surgery from 2001-2004 to evaluate the relationship between weight loss and program participation. The call program consisted of 12 months of post operative calls, 20-30 minutes in length and addressed food intake, physical activity and long-term weight maintenance strategies. Calls were weekly during the first six months and bi-weekly for months 7-12.  Post-surgery visits with the surgical team were at 3, 6, 9, 12, 18, 24 months, then annually.  Study data including weights were collected at medical visits and by program health educators during phone calls with pre and post surgical information abstracted from medical records.  One patient died peri-operatively (.5%), 23 patients (10.5%) were lost to follow up, four patients discontinued phone support between one and four months but continued with their clinic visits and 195 patients completed 12 months of clinic follow up.  65% of the group had weight measurements at 18 months (n=127) and 45% had weight measurements at 24 months.

Results: Mean age of the 12 month cohort (n=195) was 45 years with a range of 25 to 71 years.  88.2% were female. Mean pre-operative BMI was 53 with a range of 38-85.  At twelve months post surgery, mean BMI was 33 with a range of 21-51.  Mean percent excess body weight loss (%EWL) at 12 months was 73.42%, ranging from 33.40% to 128.48%. Patients completing 9-12 months of calls had a mean 12 month %EWL of 73.29% (n=176) compared to those completing 5-8 months with a mean 12 month %EWL of 65.63% (n=15) (F= 3.693, p = .056).  For the subset of 127 patients with weight measurement at 18 months, mean BMI declined to 32 and mean %EWL increased to 77.32% (n=127).  For the subset of 88 patients with weight measurement at 24 months, BMI continued to decline and %EWL stayed constant (BMI=31, %EWL= 77.19%; n=88).

 

Conclusions: Overall, patients completing the 12 month program achieved 10% greater %EWL than currently reported in the literature for similar procedures. Our results indicate patients who complete 9-12 months of a phone call support program post bariatric surgery have better weight loss than those completing 5-8 months.  Patients with longer follow up to 18 and 24 months had stable weight loss.  This study provides evidence of added benefit of a nutritional and behavioral support program for bariatric surgery patient’s weight loss.

Identification of appropriate bariatric surgery candidates using a pre-surgery telephonic behavior change program: Click here or on the image for the printable pdf version of the data poster published by Accomplish (the poster is large, and you will need to resize it on your browser or document reader)

Improving weight-loss through a post bariatric surgery telephonic nutrition and lifestyle support program: Click here or on the image for the printable pdf version of the data poster published by Accomplish (the poster is large, and you will need to resize it on your browser or document reader)