Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery Sarah Ying Tse Tan 1 & Pooi Ling Loi 1 & Chin Hong Lim 2 & Sonali Ganguly 1 & Nicholas Syn 3 & Kwang Wei Tham 1 & Hong Chang Tan 1 & Weng Hoong Chan 2 & Hui Mei Wong 4 & Phong Ching Lee 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The effect of preoperative weight loss via very low caloric diet (VLCD) on long-term weight loss post-bariatric surgery (BS) is conflicting. We analysed its impact on weight loss and other outcomes post-BS. Methods Patients (n = 306) who underwent sleeve gastrectomy or gastric bypass from 2008 to 2018 were studied. VLCD was prescribed for 14 days preoperatively. Patients were followed up for 5 years. Postoperative weight loss was compared in patients with preoperative weight gain or weight loss < 5% (WL < 5%), and weight loss ≥ 5% (WL ≥ 5%). Preoperative WL compared weight before and after VLCD; postoperative WL compared post-VLCD weight and follow-up weight. Total weight loss (TWL) encompassed pre- and postoperative WL. Results WL was < 5% in 87.3% and ≥ 5% in 12.7%. There was no significant difference in complication rate, duration of surgery or length of stay, regardless of surgical type. Patients with WL < 5% lost more weight postoperatively compared with WL ≥ 5% for up to 60 months (%postoperative WL at 1 month: WL < 5% = 13.7%, WL ≥ 5% = 10%, p = 5% prior to surgery, 87.2% of our patients would not qualify for surgery. This would significantly reduce accessibility of a clinically proven Fig. 1 Postoperative and total weight loss (a and b)
Total SG GB Total SG GB Total SG GB
Gained weight or lost weight < 5% (N = 267)
Lost weight ≥ 5% (N = 39)
p value
162.36 ± 80.78 131.86 ± 46.66 239.11 ± 96.52 2.98 ± 2.00 2.71 ± 1.42 3.73 ± 3.01 9 (3.7%) 4 (2.2%) 5 (7.6%)
177.78 ± 98.24 134.80 ± 53.60 275.45 ± 108.50 3.49 ± 3.14 3.36 ± 3.59 3.82 ± 1.60 0 (0%) 0 (0%) 0 (0%)
0.305 0.775 0.262 0.175 0.08 0.926 0.616 0.424 0.345
treatment option for morbid obesity. Furthermore, our study findings do not show that preoperative weight loss is associated with improved short- or long-term outcomes after bariatric surgery.
OBES SURG Fig. 2 Change in BMI and excess BMI loss (%) (a and b)
Patients with significant weight loss prior to surgery had reduced postoperative weight loss compared with their counterparts. This trend has been described in a retrospective analysis by Harnisch et al. [11], comparing patients with preoperative weight gain versus weight loss before RYGB describes that though there was no difference in the percentage of excess weight lost (%EWL) up to 24 months postoperatively, the sustained %EWL at 36 and 48 months was actually greater in the preoperative weight gain group compared with the preoperative weight loss group. However, these results were limited by the low long-term follow-up rates, and the authors surmised that additional research would be required to derive a valid conclusion. The resu
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