Efficacy of a dietitian-led very low calorie diet (VLCD) based model of care to facilitate weight loss for obese patients prior to elective, non-bariatric surgery.

Abstract

Elective surgery in obese adults carries a higher risk of post-operative infection and prolonged hospital stays, and surgeons may postpone surgery for patients with obesity until they lose weight. The present study aimed to determine the efficacy of a dietitian-led very low calorie diet (VLCD)-based model of care with respect to achieving weight loss for obese patients prior to surgery. This mixed-methods study included a medical chart audit of patients referred to a VLCD-based model over 23months, as well as a survey of recently treated patients and surgeons who utilised the model. Preoperative weight loss targets were set by surgeons, and the dietitian prescribed individualised VLCD-based treatment. Efficacy was determined as weight loss considered sufficient for surgery, clinical safety of VLCD-based treatment, feasibility, and stakeholder value. Pre/post-intervention differences in clinical measures were explored by paired t-test or Wilcoxon tests as appropriate. Data on seventy-eight eligible patients [mean (SD) 45(13)years, 90% female, body mass index 44.3(6.2)kgm-2 ] demonstrated significant mean (SD) weight loss of 7.4%(5.3%) body weight (P<0.05). Most patients (70%, n=50/71) achieved sufficient weight loss to proceed to surgery. Fifty-six per cent of patients reported mild side effects (n=43/77) and none led to treatment cessation. Surgeons reported VLCD-based treatment made operations easier (83%, n=10/12) and shorter (75%, n=9/12) and all recommended the model of care. All surveyed patients (n=24) reported satisfaction with their VLCD-based model experience. A dietitian-led VLCD-based model achieved sufficient weight loss to facilitate elective surgery for most patients. The approach was feasible, highly valued by patients and surgeons, and resulted in perceived surgical benefits.