Preoperative dietary counseling does not improve outcome and increases drop-out rates in patients considering gastric bypass surgery for morbid obesity

Abstract

Purpose: Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves the outcomes and postoperative compliance. Methods: We compared the outcomes of gastric bypass (GB) patients undergoing a mandatory 6 months of PDC (n 72) with a contemporaneous group of patients with no such requirements (No-PDC, n 252) who underwent surgery between January 2000 and December 2002. Results: The PDC and No-PDC groups were characterized by a similar male/female ratio (1:4 vs. 1:4.6), age (mean 42 years), mean body weight (324 vs. 309 lb), and body mass index (52 vs. 50 kg/m). The PDC group had a greater incidence of obstructive sleep apnea compared with the No-PDC group (41% vs. 28%, p 0.04) but otherwise had a similar incidence of obesityrelated comorbidities. The preoperative drop-out rate was 50% greater in the PDC group than in No-PDC group (26% vs. 17%, p 0.05). At 1 year of follow-up, the No-PDC group had a statistically greater percentage of excess weight loss (67% vs. 60%, p 0.0001), lower BMI (32 vs. 35 kg/m, p 0.015), and lower body weight (197 vs. 218 lb, p 0.01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in both groups. Conclusions: These data have demonstrated that mandatory PDC is an obstacle to patient access for surgical treatment of severe obesity that demonstrates no impact on weight loss outcome or postoperative compliance. PDC should be abandoned by the insurance industry. PII: S1550-7289(05)00125-5