The value of pre-op diets (link to full text in comments)

I just ran across this abstract - https://www.ncbi.nlm.nih.gov/pubmed/29454535 - and I'm working on attaining the full text.

The short version from the conclusion is "Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss."

Well, prep diets clearly delay treatment. But most of us delayed for much, much longer before even seeking treatment. I don't believe the delay is harmful, certainly not in the progression of this disease. But it may not help, either.

I don't see how it can lead to inferior weight loss, so I'll be interested in reading more. For me, losing a bunch before surgery really helped me get to goal.

My feeling is, the day of surgery starts a clock. A primarily mental clock. For most people, this clock winds down in about a year, maybe 16 months. That's how long we can focus hard on weight loss. Some only make it for 6 months. A few, like yourself, stretch it out longer, or can hit a snooze button and restart the clock. But really, that's rare.

Losing before surgery gives us a second clock to lose weight by. No matter how much we lose, or don't lose before surgery, the post surgery clock resets. Prep diets, in essence, give us a free weight loss period. Using it well can only help. In my opinion.

Yeah, I'm really interested in reading the full article as well. I didn't have an insurance-required pre-op diet, but I opted to do my own pre-op diet starting 2-3 months pre-op anyway.

I can see how the pre-op requirements could cause people not to end up getting surgery at all due to non-compliance, especially for those in rural areas who have difficulty getting to the follow-ups often required. But I'm surprised that the pre-op diet correlates with worse results for post-ops. Neutral I would have understood, but worse?

We'll see. Hopefully!

That is my take on them as well: they are required by insurance with the hopes that those who don't comply won't follow through. I know that if I missed an appointment and couldn't get seen within 30 days, I had to start the 6 month progress over. If you live in a region that gets harmful weather patterns, a blizzard could start the whole process over. I could see people losing motivation and giving up at that point.

I wonder if they result in worse outcomes because the body doesn't like losing massive amounts of weight. If that occurs before surgery, the loss could slow postop as the body tries to prevent more weight loss?

nosing in here: Jen I think you're onto something. We already know that many who lose large amounts of weight preop tend to lose weight more slowly and in smaller increments after surgery. (in comparison with those who don't have the big losses preop.)

I'm wondering if that whole line of thinking somehow morphed into this paper, with it's apparent conclusion that those who go on preop diets don't lose as much as quickly after surgery. Is it possible I wonder that they are taking the correlation of the two situations and making the case for actual causation? It wouldn't be too big a leap. In other words "those who lose big weights pre-op tend to lose weight more slowly postop" becomes "those who do the preop dieting tend to lose more slowly postop." Which then becomes, "those who participate in pre-surgery diets are not as successful postop."

It's a bit disingenuous of them I think to make that jump, especially because the average person doesn't know anything about WLS, much less about variations in speed of weight loss due to the factor du jour.

Where's Julie on this thing? She's probably got all kinds of science to bring to this one.

edited for at least a stab at clarity

Anecdotal observation, and speaking for myself, only- The supposition that a pre WLS dieting regimen and lose big weights pre op tend to lose more slowly post-op was not my experience.

So,.. I have no "science" to offer- While I was not required to loose any weight whatever (There was a mandated waiting period that required "nutritional counseling"- cough..cough), my opportunity to practice making better choices and eating behaviors served me well during that time as well as after WLS.

So, I guess what I am questioning just where they gathered that data from in the first place- I do not believe I am the only special snowflake here- there are certainly others ou there- Grim, for one and

I agree totally agree with you re. the need for a more careful interpretation of what may well be an incorrect correlation.

The study explains the design.

I didn't do well with the pre-op diet, I actually gained 15lbs. I was stuck in limbo dealing with issues trying to get someone to do my surgery. So I took all my frustration out by eating whatever I wanted. My crazy mind was saying well if you aren't going to have the surgery you might as well eat what you want. So I did. Not the best move. It actually took me over a year to get approved for the surgery and the insurance required a 6 month physician supervised diet. When I asked the insurance company if there was a specific weight loss amount they wanted I was told no, just to be checking in with a doctor. So to me it didn't serve any purpose other than to delay my surgery.

I think the pre-op diet my also weed-out people who aren't ready or are afraid. It took me three startups to finally get mine done. I feel it was for the best because I was really ready! I was all in and did everything I had to do to lose the weight.

Also, how many of the ones listed self paid? They didn't list any of that. Maybe with the self payers they lost more because it cost them more money out of pocket.

Interesting read and I'd also like to see the whole report.

Liz

Interesting.... I am so glad it was not something they were asking us to do back in the day. I had so many "last" meals I would never have made it to surgery.