title: Dietetic-led management of patients undergoing laparoscopic gastric banding: early results.
abstract: BACKGROUND
  Optimal results of bariatric surgery are achieved when it is performed within a multidisciplinary team. Within this team, the dietician plays a key role before and after surgery in patient education and behaviour change. With long-term follow-up, the number of patients per surgeon increases exponentially. This study evaluated the outcomes of a dietician-only led management program for patients who underwent laparoscopic gastric banding in our unit.
  
  
  METHODS
  Between April 2003 and November 2007, 1,335 patients underwent laparoscopic gastric banding in two hospitals by the same surgical team. Weight loss outcomes were compared for patients in a dietician-led management program against a surgeon/nurse specialist follow-up program with more frequent patient visits. For the dietician-led group, a standard protocol of six postoperative visits and two to three fluoroscopic adjustments was developed from referral until 2 years after surgery.
  
  
  RESULTS
  There were 316 patients followed up in a dietician-led program. They were compared with the remaining patients who were followed up in a surgeon/ nurse specialist led program. The mean preoperative weight and body mass index (BMI) for the dietetic-led subset was significantly higher (weight: 147.4 +/- 30.2; BMI: 52.8 +/- 8.9) compared with the remaining group (weight: 113.8 +/- 18.7; BMI: 41.6 +/- 5.2; p < 0.001: Mann-Whitney test). Percent BMI loss was initially lower in the dietician-led group, but this difference disappeared at the end of 24 months (p = 0.056).
  
  
  CONCLUSIONS
  A patient management program led by specialist dieticians is an effective way to manage large numbers of patients after laparoscopic gastric banding while maintaining comparable weight loss to surgeon/nurse-led series.
authors.affiliation: Upper GI Unit and Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK. singhal_rishi@rediffmail.com
authors.forename: Rishi
authors.initials: R
authors.lastname: Singhal
authors.forename: Mark
authors.initials: M
authors.lastname: Kitchen
authors.forename: Sue
authors.initials: S
authors.lastname: Bridgwater
authors.forename: Paul
authors.initials: P
authors.lastname: Super
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004046:Dietetics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy / Q000503:physiopathology / Q000601:surgery*; D010353:Patient Education as Topic; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult