title: Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity.
abstract: OBJECTIVE
  The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients.
  
  
  METHODS
  Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery.
  
  
  RESULTS
  The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days.
  
  
  CONCLUSIONS
  In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Marco Aurelio
authors: MA
authors: Santo
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Daniel
authors: D
authors: Riccioppo
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Denis
authors: D
authors: Pajecki
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Roberto de
authors: Rd
authors: Cleva
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Flavio
authors: F
authors: Kawamoto
authors: Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
authors: Ivan
authors: I
authors: Cecconello
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D001835:Body Weight; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
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