Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery.
BACKGROUND
In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort).


METHODS
A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss.


RESULTS
The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18-69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4-93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17-51%, SD: 0.09 percentage points) compared with 27% (range: 14-48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037).


CONCLUSIONS
Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.
Walsall Healthcare NHS Trust , UK.
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Patel
Walsall Healthcare NHS Trust , UK.
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Hartland
Walsall Healthcare NHS Trust , UK.
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Hollis
Walsall Healthcare NHS Trust , UK.
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Ali
Walsall Healthcare NHS Trust , UK.
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Elshaw
Walsall Healthcare NHS Trust , UK.
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Jain
Walsall Healthcare NHS Trust , UK.
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Khan
Walsall Healthcare NHS Trust , UK.
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Mirza
D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D019468:Disease Management; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D033183:Interdisciplinary Communication; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D016730:Program Development / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
Bariatric surgery; Gastric bypass; Tier 3 service; Weight loss; Weight management