title: Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks.
abstract: BACKGROUND
  Achieving program-mandated preoperative weight loss poses a challenge for many bariatric surgery candidates. No systematic method exists to identify at-risk patients early in preoperative care.
  
  
  OBJECTIVE
  This study sought to explore predictors of preoperative weight loss achievement and to develop a treatment algorithm for guiding clinical decision-making.
  
  
  METHODS
  Greenville Health System, South Carolina.
  
  
  METHODS
  A retrospective chart review was conducted for 378 patients who followed a program-mandated low-calorie diet (LCD) for 4 weeks to achieve≥8% excess weight loss (EWL). Associations between weight loss achievement and patient demographic, nutrition, psychological, clinical, anthropometric, and treatment characteristics documented at 5 preoperative evaluation events were analyzed using logistic regression.
  
  
  RESULTS
  During the LCD, 62.7% of patients achieved≥8% EWL. Independent predictors of achievement (all P<.05) were male sex (OR 2.31, 95% CI 1.21-4.42), Caucasian race (OR 2.45, 95% CI 1.38-4.34), body mass index (BMI) at surgeon evaluation (50.0-59.9 kg/m2: OR .44, 95% CI .20-.97;≥60 kg/m2: OR .15, 95% CI .05-.42), number of co-morbidities (OR .83, 95% CI .74-.93), hypertension diagnosis (OR 2.42, 95% CI 1.42-4.13), prediet weight change (OR 1.08, 95% CI 1.01-1.16), and time between surgeon evaluation and preoperative LCD initiation (61-90 d: OR .46, 95% CI .23-.93).
  
  
  CONCLUSIONS
  Patients of female sex or non-Caucasian race; with a BMI≥50 kg/m2, many co-morbidities, or no hypertension diagnosis at surgeon evaluation; who demonstrate prediet weight loss or extended wait time between surgeon evaluation and preoperative LCD initiation may be at risk for preoperative weight loss failure and may require preemptive diet modification to improve outcomes.
authors.affiliation: Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey. Electronic address: hutcheda@shp.rutgers.edu.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Hutcheon
authors.affiliation: Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Byham-Gray
authors.affiliation: Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey.
authors.forename: Andrea Fleisch
authors.initials: AF
authors.lastname: Marcus
authors.affiliation: Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina.
authors.forename: John D
authors.initials: JD
authors.lastname: Scott
authors.affiliation: Division of Bariatric and Minimal Access Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina.
authors.forename: Megan
authors.initials: M
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D050110:Bariatric Surgery; D031204:Caloric Restriction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy*; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
keywords: Bariatric surgery; Formula diet; Low calorie diet; Predictors; Preoperative weight loss