Presented at the North American Association for the Study of Obesity (Obesity Society) annual meeting October 2006, Boston MA.

Methods

Patients undergoing bariatric surgery at a staff-model HMO in Seattle WA participated in a required behavioral support program. We conducted a retrospective cohort study of 219 patients undergoing RYGB surgery from 2001-2004 to evaluate the relationship between weight loss and program participation. The call program consisted of 12 months of post operative calls, 20-30 minutes in length and addressed food intake, physical activity and long-term weight maintenance strategies. Calls were weekly during the first six months and bi-weekly for months 7-12. Post-surgery visits with the surgical team were at 3, 6, 9, 12, 18, 24 months, then annually. Study data including weights were collected at medical visits and by program health educators during phone calls with pre and post surgical information abstracted from medical records. One patient died peri-operatively (.5%), 23 patients (10.5%) were lost to follow up, four patients discontinued phone support between one and four months but continued with their clinic visits and 195 patients completed 12 months of clinic follow up. 65% of the group had weight measurements at 18 months (n=127) and 45% had weight measurements at 24 months.

Results

Mean age of the 12 month cohort (n=195) was 45 years with a range of 25 to 71 years. 88.2% were female. Mean pre-operative BMI was 53 with a range of 38-85. At twelve months post surgery, mean BMI was 33 with a range of 21-51. Mean percent excess body weight loss (%EWL) at 12 months was 73.42%, ranging from 33.40% to 128.48%. Patients completing 9-12 months of calls had a mean 12 month %EWL of 73.29% (n=176) compared to those completing 5-8 months with a mean 12 month %EWL of 65.63% (n=15) (F= 3.693, p = .056). For the subset of 127 patients with weight measurement at 18 months, mean BMI declined to 32 and mean %EWL increased to 77.32% (n=127). For the subset of 88 patients with weight measurement at 24 months, BMI continued to decline and %EWL stayed constant (BMI=31, %EWL= 77.19%; n=88).

Conclusions

Overall, patients completing the 12 month program achieved 10% greater %EWL than currently reported in the literature for similar procedures. Our results indicate patients who complete 9-12 months of a phone call support program post bariatric surgery have better weight loss than those completing 5-8 months. Patients with longer follow up to 18 and 24 months had stable weight loss. This study provides evidence of added benefit of a nutritional and behavioral support program for bariatric surgery patient’s weight loss.