Follow-up Care is an Essential Part of Post-Weight Loss Surgery Success

Bariatric surgery is a safe and effective medical procedure for the treatment of obesity and related comorbidities. In order for its effectiveness to continue long-term, patients are directed to follow up with their medical practice afterwards. However, many patients experience challenges to routine follow-up with their original surgeon, and this is true for many reasons. This is the first study that examines those reasons, and even more importantly, determines whether follow-up with a different surgeon allows patients to achieve adequate weight loss after bariatric surgery. Dr. Christine Ren-Fielding and her colleagues also compared effectiveness among various post referral management strategies.

Patient Group and Methods

The individuals in this study were referred to Dr. Christine Ren-Fielding’s practice for various reasons, the most commonly reported being unsatisfactory weight loss since the patient’s primary bariatric procedure. Patients were placed in three categories according to their management strategy.  The nonsurgical management group included all interventions that did not involve operations. These included percutaneous gastric band adjustments, dietary counseling, participation in a weight loss program, and appetite suppressant therapy. Patients in the revision category all had some kind of surgical intervention that aimed to modify the first weight loss procedure. The conversion group consisted of individuals who would go through a new surgery to change their original bariatric procedure to a different one. 569 patients were included in this study.

This study was a retrospective analysis of patients who underwent bariatric surgery elsewhere from 2001 to 2013, then were referred to Dr. Christine Ren-Fielding’s practice. The time reviewed was from when the patients were first seen at referral to the most recent follow up and most recent data collection. The team collected data at all post referral visits, which is when any patient meets with or speaks to anyone with the practice, as well as office visits with physician assistants, nurse practitioners, dieticians, surgeons, and medical bariatricians.

Data Collected During Study

The researchers gathered information including demographic material, preoperative weight/body mass index (BMI), type of and date of primary operation, date and rationale for referral, weight and BMI at referral, as well as number of post-referral visits. Inclusion criteria consisted of individuals being at least 18 years old, with a BMI greater than 35. The study specifically focused on patients who had experienced what is known as weight loss “failure.” The rationale for this is that patients who had successful weight loss had too little excess weight in order to be included in the study. Patients in the study needed to have prereferral percent weight loss (%EWL) of less than 30% for laparoscopic adjustable gastric banding (AGB) and less than 50% for laparoscopic Roux-en-Y gastric bypass (RYGB) or other weight loss procedures.

Prereferral Versus Post Referral

Dr. Christine Ren-Fielding and her team also carried out a subset study to examine only those patients with prereferral weight loss failure so they could compare weight loss results from the time from the individual’s original bariatric surgery procedure to the date of referral, then to the most recent follow-up date. For RYGB patients, %EWL was 27.4% prereferral vs. 35.6% post referral, with no major differences in pre vs. post referral outcomes among RYGB patients who had nonsurgical management. In the AGB patient group, %EWL was 13.2% prereferral and 24.0% post referral. AGB patients who were managed non-surgically had %EWL of 12.2% prereferral and 24.5% post referral. These results demonstrate that people with minimal weight loss experienced improved outcomes after referral, but that those with marginal results did not greatly improve.

Dr. Christine Ren-Fielding’s Study Results

Among all 569 patients, from the time of their original bariatric surgery procedures to their most recent follow up with Dr. Christine Ren-Fielding’s practice, the mean %EWL was 45.3% and the percent excess body mass index loss (%EBMIL) was 54.6%. Individuals who converted to another bariatric procedure enjoyed greater weight loss than those with other weight loss management approaches. These support the conclusion that patients referred elsewhere after bariatric surgery can achieve adequate weight loss. While the results will differ based on surgery type and management strategy, the findings are overall encouraging to patients coming from another practice still seeking long-term solutions to obesity and related diseases.

To find out more about bariatric surgery and other weight loss options for you or a loved one, visit the NYU Langone Weight Management Program here and learn more about the work of experts like Dr. Christine Ren-Fielding.