A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/704136
11 Review Bariatric Times • July 2016 p atients toward an understanding that bariatric surgery is tool rather than a cure for their struggle with the chronic disease of obesity. Moreover, providers must navigate a delicate balance between guiding patients toward an accurate understanding of treatment outcome without diminishing enthusiasm for the possibility of l iving a different life after substantial weight loss. Given this interplay of medical and quality of life benefits of weight loss, and the possible psychological and weight r amifications of not achieving expected outcomes, the current article has two purposes. First, we will briefly review what is known about patients' presurgery e xpectations for changes in weight, quality of life, body image, and relationships after bariatric surgery. Second, we will demonstrate ways for health care providers to a pproach these topics with patients through four prepared vignettes. WEIGHT EXPECTATIONS: RESEARCH FINDINGS Many research studies have demonstrated that patients have unrealistic expectations for weight loss after having bariatric surgery. 18–24 The most commonly used tool for assessing weight expectations is the Goals and Relative Weights Questionnaire (GRWQ) originally designed for use with nonsurgical populations. 25 The GRWQ has been adapted for use with patients seeking bariatric surgery where patients are asked to define, in pounds, their "dream," "happy," "acceptable," and "disappointed" weights after having bariatric surgery. In general, studies have found that patients' dream weights represent greater than 40 percent loss of their initial body weight ( >90% of excess weight) and correspond with achieving a BMI in the healthy weight range of 20 to 25kg/m 2 . 2 0,22 Weights patients rated as "disappointing" were those weights that were most closely associated with actual outcome after having bariatric surgery. Even when patients were asked to identify a weight they could realistically expect to achieve after RYGB and VSG, their expectations greatly exceeded actual outcome. 21 Furthermore, patients report that they would be disappointed with a sustained weight loss of 20 percent of initial weight. 20 Caucasians, younger women, and patients with greatest BMI appear to have the most unrealistic expectations for weight loss after bariatric surgery. 21 In our clinical experience, patients often present for the initial assessments unclear as to the risks and benefits of a given bariatric operation to their health. Moreover, patients may have broader health o utcomes (e.g., I want to feel better and be more active) but have not considered the impact a bariatric surgery may have on established health conditions such as T2DM and O SA. Thus, providers are responsible for addressing gaps in knowledge and discrepancies in expectations so that patients ultimately arrive at an informed d ecision about which weight loss operation is most appropriate for them. Desired weight loss is only one of several clinical indicators ( e.g., medical comorbidities, tolerance for risk, presence of sweet eating) to be discussed with patients, but an important factor to consider in selecting the surgical i ntervention. Based on our review of the literature, the following areas are important for discussion with patients about their expectations for weight loss after bariatric s urgery. First, weight loss can vary widely by the type of bariatric surgery, and from patient to patient influenced b y pre-surgical BMI, sex, physical activity level, and comorbid health problems. 8 Assisting patients with calculating their expected weight loss for RYGB and VSG based on t he bariatric surgery literature will provide them with an opportunity to discuss potential discrepancies in their expected weight loss and actual outcomes based on research f indings. It has been our experience, that while our clinical team discusses percent of excess weight loss, patients may more