Impact of the implementation of an educational curriculum and assessment tool in a six-month insurance mandated bariatric pre-operative weight loss program

Introduction and Objectives: Insurance companies may require that a patient complete 3 to 6 consecutive months of a pre-operative weight loss (POWL) program prior to bariatric surgery. No standardized curricula for POWL exists, and the impact of POWL on patients has had mixed results when the magnitude of pre-operative weight loss is used as a predictor of post-operative outcomes. However, the impact of pre-operative education, independent of weight loss, on post-operative outcomes is largely unknown. Hence, the present study was undertaken to assess whether knowledge gained through a curriculum designed to improve patient understanding of bariatric nutritional and behavioral concepts has an impact on pre-operative weight loss and ultimately on post-operative outcomes. Participants: 40 Adult patients with a BMI 4 35 kg/m seeking bariatric surgery required to attend six months of insurancemandated POWL classes agreed to participate in this project. Study Design: An 11-point quiz was provided (n1⁄440) at the first and last POWL class, in a series of 6 monthly classes. Patient knowledge of strategies associated with positive changes in eating behaviors, dietary intake, and reduced post-operative complications was tested. Weight was at each monthly POWL class. Procedures: The POWL curriculum emphasizes nutrition and behavior concepts linked to positive long-term post-operative outcomes including hydration, protein needs, post-operative complications, and general weight loss strategies. Classes were taught by a bariatric clinician: registered dietitian, physician assistant, or psychologist. Weight was measured in pounds to the first decimal place at each monthly class. A 0.5% increase or decrease from the initial weight obtained at the first POWL visit was defined as a change in weight. Results: There was a significant difference between the measured pre-POWL weight (M1⁄4301.9, SD1⁄483.9) and the post-POWL weight (M1⁄4295.0, SD1⁄482.1); t(39)1⁄4 2.67, p1⁄40.01). Seventy percent (28/40) of patients lost weight (Table 1). Table 1. Average Percent Weight Change by Weight Change Classification (see attached) There was a significant difference between the pre-POWL quiz score (M1⁄45.9, SD1⁄42.1) and post-POWL quiz scores (M1⁄49.1, SD1⁄41.9); t(39)1⁄4-11.7, p o 0.001. Ninety-five percent (38/40) of patients’ scores improved post-POWL (Table 2). Table 2. Quiz Score Classification of Study Population (see attached) There was no significant correlation between the postPOWL quiz score and change in weight (r 1⁄4 -0.073, p1⁄40.7), nor between the change in POWL quiz score and change in weight (r 1⁄4 0.22, p1⁄40.2). Conclusions: Overall, the curriculum was effective in improving patient knowledge of important nutritional and behavioral concepts. While there was a significant difference in preand postPOWL weight, and the majority of patients lost weight during the 6-month period, the average weight loss was modest, at less than 5%. In addition, there was not a significant correlation between POWL quiz score and weight loss. Further validation of the POWL quiz may be undertaken in order to better utilize this tool in the pre-operative bariatric population. Lastly, further research may gather post-operative outcomes. References: 1. Alvarado R, Alami RS, Hsu G, Safadi BY, Sanchez BR, Morton JM & Curet MJ. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1282-1286. 2. Anderin C, Gustafsson UO, Heijbel N, Thorell A. Weight Loss Before Bariatric Surgery and Postoperative Complications: Data From the Scandinavian Obesity Registry (SOReg). Ann Surg. 2014 Sept; [Epub ahead of print]. 3. Eisenberg D, Duffy AJ, & Bell RL. Does Preoperative weight change predict postoperative weight loss after laparoscopic Roux-en-Y gastric bypass in the short term? J Obes. 2010; Article ID 907097, 4 pages. doi:10.1155/2010/9070974. 4. Mrad BA, Stoklossa CJ, & Birch DW. Does preoperative weight loss predict success following surgery for morbid obesity? Am J Surg. 2008;195:570-574.