Background

It is recognized that excess weight increases the risks of surgical procedures due to increased risk of prolonged hospitalization, poor or delayed wound healing, increased risk of infection, and others. As a result, many surgeons are delaying non-emergent surgeries and recommending weight loss first. Patients are in need of more structured recommendations.

Methods

We developed a 12-week, protein-sparing meal plan using a mixture of meal replacement products andfood, along with twice monthly behavior modification group sessions (“Prepare Program”). Participants were all evaluated by a medical provider and registered dietitian (RD) on initial visit to ensure the Prepare Program was medically appropriate. All participants underwent initial resting metabolic rate testing using indirect calorimetry and body composition testing using a bioimpedence scale, as part of routine clinical care. Initial RD visit was an individual visit, subsequent visits occurred in a group setting. Participants paid a small fee for the classes and were responsible for purchase of meal replacement products.

Results

A total of 38 participants enrolled in the first 10 months of the program. Of the 38 participants, nine were male. Average age was 66, range 58 – 75. Mean starting BMI was 42.7 kg/m2, range 29-69 kg/m2. Average weight lost was 12 lbs, range of +1.5 lbs to -46 lbs (+1% to -15% total body weight [TBW]). Among those who attended at least 3 of 6 classes (n=17), average reduction in TBW was 8%. There were no adverse events. Surgical outcomes are pending. Some surgeries were cancelled due to lack of necessity for surgery following weight loss and subsequent improved symptoms.

Conclusions

Structured protein sparing diet along with behavioral modification is successful in rapid weight loss for patients whose surgeries are postponed due to excess weight and concern for surgical risk. Further follow up of surgical outcomes is pending.