Daily Food Choices with Preop & Postop Weight Loss After the MGB

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Title: The Association of Daily Food Choices with Preoperative Weight and Postoperative Weight Loss Satisfaction Following the Mini-Gastric Bypass-Original Technique
Authors Rutledge, Kular Manchanda

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Abstract
The history of Bariatric surgery includes a variety of missteps and errors (think, Lap Band and others.) At present, bariatric surgeons, nutritionists and surgical programs routinely recommend a pre and postoperatively a Very Low Calorie Diet (VLCD), high (often powdered) protein, high (saturated) fat and low “carbs.”[ The bariatric surgery patient Nutrition considerations Caroline Shannon, Ashlee Gervasoni, Trudy Williams] Similar VLCD diets were popularized in the ‘60’s but have since been largely abandoned. The present study analyzed the association of pre and postoperative Daily Food Choices (DFCs) of Sugar(like) Sweetened Beverages (SSBs), Fatty Foods (FFs), Meat (Meat) and Fresh Fruits and Vegetables (FFVs) in patients undergoing the Mini-Gastric Bypass Original Technique (MGB-OT.)

Results:
342 patients 76% female, mean age 46, mean follow up 7.4+/-4.2 years completed the online survey. As might be expected, increased preoperative “Bad” DFCs (sum of SSBs + FFs + Meat) were strongly and directly related to patients’ reported preoperative weight class (linear model R2 = 0.96) providing face validity of the survey/study. Patients’ postoperative Weight Loss Satisfaction (WLS) was assessed (judged as Poor, lost too little 2%, Fair 7%, Good 48%, “Perfect” 39% and Poor, lost too much 2%.) The Delta Bad DFCs (post - pre Bad DFCs) was associated with improved patient reported weight loss (linear model R2 = 0.95.) Additionally Delta of FFVs DFCs was associated with improved patient reported satisfaction/weight loss (linear model R2 = 0.92.) Patient reported complication rates were relatively low (None 64%, minor 25%, moderate 7% and hospitalization 5% (Gallbladder, renal stones etc.) Lower “Bad” DFCs were related to fewer and less severe reported complications (linear model R = 0.89.) Finally as reported elsewhere the MGB-OT “Tailored” Bilio-Pancreatic Limb Length (BPLL) was directly related to patient reported weight loss (R2 = 0.88), Delta Bad DFCs and Delta FFVs.

Conclusions:
As reported in other studies, the MGB-OT patient survey reported outcomes were excellent. The study is far from definitive but in short:
Daily Food Choices (DFCs) both before and after MGB-OT appear to be associated with pre and postoperative outcomes (weight, complications and others.) Additionally, the “tailored” BPLL was directly related to patient reported satisfaction, weight loss class and DFCs. The study seems to clearly demonstrate that “Bad” DFCs: fat, meat and sugar(like) sweetened beverages are associated in a direct linear fashion to both pre and postoperative outcomes. More Fresh Fruit and Vegetable DFCs were directly related to improved outcomes.

Bariatric surgery failure rates in 2020 remain high, primarily through weight regain. This is not the first study to show post op bariatric patients diets are poor and high in Meat, Fat and Sugar, surprisingly, often on the advice of the surgeon and nutritionist. The data supporting the deadly contribution of Meat, Fat and Sugar(like) DFCs to the obesity and diabetes epidemic is overwhelming. Thus this study showing that DFCs of Meat, Fat and SSBs are directly related to poor outcomes seems a simple extension of such data findings. With Sleeve failure rates reported as high as 5-30% or more, the standard pre and postoperative management guidelines might be ready for reevaluation, if the present findings are confirmed.

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