Unrealistic weight loss expectations in candidates for bariatric surgery.

BACKGROUND: Unrealistic expectations of weight loss are prevalent in obese patients and can negatively affect their adherence to dietary and health goals. We sought to examine the expectations and perceived notions about weight loss in candidates for bariatric surgery. METHODS: A total of 284 consecutive and prospective bariatric patients were surveyed using a validated Goals and Relative Weights questionnaire before an educational seminar. The participants categorized their weight loss expectations as "dream," "happy," "acceptable," and "disappointed" and rated the effect of surgically-induced weight loss on 21 indicators of health, quality of life, social functioning, and self-image on a 1-10 scale. The data are presented as the mean +/- standard deviation. RESULTS: Of the 284 patients, 230 were women and 54 were men (age 45 +/- 10 years; body mass index 50 +/- 8 kg/m(2)). These patients stated that their "dream" weight would be 89% +/- 8% excess body weight loss and that 77% +/- 9%, 67% +/- 10%, 49% +/- 14% excess body weight loss would be their "happy," "acceptable," and "disappointed" weight, respectively. Participants ranked health, fitness, body image, work performance, and self-confidence as the most important benefits of bariatric surgery. Women had greater "happy" and "acceptable" weight loss expectations and put more emphasis on physical presence (r = .17-.33, P <.01). Younger patients put more emphasis on attractiveness and improvements in social and sex life after bariatric surgery (r = .15-.19, P <.01). CONCLUSION: The results of our study have shown that although the candidates for bariatric surgery understand its benefits, they have unrealistic expectations of weight loss. In our study, the patients' most modest weight loss expectation, the "disappointed" weight, was equivalent to what providers would consider a successful weight loss outcome after bariatric surgery. Setting realistic expectations is an important aspect of the preoperative evaluation and education, especially for younger women.

The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients.

BACKGROUND: Nonalcoholic Steatohepatitis (NASH) commonly occurs in obese patients and predisposes to cirrhosis. Prevalence of NASH in bariatric patients is unknown. Our aim was to determine the role of routine liver biopsy in managing bariatric patients. METHODS: Prospective data on patients undergoing Roux-en-Y gastric bypass (RYGBP) was analyzed. One pathologist graded all liver biopsies as mild, moderate or severe steatohepatitis. NASH was defined as steatohepatitis without alcoholic or viral hepatitis. Consecutive liver biopsies were compared to those liver biopsies selected because of grossly fatty livers. RESULTS: 242 patients underwent open and laparoscopic RYGBP from 1998-2001. Routine liver biopsies (68 consecutive patients) and selective liver biopsies (additional 86/174, 49%) were obtained. Findings of cirrhosis on frozen section changed the operation from a distal to a proximal RYGBP. The two groups were similar in age, gender, and BMI. The group with the routine liver biopsies showed a statistically significant larger preponderance of NASH (37% vs 32%). Both groups had a similar prevalence of cirrhosis. Neither BMI nor liver enzymes predicted the presence or severity of NASH. CONCLUSIONS: Routine liver biopsy documented significant liver abnormalities in a larger group of patients compared with selective liver biopsies, thereby suggesting that liver appearance is not predictive of NASH. Liver biopsy remains the gold-standard for diagnosing NASH. We recommend routine liver biopsy during bariatric operations to determine the prevalence and natural history of NASH, which will have important implications in directing future therapeutics for obese patients with NASH and for patients undergoing bariatric procedures.