Swager LeeAnn C, Pratt Keeley J, Kiser Haley M, Pona Ashleigh A
Department of Human Sciences College of Education and Human Ecology The Ohio State University Columbus Ohio USA.
Department of General Surgery College of Medicine The Ohio State University Wexner Medical Center Columbus Ohio USA.
Obes Sci Pract. 2024 Dec 24;10(6):e70030. doi: 10.1002/osp4.70030. eCollection 2024 Dec.
Pre-operative eating disorders are well documented within the metabolic and bariatric surgery (MBS) population, yet subthreshold dieting attempts are less understood. The objectives of this study were to define and categorize patients' preoperative dieting attempts, and to determine how attempts are associated with postoperative outcomes, eating disorders, and demographics.
Three hundred twenty-one patients (81.0% female; 68.3% White) who had MBS (57.3% Roux-en-Y) between 2019 and 2020 were included. Preoperative dieting attempt responses were categorized as provider-managed, non-medically managed, and self-directed attempts; subtypes of dieting methods (e.g., low calorie) were described. Descriptive analyses were conducted for attempt categories and subtypes, and between attempts and readmissions, complications, eating disorders, and demographics. ANOVAs determined associations between attempts and %TWL at 6 and 12 months.
Patients reported an average of five to six preoperative dieting attempts; self-directed attempts were the most common (91.9%), and exercise was the most common subcategory (70.7%). Patients with ≥ 1 provider-managed attempt were less likely to experience a complication ( < 0.001) and more likely to experience readmission ( = 0.018). Patients with 1 self-directed attempt were less likely to experience a complication ( = 0.045) and readmission ( < 0.001). Patients who experienced ≥ 2 low fat diet attempts were more likely to have complications ( < 0.001) and readmissions ( = 0.008); patients with ≥ 2 VLCD attempts were more likely to have a complication ( < 0.001). Patients who experienced ≥ 2 non-medically managed attempts had higher preoperative BMIs ( = 0.03).
Given that patients engaged in frequent dieting attempts that fall outside formal assessments, future work should seek to expand pre-operative assessments.
术前饮食失调在代谢和减重手术（MBS）人群中已有充分记录，但阈下节食尝试的情况却鲜为人知。本研究的目的是对患者术前的节食尝试进行定义和分类，并确定这些尝试与术后结果、饮食失调及人口统计学特征之间的关联。
纳入2019年至2020年间接受MBS手术（57.3%为 Roux-en-Y 手术）的321例患者（81.0%为女性；68.3%为白人）。术前节食尝试的回答被分类为医生管理的尝试、非医学管理的尝试和自我指导的尝试；描述了节食方法的亚型（如低热量）。对尝试类别和亚型以及尝试与再入院、并发症、饮食失调和人口统计学特征之间进行了描述性分析。方差分析确定了尝试与6个月和12个月时的体重减轻百分比（%TWL）之间的关联。
患者报告平均术前进行了五到六次节食尝试；自我指导的尝试最为常见（91.9%），运动是最常见的子类别（70.7%）。有≥1次医生管理尝试的患者发生并发症的可能性较小（<0.001），但再入院的可能性较大（=0.018）。有1次自我指导尝试的患者发生并发症的可能性较小（=0.045），再入院的可能性也较小（<0.001）。经历≥2次低脂饮食尝试的患者更有可能发生并发症（<0.001）和再入院（=0.008）；经历≥2次极低热量饮食（VLCD）尝试的患者更有可能发生并发症（<0.001）。经历≥2次非医学管理尝试的患者术前体重指数较高（=0.03）。
鉴于患者进行了频繁的节食尝试，且这些尝试未纳入正式评估，未来的工作应寻求扩大术前评估。
