Women’s Health Program Helps Patients Lose Weight Prior to Surgery, Reducing Risks

In an effort to minimize surgical complications associated with obesity and set patients up for success postsurgery, surgeons are referring obese patients for weight loss management prior to surgical procedures.

Almost 40 percent of U.S adults — 93 million people — are considered obese with a BMI of 30 or higher, according to the U.S. Centers for Disease Control and Prevention. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer.

Karen Cooper, DO, Director, Women’s Weight Management Program, Ob/Gyn & Women’s Health Institute, says obese patients face higher risks intraoperatively and postoperatively — including cardiac and respiratory issues, wound complications, surgical site infections and venous thromboembolism, among others.

Obesity also can hinder surgical technique, administration of medication and patient recovery.

“The risks for morbidity and mortality are well documented with obesity and surgical procedures, more so when a patient has associated comorbid conditions — including obstructive sleep apnea, coronary artery disease and poorly controlled hypertension,” says Dr. Cooper. “Patient safety, shorter recovery times, shorter hospital stays, reduced infection rates — for all of those reasons, perioperative weight loss can be beneficial.”

When is weight loss indicated?

While perioperative weight loss in an overweight or obese individual can lessen operative risk, patients unable to attain weight loss will not be denied a life-saving procedure. For elective surgeries, such as breast reconstruction and abdominoplasty, postoperative satisfaction is increased in patients with a normal body mass index compared to obese patients.

Some surgical procedures could be delayed until a moderate amount of weight loss is obtained, since visceral fat can hinder surgical technique.

“When someone is morbidly obese, visceral fat is also increased, particularly in the liver,” Dr. Cooper says, adding that weight loss prior to bariatric surgery can decrease the size of the liver — a portion of which sits across the stomach area. “This provides a more favorable operative environment for the surgeon due to the reduction in difficulty when retracting the liver in bariatric surgical procedures.”

Orthopaedic surgeons may require weight loss prior to surgery to reduce the risk of infection, allow the joint to be positioned properly and to increase wearability. Sometimes, she says, the orthopedic surgeon may require weight loss to determine if weight is a factor in a patient’s condition (e.g., knee pain).

Weight management program

For patients referred to her for perioperative weight loss, Dr. Cooper uses a high protein diet for safe and effective weight loss in a short time period.

“In our program, we advocate a diet that is high in protein and low in fat. It’s a modification of carbohydrate intake, while increasing protein and decreasing fat intake,” Dr. Cooper says. “This differs from similar ketogenic diets that are high in both fat and protein.” For patients who fit the medical criteria, medications may also be prescribed to enhance continued weight loss.

Patient satisfaction

In conjunction with registered dietitians, Dr. Cooper successfully guides perioperative weight loss in patients who are highly motivated by the end result – their surgical procedure.

“The surgical procedure is a great motivator,” she says. “It’s critical for the surgeon and the medical provider to discuss the risks with the patient and explain why it’s important for perioperative weight loss to occur. Once patients understand the why, they are on board.”

For patients who require abdominally based free flap breast reconstruction — almost always due to mastectomy caused by breast cancer — Dr. Cooper discusses the procedure in detail. She shows patients the advantages of perioperative weight loss and discusses why exercise activity is important and how it will enhance recovery.

“By the end of the visit, they are ready to engage in regularly scheduled aerobic and strengthening activity to improve their cardiorespiratory and musculoskeletal system for the best outcome,” says Dr. Cooper.

“It’s really about compassionate and empathic care, explaining the why of the procedure, and choosing an effective diet plan,” Dr. Cooper says, adding that very few patients choose not to follow through with perioperative weight management under her supervision. Patients who achieve their desired perioperative weight are more satisfied postoperatively and more successful at maintaining their weight loss.