Preoperative Weight Loss:

Effects on Long Term Psychological Health Along

with Co-morbidities

By:
Natalie Dalton

A Mini-Proposal Submitted to Institutional Review Board

Union Institute & University

Psychology Department

Introduction

Ever since our world started to develop into what we know today there has been a big
issue weighing on the minds and bodies of different individuals all over the world. This issue is
being obese, or in other words very overweight. It has been since the early 1960s that there was
a new type of surgery being spoken of all throughout the medical community. This new idea was
Gastric Bypass surgery. The idea behind Gastric Bypass surgery was brought about by a Doctor
Mason and Ito and it only started because of when patients who had ulcers had part of their
stomach removed to repair the ulcers, those patients began to lose weight and doctors started to
look into using the surgery for obese patients. (ASMBS. 2004.)
Preoperative weight loss, however, did not affect the major complication or conversion rates,
and its long-term effects were not apparent through this study. Also, preoperative weight loss did
not have any bearing on the resolution of co-morbidities. (Department of Surgery, Stanford
University School of Medicine. 2006.)
Preoperative weight loss is associated with fewer complications after gastric bypass surgery.
(Benotti PN, Still CD, Wood G, et al.2009.)
According to previous studies there is not much research on the long term effect of
preoperative weight loss, studies show just up to 1 year after in research. Even more so when it
comes to the psychological aspects that patients go through right after surgery to many years
later.
Even though the surgery causes an individual to lose weight, would it be helpful for the
patient to lose weight before the surgery to help their psychological health after the surgery, long
term?
To expand on the main focus of this research is to close the gap after Gastric Bypass
Surgery to up to approximately 10 years after the surgery, to see if the weight stays off longer
and how this affects their psychological health, along with other health conditions presented
before surgery.

Methodology

Method:
To research this topic there will be 2 groups, the first will be of 100 Gastric Bypass
patients that have lost 10% or more of their preoperative weight. The second group will also be
of 100 Gastric Bypass patients; however these patients will have, at the most lost 5% of their
preoperative weight. Within each group there will be a diverse selection of participants. They
will be from diverse ethnical backgrounds, religions, and not an exact number of each gender in
both groups. The research will begin with preoperative questionnaires for each participant about
their current health conditions, there will also be a psychological evaluation of each participant
to have a start point for the research. Along with this the surgeons will submit their notes,
including the weight loss of the patient before the surgery and the months leading to the surgery.
Once the surgery has been performed the surgeons will submit their notes on each participant at
all follow-ups up to the first year. During this time there will not be any extensive interviewing
so the participant can recover. For the next 10 years each participant will be required to have a
follow-up with their surgeon to have a physical evaluation, the findings for those will be
submitted into the participants file. Along with the physical evaluations each year, there will also
be a psychological evaluation completed by a licensed psychologist, the results will also be
submitted and put into the participants file. Considering that participants will have their surgeries
at different times in the same calendar year, it will take the 10 years of collection and then
approximately 1 to 2 years to have a final report for both groups and then the groups will be
compared and find the results to how the participants did after the surgery, to see if there is any
correlation with the preoperative weight loss.

Procedure:
For each group of participants they will be asked by their surgeon if they would like to
participate in the research study. The surgeons that are willing to participate and ask their
patients, will be given a detailed letter explaining the research and will include which group they

will be in, how they will be studied, what they will be required to do if they decide to participate,
and contact information if they have any questions when considering the study. If the participant
decides to be included their name and contact information will be released and will contact them
directly about the study and ask to meet them in person to explain the study to them in person to
make sure they fully understand what will be done.
Once the participant is part of the study they will then go on about their surgery and only
their information will be released. Then, as mentioned above, the study will begin and go as
described above.

Ethical Consideration:
When it comes to this research study there are certain ethical considerations to be mindful
of. Since there are human participants they will have full disclosure of the study and we will be
planning to meet them all in person to be sure that they are in full understanding of what will be
happening. When it comes to physical and psychological evaluations no specific information will
be mentioned in the research. The only components will have to do with the percentage of weight
loss and the change in their psychological health, along with any co-morbidities that resolve over
the time of the study. The participants will also know that if at any time there is anything that
they are not comfortable with will be addressed and there will be a solution to the issue. Along
with this the participants will be, if needed put into the certain subgroups for consideration if
needed.

Resources

Alami, R. S., Morton, J. M., Schuster, R., Lie, J., Sanchez, B. R., Peters, A., & Curet, M. J.
(2007). Is there a benefit to preoperative weight loss in gastric bypass patients? A
prospective randomized trial. Surgery for Obesity and Related Diseases, 3(2), 141-145.

Benotti, P. N., Still, C. D., Wood, G. C., Akmal, Y., King, H., El Arousy, H., ... & Strodel,
W. (2009). Preoperative weight loss before bariatric surgery. Archives of Surgery,
144(12), 1150-1155.

Livhits, M., Mercado, C., Yermilov, I., Parikh, J. A., Dutson, E., Mehran, A., ... &
Gibbons, M. M. (2009). Does weight loss immediately before bariatric surgery improve
outcomes: a systematic review. Surgery for Obesity and Related Diseases, 5(6), 713-721.

Still, C. D., Benotti, P., Wood, G. C., Gerhard, G. S., Petrick, A., Reed, M., & Strodel, W.
(2007). Outcomes of preoperative weight loss in high-risk patients undergoing gastric
bypass surgery. Archives of surgery, 142(10), 994-998.