SPOTLIGHT ON A SUPPLEMENT TO BARIATRIC TIMES VOL. 21 • DECEMBER 2024 BARIATRICTIMES.COM TECHNOLOGY There’s an App for That: Improving Weight Loss Outcomes with Baritastic by CASSIE I. STORY, RDN Ms. Story is Director of Nutrition, Bariatric Advantage, in Aliso Viejo, California. She also works in private practice in Scottsdale, Arizona. Bariatric Times . 2024;21(Suppl 1):S1–S3. WEIGHT RECURRENCE OR INADEQUATE WEIGHT LOSS AFTER SLEEVE GASTRECTOMY Success, in terms of body weight only, is commonly defi ned as achieving and maintaining more than 50-percent EWL over the long-term following surgery. While the prevalence of WR varies depending on how it’s defi ned, a signifi cant proportion of patients experience WR over time, leading some to require revisional procedures. As long-term data become more available, studies show that up to one in three patients with SG will undergo a second operation for IWL within 10 years of their primary procedure. 5–7 Variability in percentage of EWL (EWL%) at 12 months post-SG is signifi cant, ranging from 30 to 70 percent. By 24 months, the typical reported range across studies is 45 to 65 EWL%, with some cohorts reporting as low as 31 percent, indicating that some patients fail to meet the long-term benchmark for weight loss success by the two-year mark. 5,8 A retrospective analysis of 149 patients 10-years post-SG found that the group had an average of 36 EWL%, compared to 68 percent at one year, with only 19.5 percent of patients maintaining 50-percent-or-greater EWL without requiring revisional surgery. 9 Similarly, a multicenter retrospective study of 339 patients found that only 20 percent sustained signifi cant weight loss after seven years, with 15.9 percent experiencing IWL and 64 percent experiencing signifi cant WR. Notably, a greater percentage of total body weight loss (%TBWL) in the fi rst year correlated with higher weight loss at the fi nal follow-up. 10 INTRODUCTION By 2030, nearly half of United States (US) adults are projected to have obesity, with 1 in 4 expected to have Class III obesity. 1 Losing weight is a complex and challenging process, and maintaining it is even more diffi cult. Metabolic and bariatric surgery (MBS) is the most eff ective treatment for sustained weight loss in individuals with obesity, with sleeve gastrectomy (SG) being the most common procedure. However, long-term weight management depends on patients’ adherence to necessary lifestyle changes. Studies show that approximately 20 to 30 percent of patients undergoing surgery experience either insuffi cient weight loss (IWL) or weight recurrence (WR) as early as 18 months postsurgery, and recent evidence suggests that WR is more common and signifi cant following SG, compared to Roux-en-Y gastric bypass (RYGB). 2 Bariatric procedures also come with long-term nutritional complications, such as inadequate protein intake, leading to sarcopenic obesity and/ or unfavorable body composition, and multiple micronutrient defi ciencies that directly aff ect the body’s metabolic processes, which can impact a patient’s body weight. 3 Adequate lifelong follow-up and adherence to postoperative lifestyle recommendations have been shown to result in greater long-term excess weight loss (EWL). 4 However, long-term follow-up is often poor, with patients citing lack of time and long distances as barriers to attending regular clinic visits. Clinicians face the challenge of time constraints from quick, back-to-back clinic appointments that require focusing on immediate concerns, often leaving little time to support patients in building the necessary long-term behavior changes for success. This is where mobile health (mHealth) applications like Baritastic can play a pivotal role. The complexities of behavioral change, particularly in the context of obesity—which is infl uenced by both environmental and physiological factors— demand comprehensive strategies that extend beyond initial patient education. Baritastic provides a wide range of supportive features for self-management, including tools for monitoring food intake and body weight, setting reminders to take supplements, and off ering personalized educational resources and goal-setting functions. These features help patients manage the complex demands of postsurgery life while reducing the burden on clinicians. THE IMPORTANCE OF SELF-MONITORING POST-SG While self-monitoring is essential for weight management, WR can still occur due to factors Sponsored by BARIATRIC TIMES December 2024 • Volume 21 • Supplement 1 S1
Bariatric Times December 2024: S-1
