Exercise and pre-habilitation with high whey-protein-based meal replacement therapy promote weight loss and preserve muscle mass before bariatric surgery

Abstract

Background: Bariatric surgery is considered as an effective therapy for those with morbid obesity. Preoperative weight loss with a very low-calorie diet is commonly used to ease the bariatric surgery. Pre-habilitation increases functional and physiological capacity. The study demonstrated the changes of body composition and functional status following short term pre-habilitation before bariatric surgery. Method: This prospective study targeted those admitted for bariatric surgery. Participants underwent the biweekly pre-habilitation program included an individualized high whey-based protein very low-calorie (VLCHP) enteral regime (600–900 kcal/day) and moderate intensive exercise before bariatric surgery. Body composition and waist circumference were assessed after fortnight. Participants were segregated into morbid obese (MOG) (BMI <49 kg/m2) and super morbid obese group (SMOG) (BMI ≥50 kg/m2) for analysis. Result: Majority of participants were female (71%) with median age 36.0 years old (MOG) and 34.3 years old (SMOG) respectively. SMOG achieved significant greater loss in weight (−7.4 kg vs −4.0 kg), fat percentage (−4.4% vs −1.7%) and fat mass (−9.9 kg vs −3.8 kg); but MOG had a significant increment in muscle mass (3.2 kg vs 2.8 kg) as compared to SOG (p < 0.001). Discussion: Body composition measurement and changes remain critical in nutritional assessment to achieve successful surgery and minimize nutritional complication. Whey-based VLCHP attenuates muscle loss and preserves myofibrillar protein synthesis; promotes a better muscle strength and mass growth during periods of negative energy balance combined with moderately intense aerobic activity. Conclusion: Individualized whey-based VLCHP enteral regime and moderate intensive exercise encourage weight loss; increases muscle mass and strength; improve function status prior to bariatric surgery.

Keywords

• Bariatric
• High protein low calories
• Exercise