BACKGROUND:
A key component to optimizing results and increasing surgical options for patients desiring body contouring is identifying patients with a normal body mass index. Whether post-bariatric or lifestyle programs aid in improving weight loss and attainability of plastic surgery has not been determined. With increased emphasis on obtaining comprehensive pre-operative evaluations, few studies have investigated the influence of nutrition and exercise on BMI indices in patients presenting for body contouring surgery.
METHODS:
46 consecutive massive weight loss patients (>50 lb weight loss) presenting for body contouring following bariatric surgery (n=38) or self weight loss (n=8) were prospectively evaluated by a registered dietician in our Life After Weight Loss Program. Two-week food logs and behaviors were assessed for vomiting, dumping, food aversions, and eating disorders. Exercise regimen, pre- and post-weight loss BMI, and medical comorbidities were measured. Outcome measure included medical/surgical clearance.

RESULTS:
Mean values were as follows: age 47.2years(+/-12.6), maximum BMI 55.9 kg/m²(+/-12.3), current BMI 35.2(+/-9.7), ΔBMI of 21.1(+/- 8.8), daily protein intake 64.9grams(+/-19.5). Median exercise was 3 days a week (IQR=4). The mean delta BMI in the bariatric surgery group was 23.4(+/- 8.7) versus 14.8(+/- 5.6) in the self weight loss group(p=0.02), and was correlated with maximum BMI (r=0.69, p<0.0001) and exercising (r=0.50, p=0.04), but not protein intake(-0.23, 0.36). Age was associated with current BMI (0.44, 0.04), and negatively associated with protein intake (-0.49, 0.05) and exercising (-0.57, 0.02). The main effects of exercise (p<0.0001), maximum BMI (p<0.0001), and weight loss method (p=0.006) were significant, while age (p=0.86) was not. It was suggestive that higher daily protein intake (>=60 grams) was associated with less delta BMI (p=0.06). The χ² tests subsequent to the overall analysis found that any exercise was significantly better than none, where the mean delta BMI ranged from 23-27 for those who exercised 1-6 times per week vs. 9 for those who did not exercise (p-value range = <0.0001-0.002); differences among the number of days spent exercising were not significant, using the false discovery rate to adjust for multiple comparisons. The mean current BMI for those who exercised was significantly lower than those who did not (30.8+/- 2.7 vs. 48.5+/- 11.9; p<0.0001).

CONCLUSIONS:
Compliance with exercise optimizes weight loss in patients presenting for body contouring surgery. Higher protein negatively influenced weight loss, and may be beneficial only peri-operatively for wound healing. Further evaluation of the elements of diet will be required to determine its role. Thus, comprehensive post-bariatric or lifestyle programs that promote exercise should be advocated by plastic surgeons to increase both the surgical options available to the patient and ultimately the attainability of plastic surgery.