Weight Loss Surgery: The Four Pronged Approach

Rona Osborne
Specialist Bariatric Surgery Dietitian, Glasgow & Clyde Weight Management Service
Amanda Hallson
Advanced Dietitian Weight Management, Glasgow & Clyde Weight Management Service


Weigh loss surgery, also known as Bariatric surgery, has been offered as a treatment option for overweight and obese individuals since the early 1980’s. Since then the practice has moved on leaps and bounds with Dietitians and other AHPs’ delivering first rate interventions as part of multidisciplinary services. The three most widely used types of weight loss surgery are:Gastric Band

  1. gastric band – where a band is used to reduce the stomach’s size, so a smaller amount of food is required to make you feel full
  2. gastric bypass – where your digestive system is re-routed past most of your stomach, so you digest less food and it takes much less to make you feel full
  3. sleeve gastrectomy – where some of the stomach is removed to reduce the amount of food that’s required to make you feel full

Bariatric surgery cGastric Bypassan effectively reduce body weight and treat obesity associated metabolic diseases such as diabetes mellitus. There are also significant benefits to individuals’ functional status and psychological health. “Overall mortality is 29-40% lower in the seven to ten years post surgery in patients receiving Bariatric Surgery compared with BMI-matched subjects not receiving surgery”1.

This proven surgical approach has fuelled the number of bariatric surgeries performed in the last 20 years, however it is paramount that weight loss surgery is not seen as a single stand alone intervention but included as part of a supported programme involving a multi-disciplinary team including dietitians, clinical psychologists, physiotherapists, nurses and surgeons.

The four pronged approach

The use of the four pronged approach model illustrates the importance of surgery being 4 Pronged Approachonly one element of a successful weight reduction outcome. At the Glasgow and Clyde Weight Management Service this model is used at all stages of the patient’s surgery pathway, including the initial surgery information session, the preparation for surgery education programme and the post-operative group review sessions. The 4-pronged approach enables patients to obtain clearer insight into what aspects of their lifestyle surgery will help with, and allows the team to explore and ensure realistic expectations.

Weight loss surgery results in an overall reduction in total quantity of food as well as impacting on food choices. Patients learn through the four pronged approach that weight loss surgery does not necessarily impact on other areas of their lifestyle i.e. a patient that struggles with emotional eating will not automatically change this behaviour following a surgical intervention. And likewise a patient that is suffering arthritic pain will not necessarily have relief of pain following a weight loss procedure enabling them to be more active.

Using this 4 pronged approach model helps to demonstrate the importance of the individuals’ involvement in the entire process. This can help in two ways, the patient becomes more empowered knowing that much of the success of the procedure is dependent on them; and secondly it highlights to the patient if they may benefit from additional support from members of the MDT such as psychology or physiotherapy

Those individuals that believe surgery is the easy answer to weight loss often find out early on that this is a gross misconception. In practice it appears that those patients who are well informed about the surgical procedure itself, as well as the necessary dietary and lifestyle changes that are required to go alongside the procedure tend to have better weight loss outcomes. This coincides with the current guidance that highlights that patients who receive, preparation, education and pre and post-surgery support are more likely to be successful.

At the Glasgow and Clyde Weight Managemenet Service the bariatric Dietitian is integral to the surgical service and to clinical decision making.

Where does the Dietitian fit in your local bariatric surgical service?


1. SIGN 115 (Feb 2010). Management of Obesity. A national clinical guideline.


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