Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study.

David Benaiges,Helena Julià,Laia Fontané,Aleix De Vargas-Machuca,Manuel Pera,Maria Bisbe,Olga Castañer,Montserrat Villatoro,Juana A Flores-Le Roux,Jose M Ramon,Juan Pedro-Botet,Elisenda Climent,Alberto Goday

doi:10.3390/jcm9103193

Abstract

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. Results: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. Conclusions: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained.

Highlights

Bariatric surgery (BS) has proved to be the most effective treatment for morbidly-obese patients when conventional therapy has failed
Several studies have shown that post-surgical weight loss varies widely among patients and a notable percentage can be qualified as poor weight loss (WL) responders [3,4,5,6]
Baseline characteristics of poor WL responders at 5 years were comparable to good WL responders except for age, high-density lipoprotein (HDL) cholesterol and type of surgery (Table 1)

Summary

Introduction

Bariatric surgery (BS) has proved to be the most effective treatment for morbidly-obese patients when conventional therapy has failed. Several studies have shown that post-surgical weight loss varies widely among patients and a notable percentage can be qualified as poor weight loss (WL) responders [3,4,5,6]. They are more frequently identified at mid-term follow-up taking into account that most patients experience a slight weight regain from the first year post-surgery [3,7,8]. The Farias et al study is the only work comparing good and poor WL responders Those authors only reported results on the remission rates of obesity-related comorbidities with a shorter follow-up (2 years) [6]

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