Abstract
PurposeThe aim of this exploratory study was to investigate whether the degree of weight loss properly reflects improvements in cardiometabolic health among patients who underwent Roux-en-Y gastric bypass.MethodsIn this ancillary analysis from a clinical trial, patients were clustered into tertiles according to the magnitude of the percentage weight loss (1st tertile: “higher weight loss”: −37.1 ± 5.8%; 2nd tertile: “moderate weight loss”: −29.7 ± 1.4%; 3rd tertile: “lower weight loss”: −24.2 ± 2.3%). Delta changes (9 months after surgery-baseline) in clustered cardiometabolic risk (i.e., blood pressure index, fasting glucose, high-density lipoprotein [HDL] and triglycerides [TG]), glycated hemoglobin (HbA1c), homeostasis model assessment (HOMA-IR), and C-reactive protein (CRP) were calculated.ResultsA total of 42 patients who had complete bodyweight data (age = 40 ± 8 year; BMI = 47.8 ± 7.1 kg/m2) were included. Surgery led to substantial weight loss (−37.9 ± 11.3 kg, P < 0,001), and clinically significant improvements in blood pressure index (−17.7 ± 8.2 mmHg, P < 0.001), fasting glucose (−36.6 ± 52.5 mg/dL, P < 0.001), HDL (9.4 ± 7.1 mg/dL, P < 0.001), TG (−35.8 ± 44.1 mg/dL P < 0,001), HbA1c (−1.2 ± 1.6%, P < 0.001), HOMA-IR (−4.7 ± 3.9 mg/dL, P < 0.001) and CRP (−8.5 ± 6.7 μg/mL P < 0.001). Comparisons across tertiles revealed no differences for cardiometabolic risk score, fasting glucose, HbAc1, HOMA-IR, blood pressure index, CRP, HDL, and TG (P > 0.05 for all). Individual variable analysis confirmed cardiometabolic improvements across the spectrum on weight-loss. There were no associations between weight loss and any dependent variable.ConclusionWeight loss following bariatric surgery does not correlate with improvements in cardiovascular risk factors. These findings suggest that weight loss alone may be insufficient to assess the cardiometabolic success of bariatric surgery, and the search for alternate proxies that better predict surgery success are needed.
Highlights
Bariatric surgery is the preferred treatment for morbid obesity because it yields substantial and sustained weight loss, and reduces the severity of cardiometabolic risk factors (Schauer et al, 2017; Schiavon et al, 2017)
Recent evidence hints that individuals with obesity who engage in lifestyle interventions experience improvements in cardiometabolic risk factors regardless of weight loss (Ross et al, 2000; Hyde et al, 2019), suggesting that more attention should be paid to broader health markers other than weight alone in the management of obesity
One could speculate that bariatric surgery-induced weight loss per se may be a marker for treatment success. This hypothesis was tested by examining whether the magnitude of weight loss induced by bariatric surgery correlates with reduced cardiometabolic risk factors
Summary
Bariatric surgery is the preferred treatment for morbid obesity because it yields substantial and sustained weight loss, and reduces the severity of cardiometabolic risk factors (Schauer et al, 2017; Schiavon et al, 2017). There is still a large number (∼15–35%) of patients undergoing bariatric surgery who fail to meet clinical meaningful weight loss goals, or even experience weight regain when evaluated 12 months after surgical intervention (Magro et al, 2008; Colquitt et al, 2014). These variations may be explained by multiple factors, but changes in behavior after surgery appears to be an important determinant of success (Odom et al, 2010; Robinson et al, 2014). This hypothesis was tested by examining whether the magnitude of weight loss induced by bariatric surgery correlates with reduced cardiometabolic risk factors
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