MON-590 Presence of Diabetes Diminishes the Ultimate Weight Loss After Bariatric Surgery

Genetic risk score based on obesity-related genes and progression in weight loss after bariatric surgery: a 60-month follow-up study

This study evaluated the influence of patient characteristics, preoperative weight loss, and type of surgical procedure on long-term weight loss after bariatric surgery (BS). Subjects were a prospective cohort of 95 patients who underwent BS with 4 years of follow-up. Seventy-seven patients (81.1%) underwent laparoscopic Roux-en-Y gastric bypass, and 18 (18.9%) had laparoscopic sleeve gastrectomy. Age, gender, initial body mass index (BMI), preoperative percentage of excess weight loss, presence of type 2 diabetes mellitus, current smoking status, and surgical technique were analyzed via multivariate linear regression analysis to identify predictors of weight loss during the 4 years after the surgery. Maximum percentage of excess weight loss was obtained at 18 months. Age and preoperative BMI were negatively associated with percentage of excess weight loss at 1, 2, 3, and 4 years after BS (P < .005). At 4 years, laparoscopic Roux-en-Y gastric bypass was independently associated with a higher weight loss than laparoscopic sleeve gastrectomy (P < .05). Younger age, lower BMI, and laparoscopic Roux-en-Y gastric bypass are independent predictors of long-term weight loss after BS.

ABSTRACTBACKGROUND:Although bariatric surgery is highly effective for the treatment of obesity and its comorbidities, preoperative weight loss has an impact on its results.AIMS:The aim of this study was to correlate preoperative weight loss with the outcome of bariatric surgery using the Bariatric Analysis and Reporting Outcome System scores.METHODS:This is a cross-sectional, observational study with 43 patients undergoing bariatric surgery that compared a group of 25 patients with a percentage of preoperative excess weight loss ³8% with a group of 18 patients with a percentage of preoperative excess weight loss <8% or with weight gain. The research took place at the bariatric surgery outpatient clinic of the Oswaldo Cruz University Hospital with patients 1 year after the surgery.RESULTS:Patients had a mean age of 40.8 years (42.7 percentage of preoperative excess weight loss ≥8% vs. 38.2 percentage of preoperative excess weight loss <8%, p=0.095). No significant difference was found between the two groups regarding preoperative comorbidities and body mass index at entry into the program. Higher preoperative body mass index (48.69 vs. 44.0; p=0.029) was observed in the group with percentage of preoperative excess weight loss <8%. No significant difference was found regarding the percentage of excess weight loss (71.4±15.4%; percentage of preoperative excess weight loss ≥8% vs. 69.47%±14.5 percentage of preoperative excess weight loss <8%; p=0.671), the result of the surgery according to the Bariatric Analysis and Reporting Outcome System scores protocol, the resolution of comorbidities, the quality of life, and the surgical complications between the two groups.CONCLUSIONS:Based on the available data, it is reasonable that bariatric surgery should not be denied to people who have not achieved pre-established weight loss before surgery.

Analysis of medium-length biliopancreatic limb on weight loss efficacy in Roux-en-Y gastric bypass: A propensity score-matched retrospective cohort study.

Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery

Role of the FKBP5 polymorphism rs1360780, age, sex, and type of surgery in weight loss after bariatric surgery: a follow-up study

Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery

Letter to the Editor concerning "Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy".

Percentage of excess weight loss (%EWL) is the most common metric used after bariatric surgery. However, there has been consistent argument against its use since it varies significantly by initial body mass index (BMI). This study aimed to validate the newly suggested percentage of alterable weight loss (%AWL) metric in Korean patients. A retrospective review of the prospectively established database at Soonchunhyang University Seoul Hospital identified 165 patients who underwent primary laparoscopic Roux-en-Y gastric bypass (RYGB) and had at least 2-year follow-up weight loss results after surgery. Patients were classified into subgroups based on initial BMI, and their weight loss results expressed as BMI, %EWL, %AWL, and percentage of total weight loss (%TWL) were compared in terms of nadir weight and weight loss trajectory. The study cohort included 27 male (16.4%) and 138 female (83.6%) patients with a mean baseline BMI of 38.1 ± 5.4. Nadir weight was achieved at mean 24.1 ± 10.6months postoperatively. Female patients required significantly longer to achieve nadir weight than male patients (16.2 vs. 22.4months, p = 0.001), and they achieved less weight loss expressed as nadir BMI, %EWL, and %AWL. Of these metrics, only %AWL was not significantly influenced by preoperative BMI and showed the least variation (25.2%) for reporting weight loss. The AWL metric can report weight loss regardless of baseline BMI in Korean patients undergoing RYGB; however, it must be validated in a larger population involving multiple centers from the Asia-Pacific area before being used clinically.

Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment. One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n = 127, mean body mass index (BMI) 45.7 ± 5.7 kg/m(2)) or sleeve gastrectomy (SG; n = 46, mean BMI 55.9 ± 7.8 kg/m(2)) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis. After 1 year of observation, %EWL was 62.9 ± 18.0 % in RYGB and 52.3 ± 15.0 % in SG (p = 0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7 ± 8.4 % in RYGB and 30.5 ± 7.6 % in SG patients, p > 0.4). Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery.

Whether or not the initial body mass index (BMI) influences weight loss and comorbidities improvement after bariatric surgery continues to be a matter of debate. The main reason for this is a lack of studies including obesity class I. Retrospective study with patients submitted to gastric bypass at a single institution. They were classified based on initial BMI (obesity class I, II, and III), and a comparative analysis of their metabolic profile (glucose, HbA1c%, C-peptide, insulin and diabetes medication), lipid profile (triglycerides, total cholesterol, HDL, LDL), and clinical data (systolic/diastolic blood pressure and cardiovascular risk) was performed at 0 and 12months. Diabetes remission and weight loss were also analyzed. Two-hundred and twenty patients were included (23 in group 1, 113 in group 2, and 84 in group 3). Initial weight, BMI, and number of patients with T2DM were statistically different in group 1; other parameters were homogenous. At 12months, every group had similar improvement of the metabolic profile, excepting serum insulin. Diabetes remission was 57.9, 61.1, and 60% for group 1, 2, and 3. For weight loss, there were differences between groups when using BMI and percentage of excess weight loss, but not with percentage of total weight loss. The non-metabolic and clinical data improved without differences, except for total cholesterol and LDL. The metabolic, lipid, and clinical profiles associated with obesity present similar improvement 1year after laparoscopic gastric bypass, despite different baseline BMI. Diabetes remission and percentage of total weight loss were also similar.

Introduction After bariatric surgery, insufficient weight loss (IWL)—a failure to achieve sufficient weight loss—is the main reason for undergoing a second revisional bariatric surgery. Not only is a standardized definition for IWL missing, but its pre-, peri, and postoperative predictor factors remain unclear. This study aims to assess rates of IWL two years after bariatric surgery, applying 4 definitions; and identify predictors of IWL to improve patient counselling regarding their prevention and optimize intraoperative bariatric procedures. Methods We conducted a single-centre retrospective cohort study with 1056 consecutive patients submitted to bariatric surgery between 2019 and 2021. Regarding IWL, the following four definitions were applied: (1) body mass index (BMI) higher than 35 kg/m2 at 24 months; (2) percentage of excess weight loss (%EWL) of less than 50% at 18 months; (3) percentage of total weight loss (%TWL) of less than 20% at 24 months; (4) percentage of alterable weight loss (%AWL) of less than 35% at 24 months. All participants were followed for at least 2 years. Univariate and multivariate analyses were performed using logistic regression to compute the odds ratio (OR) and the 95% confidence intervals (95%c.i.). Results A total of 1056 patients were included, with a mean age of 45.8 (±10.3) years, of which 82.9% were female. Significant insufficient weight loss rates ranged from 6 to 14% depending on the definition, being the %EWL the definition with the highest proportion of patients with IWL. Considering %TWL as the definition for IWL, patients with IWL had significantly longer hospital time response (adjusted odds ratio: 1.03, 95% c.i.: 1.02–1.05) and were more submitted to sleeve gastrectomy (adjusted odds ratio: 2.51, 95% c.i.: 1.46–4.30). Male gender was associated with IWL only considering the first definition (BMI &amp;gt; 35 kg/m2) (adjusted odds ratio: 3.55, 95% c.i.: 2.36–5.33) and the second definition (%EWL) (adjusted odds ratio: 4.43, 95% c.i.: 2.80–7.02). The multivariate analysis showed that a longer hospital response and sleeve gastrectomy were independent predictors of IWL after bariatric surgery, regardless of the definition. Conclusion The predictors of insufficient weight loss varied depending on the definition applied. However, regardless of the IWL’s definition, a longer hospital response and sleeve gastrectomy were independent predictors of insufficient weight loss after bariatric surgery.

One-stage conversion of Roux-en-Y gastric bypass to a modified biliopancreatic diversion with duodenal switch using a hybrid sleeve concept

Several tools are used to assess postoperative weight loss after bariatric surgery, including the percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess body mass index (BMI) loss (%EBMIL). A repeated series of measurements should be considered to assess weight loss as accurately as possible. This study aimed to test weight loss metrics. Data were obtained from a prospective database of patients with obesity who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2016 and 2017 in a French tertiary referral bariatric center. A multilevel mixed-effects linear regression model with repeated measures was used to analyze repeated weight measurements over time. A total of 435 patients underwent LRYGB (n = 266) or LSG (n = 169). At 2years, the average %EWL, %EBMIL, and %TWL were 56.8%, 61.3%, and 26.6%, respectively. Patients who underwent LSG experienced lower weight loss (β: -4233 in %TWL model, β: -6437 in %EWL model, and β: -6989 in %EBMIL model) than those who underwent LRYGB. In multivariate mixed analysis, preoperative BMI was not significantly associated with %TWL at 2years (β, -0.09 [-0.22-0.03] p = 0.1). Preoperative BMI was negatively associated with both %EWL (β, -1.61 [-1.84--1.38] p < 0.0001) and %EBMIL (β, -1.91 [-2.16--1.66] p < 0.0001). This is the first study to assess %TWL use for postoperative weight measurement, using a multilevel mixed-effects linear regression model %TWL is the measure of choice to assess weight loss following bariatric surgery.

INTRODUCTION:Safe, effective weight loss with resolution of comorbidities has been convincingly demonstrated with bariatric surgery in the aged obese. They, however, lose less weight than younger individuals. It is not known if degree of weight loss is influenced by the choice of bariatric procedure. The aim of this study was to compare the degree of weight loss between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients above the age of 50 years at 1 year after surgery.MATERIALS AND METHODS:A retrospective analysis was performed of all patients more than 50 years of age who underwent LSG or LRYGB between February 2012 and July 2013 with at least 1 year of follow-up. Data evaluated at 1 year included age, sex, weight, body mass index (BMI), mean operative time, percentage of weight loss and excess weight loss, resolution/remission of diabetes, morbidity and mortality.RESULTS:Of a total of 86 patients, 54 underwent LSG and 32 underwent LRYGB. The mean percentage of excess weight loss at the end of 1 year was 60.19 ± 17.45 % after LSG and 82.76 ± 34.26 % after LRYGB (P = 0.021). One patient developed a sleeve leak after LSG, and 2 developed iron deficiency anaemia after LRYGB. The remission/improvement in diabetes mellitus and biochemistry was similar.CONCLUSION:LRYGB may offer better results than LSG in terms of weight loss in patients over 50 years of age.