Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Hans Jørgen Nielsen,Jörg Assmus,Alexander Fosså,Johan Fernø,Marianne Jensen Hjermstad,Vigdis Halvorsen Dagsland,Tone Nygaard Flølo,Iren Hjellestad,John Roger Andersen,Gunnar Mellgren,Simon Nitter Dankel,Håvard Luong Thorsen,Bjørn Gunnar Nedrebø,Oddrun Anita Gudbrandsen,Ronette L Kolotkin

doi:10.1038/s41366-021-01028-5

Abstract

Background/objectivesThere is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities.We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB.Subjects/methodsPatients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015.Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates.ResultsOf 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up.ConclusionIn routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.

Highlights

Obesity affects 650 million people worldwide and is associated with a number of obesity-related diseases such as type 2 diabetes (T2D) and cardiovascular diseases, reduced life expectancy and lower quality of life (QOL) [1, 2]
Results from stringent randomized controlled trials (RCT) may have limitations in terms of Outcome definitions Weight and obesity-related comorbidities were assessed according to international guidelines [23]
To better capture the impact of bariatric surgery weight loss was defined as %EBMIL below 50 or %TWL below 20 [24]

Summary

Introduction

Obesity affects 650 million people worldwide and is associated with a number of obesity-related diseases such as type 2 diabetes (T2D) and cardiovascular diseases, reduced life expectancy and lower quality of life (QOL) [1, 2]. Each 5 kg/m2 increase of bodymass index (BMI) above the normal range of 18–25 kg/m2 is associated with a 30% increase in overall mortality, and BMI above 40 kg/m2 may reduce life expectancy by 8–10 years [3]. Bariatric surgery is the most effective treatment for severe obesity, defined as BMI above 40 kg/m2, or above 35 kg/m2 in the presence of obesity-related comorbidities with a suggested benefit for lower BMI categories of 30–35 kg/m2 [5,6,7].

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