Abstract
BackgroundObesity surgery has proven its effectiveness in weight loss. However, after a loss phase of about 12 to 18 months, between 20% and 40% of patients regain weight. Prediction of weight evolution is therefore useful for early detection of weight regain.ObjectiveThis proof-of-concept study aimed to analyze the postoperative weight trajectories and to identify “curve families” for early prediction of weight regain.MethodsThis was a monocentric retrospective study with calculation of the weight trajectory of patients having undergone gastric bypass surgery. Data on 795 patients after a 2-year follow-up allowed modeling of weight trajectories according to a hierarchical cluster analysis (HCA) tending to minimize the intragroup distance according to Ward. Clinical judgement was used to finalize the identification of clinically relevant representative trajectories. This modeling was validated on a group of 381 patients for whom the observed weight at 18 months was compared to the predicted weight.ResultsTwo successive HCA produced 14 representative trajectories, distributed among 4 clinically relevant families: Of the 14 weight trajectories, 6 decreased systematically over time or decreased and then stagnated; 4 decreased, increased, and then decreased again; 2 decreased and then increased; and 2 stagnated at first and then began to decrease. A comparison of observed weight and that estimated by modeling made it possible to correctly classify 98% of persons with excess weight loss (EWL) >50% and more than 58% of persons with EWL between 25% and 50%. In the category of persons with EWL >50%, weight data over the first 6 months were adequate to correctly predict the observed result.ConclusionsThis modeling allowed correct classification of persons with EWL >50% and could identify early after surgery the patients with potentially less that optimal weight loss. Further studies are needed to validate this model in other populations, with other types of surgery, and with other medical-surgical teams.
Highlights
Data on 795 patients after a 2-year follow-up allowed modeling of weight trajectories according to a hierarchical cluster analysis (HCA) tending to minimize the intragroup distance according to Ward
A comparison of observed weight and that estimated by modeling made it possible to correctly classify 98% of persons with excess weight loss (EWL) >50% and more than 58% of persons with EWL between 25% and 50%
Obesity surgery has proved to be effective in the long term for weight loss and for remission or improvement of comorbidities associated with excess weight
Summary
Obesity surgery has proved to be effective in the long term for weight loss and for remission or improvement of comorbidities associated with excess weight. Careful monitoring of early postoperative weight trajectories could be one way to achieve early identification of patients with weight regain. Wise et al [11] have shown that an exponential decay can describe the weight path in the 3 months after gastric bypass. They used excess weight loss (EWL) and did not show a long-term 5-year prediction value of the classification. Prediction of weight evolution is useful for early detection of weight regain
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