Clinical factors associated with weight loss outcomes after Roux‐en‐Y gastric bypass surgery

Abstract

OBJECTIVE Gastric bypass surgery is an effective therapy for extreme obesity. However, substantial variability in weight loss outcomes exists that remains largely unexplained. Our objective was to determine whether any commonly collected pre-operative clinical variables were associated with weight loss following Roux-en-Y gastric bypass surgery. DESIGN The analysis was based on a prospectively recruited observational cohort of 2365 patients who underwent Roux-en-Y gastric bypass surgery from 2004-2009. Weight loss was stratified into three major phases, early (0-6 months), nadir, and long-term (>36 months). Multivariate regression models were constructed using a database of over 350 variables. RESULTS A total of 12-14 pre-operative variables were independently associated (p<0.05) with each of the temporal weight loss phases. Pre-operative variables associated with poorer nadir and long-term weight loss included: higher baseline BMI, higher pre-operative weight loss, iron deficiency, use of any diabetes medication, non-use of bupropion medication, no history of smoking, aged >50 years, and the presence of fibrosis on liver biopsy. CONCLUSIONS Several variables previously associated with poorer weight loss after RYGB surgery including age, baseline BMI, and type 2 diabetes were replicated. Several others suggest possible clinical interventions for post-operative management of RYGB patients to improve weight loss outcomes.

Genome-wide analysis of hepatic lipid content in extreme obesity

“…A summary of demographic and clinical characteristics of the final cohort (n=1868) is shown in Table 1. As is typical for patients enrolled in bariatric surgery programs [27], the population was primarily female (>81%). In addition, the percentage of males with grade 2 and 3 hepatic lipid content was significantly higher than in those without liver fat.…”

Predictors for Weight Loss Failure Following Roux-en-Y Gastric Bypass

“…Overall impact of surgery on long term mortality reduction has already been observed on obese patients with 40% reduction on all causes mortality, 56% on coronary heart disease, 92% on diabetes complications and 60% on any type of cancer (1) . Nevertheless, some individuals may regain variable amounts of weight after a period of rapid weight loss, while others fail to lose significant weight despite the major structural and physiological changes brought by the surgery (22) . Hence, postsurgical weight loss failure constitutes a major concern since it is poorly understood and brings unsatisfactory outcomes and possible need of further interventions (12) .…”

The Time to Weight-Loss Steady State After Gastric Bypass Predicts Weight-Loss Success

“…The only factor we could find of significance to predict the time to SS was older patients had a shorter SS period compared to younger patients. Older age has previously been found to be a risk factor for higher nadir weight following gastric bypass [12,13]. Sugarman et al reported a significantly better %EWL and %BMI loss for patients <60 years old compared to patients >60 years of age after RYGB [14].…”