Factors influencing long-term weight loss after bariatric surgery

Chang, Wenguang; Hawkins, Devon; Brockmeyer, Joel R.; Faler, Byron J.; Hoppe, Samuel; Prasad, Balakrishna M.

doi:10.1016/j.soard.2018.12.033

Cited by 45 publications

(20 citation statements)

References 12 publications

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“…The greater weight loss among younger patients and those without obesity-related comorbidities is in-line with previous studies [ 5 , 7 , 9 ] and may be related to other factors, such as mobility, covariation with other risk factors (such as comorbid disease and age), and established insulin resistance with higher circulating insulin levels, as well as to the effects of medication on weight gain. Clinical depression has also been reported to be associated with poorer follow-up attendance, which in turn is known to be associated with poorer long-term weight results [ 28 , 37 ].…”

Section: Discussionsupporting

confidence: 89%

The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

et al. 2020

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Introduction Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. Materials and methods This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. Results The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B −2.4 [95% CI −2.9 to −1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4–1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4–1.2], p < 0.0001) lost significantly more weight. Conclusions All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.

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Section: Discussionsupporting

confidence: 89%

The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

et al. 2020

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“…In their study, patients with late onset of diabetes had a lower chance of durable diabetes remission after bariatric surgery [14]. Furthermore, older patients are known to lose less weight than younger patients after bariatric surgery [28], a factor also associated with reduced chance of achieving complete remission. A combination of a slightly different metabolic profile with poorer weight loss among older patients may well explain the negative association between age and diabetes remission.…”

Section: Discussionmentioning

confidence: 99%

Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study

et al. 2019

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BackgroundAlthough bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.Methods and findingsWe conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79–0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75–0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85–0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20–0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93–0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97–0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29–1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05–1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.ConclusionsIn this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.

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“…However, this was a retrospective study analyzing patients who underwent laparoscopic sleeve gastrectomy and RYGB, not SA-DI-S or SG-LDJB. 9 In our study on SG-LDJB, patients with diabetes were significantly older than those without diabetes, but the preoperative BMI of both groups was similar. Diabetes was found to be an independent predictor even after adjusting for age as a variable in multiple regression analysis.…”

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confidence: 51%

“…Including WL and BMIL also makes the results more comprehensive. Chang et al 9 showed that poor weight-loss outcomes in patients with diabetes were due to patient age rather than diabetes itself.…”

mentioning

confidence: 99%

Response: Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14)

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et al. 2020

Journal of Obesity & Metabolic Syndrome

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Factors influencing long-term weight loss after bariatric surgery

Cited by 45 publications

References 12 publications

The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study

Response: Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14)

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