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

Abstract

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.

Comparison of Linear versus Circular-Stapled Gastroenterostomy in Roux-en-Y Gastric Bypass: A Nationwide Population-Based Cohort Study

“…In order to identify patients that are at risk of developing nonresponse, multiple factors have been investigated and so far, a pattern of an older age, a higher preoperative BMI, the presence of comorbidities, and behavioral and psychosocial factors have been shown to predict non-response [8,24,[31][32][33]. The current study showed male gender and preoperative hypertension increased the risk of non-response.…”

“…This is CSA = circular-stapled anastomosis, LSA = linear-stapled anastomosis, TWL = total weight loss 1 Defined as successful weight loss (≥20% total body weight loss) within 1.5 years after surgery 2 Defined as significant weight regain (≥20% of a patients' lost weight) after initial successful weight loss (≥20% total body weight loss) 2 years after surgery 3 The total amount of patients included in the CSA group was 881 patients. The total amount of patients included in the LSA group was 11,587 patients [32].…”

Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients

“… 18 Previous studies have reported lower weight loss and improvement in health-related quality of life, as well as higher loss to follow-up after bariatric surgery for patients living in larger cities. 19 20 28 While part of these findings may be explained by the chronic stress and higher cortisol levels of urban life, as well as the higher availability of energy-dense food, the cause of these negative associations remains largely unknown. 29 However, low socioeconomic status and income are associated with poor health literacy, factors known to influence postoperative recovery and treatment compliance.…”

“…17 Recent studies have also reported an association between several socioeconomic factors and the risk for complications, as well as the effect on weight loss and improvements in health-related quality of life after bariatric surgery. [18][19][20] However, the effect of socioeconomic factors on remission rates of T2D after bariatric surgery remains unknown.…”

Place Work on a Scale: What Do We Know About the Association Between Employment Status and Weight Loss Outcomes After Bariatric Surgery?

“…Additionally, Cadena-Obando et al found that lacking a fulltime job pre-surgery was a negative predictor for achieving successful weight loss (≥50%excess body weight loss) one year after various bariatric procedures [ 19 ]. Only the study by Stenberg et al reported long-term results and these results are in contrast to the abovementioned studies, as the authors found that pre-surgical employment as a professional or technician is independently associated with a lower %total weight loss (TWL) five years after Roux-en-Y gastric bypass (RYGB) [ 20 ].…”