What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review

Rijswijk, Anne-Sophie van; Olst, Nienke van; Schats, Winnie; Peet, Donald L. van der; Laar, Arnold van de

doi:10.1007/s11695-021-05394-x

Cited by 59 publications

(60 citation statements)

References 75 publications

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“…In the present study, we tried to minimize a potential sex bias by keeping similar proportions of men and women among the different procedures, as well as by excluding for the analysis all the transcripts and CpG sites located on sexual chromosomes. Similarly, we used %TWL instead of %EWL as a measure of body weight loss, in an effort to reduce the impact of initial BMI, as recently reported [ 45 ]. Also, in order to take into account baseline differences between participants, differential gene expression analysis was performed by using a paired design, and linear as well as logistic models were adjusted for age, sex and initial BMI.…”

Section: Discussionmentioning

confidence: 99%

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Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery

et al. 2022

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Background Bariatric surgery is an effective therapy for individuals with severe obesity to achieve sustainable weight loss and to reduce comorbidities. Examining the molecular signature of subcutaneous adipose tissue (SAT) following different types of bariatric surgery may help in gaining further insight into their distinct metabolic impact. Results Subjects undergoing biliopancreatic diversion with duodenal switch (BPD-DS) showed a significantly higher percentage of total weight loss than those undergoing gastric bypass or sleeve gastrectomy (RYGB + SG) (41.7 ± 4.6 vs 28.2 ± 6.8%; p = 0.00005). Individuals losing more weight were also significantly more prone to achieve both type 2 diabetes and dyslipidemia remission (OR = 0.75; 95%CI = 0.51–0.91; p = 0.03). Whole transcriptome and methylome profiling showed that bariatric surgery induced a profound molecular remodeling of SAT at 12 months postoperative, mainly through gene down-regulation and hypermethylation. The extent of changes observed was greater following BPD-DS, with 61.1% and 49.8% of up- and down-regulated genes, as well as 85.7% and 70.4% of hyper- and hypomethylated genes being exclusive to this procedure, and mostly associated with a marked decrease of immune and inflammatory responses. Weight loss was strongly associated with genes being simultaneously differentially expressed and methylated in BPD-DS, with the strongest association being observed for GPD1L (r2 = 0.83; p = 1.4 × 10–6). Conclusions Present findings point to the greater SAT molecular remodeling following BPD-DS as potentially linked with higher metabolic remission rates. These results will contribute to a better understanding of the metabolic pathways involved in the response to bariatric surgery and will eventually lead to the development of gene targets for the treatment of obesity. Trial registration ClinicalTrials.gov NCT02390973.

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Section: Discussionmentioning

confidence: 99%

“…Ideal weight is defined as the weight corresponding to a BMI of 23 kg/m 2 . A recent systematic review[75]investigated weight loss outcomes of RYGB and SG concluded that %TWL should be preferred over %EWL to minimize baseline BMI influence [ 45 ]. In this view, %TWL was used in the present study as the main weight loss outcome.…”

Section: Methodsmentioning

confidence: 99%

Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery

et al. 2022

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“…We believe that %EWL is a better assessment of weight loss than %TWL as it is expected to be higher with high BMI patients as in our study, while %EWL indicates how much the patient succeeded to lose from the excess weight regardless of baseline weight; in addition, successful %TWL cut-off is not standardized in the literature, ranging from 10 to 25%, and is mainly used to assess non-surgical weight loss. In a recent systemic review by van Rijswijk, it was shown that %TWL is more accurate than EWL% [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Laparoscopic Sleeve Gastrectomy for Weight Loss in Mild Obesity: Prospective Cohort Study with 3-Year Follow-up

et al. 2022

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Purpose Patients with mild obesity especially in absence of associated medical problems (OAMP) are commonly managed by non-surgical approaches. Laparoscopic sleeve gastrectomy (LSG) has proved itself to be effective and it is now the most performed weight loss procedure. We aimed to study the effectiveness and safety of LSG for weight loss in mild obesity. Methods A prospective cohort study. Group A; BMI (30–34.9 kg/m2), and group B; BMI ≥ 40 or BMI ≥ 35 with OAMP. Demographic data, perioperative complications, % excess weight loss (EWL), % total weight loss (TWL), nutritional profile, and evolution of OAMP were recorded and statistically analyzed. Results A total of 250 patients, with 80 patients (32%) in group A, and 170 (68%) in group B. The majority were female. The mean preoperative weight, BMI, and excess weight were 90.1 ± 9.52, 32.7 ± 1.4, and 21.5 ± 4.9 in group A, and 129.88 ± 26.12, 47.8 ± 8.2, and 62.3 ± 23.6 kg in group B respectively. The low BMI group had significantly lower OAMP, with higher pre-LSG non-surgical procedures rate. Overall post-operative morbidity rate was significantly higher in group B. %TWL was significantly lower in low BMI group. Nutritional profile was within the normal range in both groups at 3-year follow-up. Conclusion Laparoscopic sleeve gastrectomy is a safe and effective weight loss solution for mild obesity with better outcome than for higher BMI. Further studies are warranted to reconsider NIH’s statement for medicolegal aspects, and for matching the current changes in bariatric surgery practice, safety evidence, and patients’ demand. Graphical abstract

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“…The use of %EWL for the evaluation of BS weight-outcome has been recently questioned, mostly due to its dependency on pre-BS weight excess 37 , 38 , with the percentage of total-weight-loss (%TWL), calculated as: being proposed as an alternative parameter 37 , 38 . However, there is still no consensus in literature about which threshold to adopt for the definition of BS unsuccess, since %TWL < 20% was proposed by some authors 37 – 39 , while %TWL < 25% was suggested by others 40 .…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a scoring system for pre-surgical and early post-surgical prediction of bariatric surgery unsuccess at 2 years

Bioletto

Pellegrini

D’Eusebio

et al. 2021

Sci Rep

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Bariatric surgery (BS) is an effective treatment for morbid obesity. However, a simple and easy-to-use tool for the prediction of BS unsuccess is still lacking. Baseline and follow-up data from 300 consecutive patients who underwent BS were retrospectively collected. Supervised regression and machine-learning techniques were used for model development, in which BS unsuccess at 2 years was defined as a percentage of excess-weight-loss (%EWL) < 50%. Model performances were also assessed considering the percentage of total-weight-loss (%TWL) as the reference parameter. Two scoring systems (NAG-score and ENAG-score) were developed. NAG-score, comprising only pre-surgical data, was structured on a 4.5-point-scale (2 points for neck circumference ≥ 44 cm, 1.5 for age ≥ 50 years, and 1 for fasting glucose ≥ 118 mg/dL). ENAG-score, including also early post-operative data, was structured on a 7-point-scale (3 points for %EWL at 6 months ≤ 45%, 1.5 for neck circumference ≥ 44 cm, 1 for age ≥ 50 years, and 1.5 for fasting glucose ≥ 118 mg/dL). A 3-class-clustering was proposed for clinical application. In conclusion, our study proposed two scoring systems for pre-surgical and early post-surgical prediction of 2-year BS weight-loss, which may be useful to guide the pre-operative assessment, the appropriate balance of patients’ expectations, and the post-operative care.

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What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review

Cited by 59 publications

References 75 publications

Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery

Molecular remodeling of adipose tissue is associated with metabolic recovery after weight loss surgery

Effectiveness and Safety of Laparoscopic Sleeve Gastrectomy for Weight Loss in Mild Obesity: Prospective Cohort Study with 3-Year Follow-up

Development and validation of a scoring system for pre-surgical and early post-surgical prediction of bariatric surgery unsuccess at 2 years

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