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Weight loss post-RYGB

Patient factors predicting weight loss post-RYGB

Two-year follow-up data showed an association between psychiatric disorder, preoperative diabetes, preoperative hypertension, high preoperative BMI, and unsuccessful weight loss
Patients with adulthood onset of obesity were more likely to achieve successful weight loss, compared to patients with obesity since childhood.

Certain patient factors can determine whether weight loss after Roux-en-Y gastric bypass (RYGB) surgery is successful, according to the authors from the Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden. Factors such as an earlier age of onset of obesity, high preoperative BMI, psychiatric disorder, diabetes, and hypertension are associated with unsuccessful weight loss, the research states.

The study, ‘Patient Factors Predicting Weight Loss after Roux-en-Y Gastric Bypass’, published in the Journal of Obesity, sought to identify pre-operative patient related factors predicting unsuccessful weight loss following RYGB surgery. All data from patients undergoing RYGB in one hospital in southern Sweden (Vrinnevi Hospital, Norrköping) was collected between January 2006 and June 2012, and follow-up data were collected from the Scandinavian Obesity Surgery Registry (SOReg) and patients’ charts.

A total of 281 patients were included in the study, with follow-up data at one year was available in 96% of cases and in 88% and 65% at two and three years, respectively. The majority of the patients were female (n=198, 70.4%) and the mean age was 40.8 (range 16–67).

The overall mortality rate was 0.5% (two patients, one heart failure after a re-operation at the fourth postoperative day due to massive bleeding from the gastroentero anastomosis, the second patient committed suicide 22 months after surgery). An open RYGB surgical approach was used in 160 patients (56,9%), while the rest had a laparoscopic procedure. No statistically significant difference in weight loss after surgery was detected between the laparoscopic and the open surgery groups.

A mean EWL% of over 70% was detected during follow-up until three years postoperatively. The rate of diabetes remission after surgery was 56% at one-year follow-up, 63% after two years, and 66% after three years. The corresponding figures for hypertension were 39%, 41%, and 57% and for hyperlipidemia 54%, 34%, and 74%. Remission was defined as patients no longer requiring any antidiabetic, antihypertensive, or lipid-lowering agents.

Figure 1: Demographic and post-operative clinical data of comorbidity

Two-year follow-up data showed an association between psychiatric disorder, preoperative diabetes, preoperative hypertension, high preoperative BMI, and unsuccessful weight loss. At three-year follow-up, there was no statistically significant associations were detected by the analysis.

According to the authors, the pre-operative factors associated with suboptimal weight loss at one year after RYGB included onset of obesity in childhood, greater preoperative weight, and a high initial BMI. However, when considering the onset of obesity, gender, marital status and employment, the results are harder to interpret. Nevertheless, in this study they explain that patients with adulthood onset of obesity were more likely to achieve successful weight loss, compared to patients with obesity since childhood.

“Our study shows that a high preoperative weight, high preoperative BMI, childhood obesity, psychiatric disorder, preoperative diabetes, and preoperative hypertension are independently associated with a risk of suboptimal weight loss after RYGB,” the authors conclude. “These findings emphasise the need of being extraobservant on support of patients with these risk factors. Patients suffering from obesity are a heterogeneous group of individuals, where much more knowledge is needed in the struggle to be able to tailor the optimal treatment for each person. Our results may add a small piece to this multi-dimensional puzzle.”

This is an open access article distributed under the terms of the Creative Commons Attribution License

To access this paper, please click here

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