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SAGES 2013

Males have more to gain from bariatric surgery, study claims

Males have a significantly higher incidence of metabolic syndrome and predisposed to cardiovascular disease

Men have more to gain from bariatric surgery, according to researchers from the University of California, Davis. In a review of 1,368 consecutive patients evaluated for bariatric surgery over a four-year period, men on average presented with 4.54 serious comorbidities and 3.70 complicated comorbidities, compared with women who presented with 4.15 serious comorbidities and 3.08 complicated comorbidities. 

“Although men typically comprise less than 20% of bariatric surgery patients, they have more to gain from these operations,” the investigators note. “Men present later in life, with more advanced obesity, and with more complicated comorbidities.”

Despite similar rates of obesity among American men and women, previous population-based studies suggest that bariatric surgery patients are disproportionately female. The authors explained that in their experience suggests that when the obese men present for bariatric surgery, their obesity is more advanced and comorbid diseases are more severe. This study tried to quantitatively assess this observation.

The study examined the prevalence of depression, diabetes mellitus, dyslipidemia, gastro-oesophageal reflux disease, hypertension, back pain, and obstructive sleep apnoea were assessed and a severity score from

1-5 was assigned to each comorbidity (upon patient Presentation), based on the Assessment of Obesity Related Comorbidities Scale (AORC).

Patients requiring treatment or those who had complications of the disease were given a score of 3, 4, or 5 and designated as having complicated

comorbid disease. Metabolic syndrome was defined as the concurrent presence of diabetes mellitus, dyslipidemia and hypertension.

Unsurprisingly, most patients were female (n=1115, 82%), although male patients were older (44.5 ± 9.5 years vs 42.6 ± 9.6 years, p<0.01) and had higher BMI (48.7 ± 7.8 vs 46.6 ± 7.4, p<0.0001).

Females presented with class I or II obesity (14.3% vs 5.1%, p<0.0001), while more men presented with class IV obesity (29.6% vs 22.8%, p<0.05). These differences in class III and class V obesity was not statistically significant.

The results revealed that men presented with more diabetes mellitus, (36.4% vs 29.0%, p<0.05), hypertension (68.8% vs 55.3%, p<0.0001), obstructive sleep apnoea (71.9% vs 45.7%, p<0.0001) and metabolic syndrome (20.9% vs 1.5%, p<0.0001). Males also presented with more complicated diabetes mellitus (32.4% vs 23.9%, p<0.01), dyslipidemia (36.8% vs 23.3%, p<0.0001), hypertension (58.5% vs44.5%, p<0.0001), back pain (26.1% vs 18.9%, p<0.05), obstructive sleep apnoea (56.5% vs 30.0%, p<0.0001) and MetS (17.8% vs 10%, p<0.001).

Females presented with more gastro-oesophageal reflux disease (52.7% vs 41.5%, p<0.01), complicated gastro-oesophageal reflux disease (26.6% vs 18.2%, p<0.01) and complicated depression (37.4% vs 28.9%, p<0.01).

“Most notably, males have a significantly higher incidence of metabolic syndrome and are, thus, predisposed to cardiovascular disease,” the authors conclude. “Such findings mandate more research and resources to investigate this barrier to treatment and to provide the morbidly obese male with the surgical care he clearly needs.”

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