Improvements in the physical component of quality of life (QoL) after metabolic and bariatric surgery (MBS) varies for patients with different preoperative weights and comorbidity statuses, but that all patients did see an improvement across the 1st year post-surgery, according to Canadian authors writing on behalf of the REBORN study team. Therefore, they propose that these outcomes can be “a starting point to propose revisions on how to prioritise patients for MBS leading to the appropriate selection with a special focus on the health-related impacts of obesity beyond just weight.”
The authors noted that previous studies have shown that all obesity classes, with and without metabolic conditions, impact physical and/or mental QoL, but to different extents. Nevertheless, they said it is unclear how MBS-induced changes in QoL vary across obesity classes and comorbidity status. Therefore, this sub-analysis of the REBORN study, assessed MBS-induced changes in both QoL and weight over the first postoperative year across different obesity and comorbidity statuses.
In total, 514 patients were included in this sub study analysis and divided into three groups: Group 1 (obesity class II without comorbidities, n=28); Group 2 (obesity class II with comorbidities, n=36); and Group 3 (obesity class III, n=460). All patients completed a QoL (Short-Form QoL questionnaire [SF-12]) and anthropometrics were measured at six months before, and six and 12 months after surgery.
They reported that the physical component of the SF-12 improved consistently for all groups overtime. However, the improvements were greatest in Group 3 vs. Group 1. Conversely, for the mental aspect of QoL of life they saw no statistically significant differences in the impact of time, group or their interaction. There was also a significant main effect of time for weight, BMI, and %EWL, with significant reductions in all measures of body weight from pre- to 12 months post-surgery. There were significant interactions between time and group for weight, BMI and %EWL, with those in Group 3 showing the greatest weight loss over time compared to the other two groups.
The authors said the results suggest that MBS may enhance the physical aspect of quality of life across groups with different classes of obesity and comorbidity status, which was in line with changes in weight-related variables. They explained that the fact Group 3 (class III obesity) had the most favourable physical QoL and weight outcomes, is likely because having more excess body weight to lose and the changes in physical QoL may also be related to the reduction in weight translating to a greater potential for mobility.
“These results clearly show that patients who are categorised as ineligible according to the NIH eligibility criteria might also benefit from MBS. Previous studies suggest that higher preoperative BMI is not the only determinant for the consequences of MBS on postoperative obesity-related conditions and mortality.” The authors write. “…The most recent international ASMBS/IFSO 2022 guidelines also align with our findings. These guidelines recommend MBS for a significant proportion of individuals living with various levels of obesity and obesity-related comorbidities. This includes patients with obesity class II and higher, those with obesity class I and higher who have type 2 diabetes, and individuals with class I obesity who do not achieve substantial or durable weight loss or improvement in comorbidities using nonsurgical methods. The recommendation is primarily based on evidence indicating that obesity-related conditions can significantly improve, and in some cases, even remit, following the weight loss associated with MBS. This is in line with what we propose which is to include all patients who might benefit from surgery.”
The findings were reported in the paper, ' Who gains the most quality-of-life benefits from metabolic and bariatric surgery: findings from the prospective REBORN cohort study', published in SOARD. To access this paper, please click here
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