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Suboptimal Weight Loss after Gastric Bypass Surgery: Correlation of Demographics, Comorbidities, and Insurance Status with Outcomes

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Although Roux-en-Y gastric bypass surgery (RYGBP) is safe and effective at achieving weight loss in the majority of severely obese patients, a subset fails to achieve expected weight loss outcomes. Factors associated with poor weight loss are not well defined. Patients undergoing open RYGBP using a standardized surgical technique and clinical pathway by a single surgeon at a dedicated bariatric center were reviewed. Suboptimal weight loss was defined as failure to lose at least 40% excess body weight by 12 months postoperatively. Of 555 consecutive patients who underwent RYGBP from 1999 to 2004, a 12-month follow-up was available for the 495 (89%). Suboptimal weight loss occurred in 55 (11%) and was associated on unadjusted bivariate analysis with increased body mass index (BMI; p = 0.0002), diabetes mellitus (p = 0.0002), Medicaid insurance (p = 0.04), and male sex (p = 0.01). On adjusted multivariate analysis, increased BMI (p = 0.003), diabetes (p = 0.002), and male gender (p = 0.04) were associated with suboptimal weight loss, but type of insurance (p = 0.11) was not. Medicaid patients were younger (p = 0.01) and had higher BMI (p = 0.0002). Suboptimal weight loss after RYGBP appears to be associated with greater BMI, male sex, and diabetes but not type of insurance. This study may help identify patients who could benefit from increased perioperative education and counseling or selection of procedures with greater malabsorption.

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References

  1. Buchwald H. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis 2005;1(3):371–381, May–Jun.

    Article  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–1555, Apr 5.

    Article  PubMed  CAS  Google Scholar 

  3. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142(7):547–559, Apr 5.

    PubMed  Google Scholar 

  4. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36(1):20–25, Jul.

    PubMed  CAS  Google Scholar 

  5. NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991;115(12):956–961, Dec 15.

    Google Scholar 

  6. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294(15):1909–1917, Oct 19.

    Article  PubMed  CAS  Google Scholar 

  7. Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–624, Jun.

    Article  PubMed  CAS  Google Scholar 

  8. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240(3):416–423; discussion 423–414, Sep.

    Article  PubMed  Google Scholar 

  9. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA 13 2004;292(14):1724–1737, Oct.

    Article  CAS  Google Scholar 

  10. Bloomston M, Zervos EE, Camps MA, Goode SE, Rosemurgy AS. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg 1997;7(5):414–419, Oct.

    Article  PubMed  CAS  Google Scholar 

  11. Brolin RE, Kenler HA, Gorman JH, Cody RP. Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 1992;215(4):387–395, Apr.

    Article  PubMed  CAS  Google Scholar 

  12. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg 2000;231(4):524–528, Apr.

    Article  PubMed  CAS  Google Scholar 

  13. Murr MM, Balsiger BM, Kennedy FP, Mai JL, Sarr MG. Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass. J Gastrointest Surg 1999;3(6):607–612, Nov–Dec.

    Article  PubMed  CAS  Google Scholar 

  14. Lutfi R, Torquati A, Sekhar N, Richards WO. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surg Endosc. May 2 2006.

  15. Ma Y, Pagoto SL, Olendzki BC, Hafner A, Perugini R, Mason R, Kelly J. Predictors of weight status following laparoscopic gastric bypass. Obes Surg 2006;16(9):1227–1231, Sep.

    Article  PubMed  Google Scholar 

  16. Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DEM, Kelly JJ. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003;138(5):541–545; discussion 545–546, May.

    Article  PubMed  Google Scholar 

  17. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg 2000;10(3):233–239, Jun.

    Article  PubMed  CAS  Google Scholar 

  18. Durkin AJ, Bloomston M, Murr MM, Rosemurgy AS. Financial status does not predict weight loss after bariatric surgery. Obes Surg 1999;9(6):524–526, Dec.

    Article  PubMed  CAS  Google Scholar 

  19. Flum DR, Salem L, Elrod JA, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294(15):1903–1908, Oct 19.

    Article  PubMed  CAS  Google Scholar 

  20. Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg 2006;141(11):1115–1120; discussion 1121, Nov.

    Article  PubMed  Google Scholar 

  21. Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass. Ann Surg 2006;244(4):611–619, Oct.

    PubMed  Google Scholar 

  22. Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg 2002;12(4):540–545, Aug.

    Article  PubMed  Google Scholar 

  23. Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006;244(5):741–749, Nov.

    Article  PubMed  Google Scholar 

  24. Rubino F, Gagner M, Gentileschi P, Fukuyama S, Feng J, Diamond E. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 2004;240(2):236–242, Aug.

    Article  PubMed  Google Scholar 

  25. Alvarado R, Alami RS, Hsu G, Safadi BY, Sanchez BR, Morton JM, Curet MJ. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005;15(9):1282–1286, Oct.

    Article  PubMed  CAS  Google Scholar 

  26. Nelson WK, Fatima J, Houghton SG, Thompson G, Kendrick M, Mai J, Kennel K, Sarr M. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery 2006;140(4):517–522, discussion 522–513, Oct.

    Article  PubMed  Google Scholar 

  27. Cordera F, Mai JL, Thompson GB, Sarr MG. Unsatisfactory weight loss after vertical banded gastroplasty: is conversion to Roux-en-Y gastric bypass successful? Surgery 2004;136(4):731–737, Oct.

    Article  PubMed  Google Scholar 

  28. Nesset EM, Kendrick ML, Houghton SG, Mai JL, Thompson GB, Que FG, Thomsen KM, Larson DR, Sarr MG. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis 2007;3(1):25–30; discussion 30, Jan–Feb.

    Article  PubMed  Google Scholar 

  29. Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg 1997;1(6):517–524; discussion 524–516, Nov–Dec.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank the Johns Hopkins surgical house staff and the Johns Hopkins Bayview Medical Center nurses for their skill and devotion.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA

    Genevieve B. Melton, Kimberley E. Steele, Michael A. Schweitzer, Anne O. Lidor & Thomas H. Magnuson

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  1. Genevieve B. Melton
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  2. Kimberley E. Steele
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  3. Michael A. Schweitzer
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  4. Anne O. Lidor
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  5. Thomas H. Magnuson
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Correspondence to Thomas H. Magnuson.

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Discussion

Michael G. Sarr, M.D. (Rochester, MN): This is a vexing problem for the bariatric surgeon. Do you really think that if you can identify these patients that you have an effective intervention preoperatively to offer?

Genevieve B. Melton, M.D. (Baltimore, MD): Dr. Sarr, thank you for your question. Yes, I think that there is some evidence that there are things that we can do to help these patients. First, with respect to preoperative interventions, the Stanford group, has reported that you can have improved weight loss outcomes if patients are encouraged to lose weight preoperatively. Second, with the super obese patients with BMIs over 50, there is evidence that doing a more distal gastric bypass, a Roux limb usually between 100 to 250 cm, can help patients lose more weight. Also, with the duodenal switch, similar improved weight loss outcomes have been noted in the subset of the heaviest patients.

John M. Kellum, Jr., M.D. (Richmond, VA): I too enjoyed your paper. I want to focus on the diabetic problem, because we recently looked at our database of over 4,500 patients and found that indeed they do lose less excess weight. Even though statistically it is very significant, at P < 0.0001, we are talking only about a 67% versus a 60% loss of initial excess weight. And I agree with your findings that it doesn't affect resolution of diabetes. It is known that patients with Type 2 diabetes all have insulin resistance, which slows down metabolic rate. So I am wondering if any type of preoperative counseling will affect weight loss in the diabetic? I hope this won't be used as a reason not to do gastric bypass in the diabetic patient.

Dr. Melton: Dr. Kellum, thank you for your question and comments. I think in fact that this study suggests that we get very good resolution of diabetes after Roux en Y gastric bypass. Evidence from the Rubino group with an animal model has demonstrated that if you bypass the duodenum and proximal jejunum that you often will have resolution of diabetes. In fact, this has been done with patients in India, Mexico and Brazil where they have bypassed the duodenum and have observed resolution of diabetes.

Perhaps the best study out there with respect to diabetes resolution with gastric bypass surgery is from the University of Pittsburgh from Dr. Schauer’s group, which also has shown very good resolution, about 80%, of diabetes, but they have five year data. They demonstrated that those with a shorter duration of diabetes were more likely to have resolution, as well as diet controlled diabetics. In addition, those that lose more weight following surgery tend to resolve more often, as well.

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Melton, G.B., Steele, K.E., Schweitzer, M.A. et al. Suboptimal Weight Loss after Gastric Bypass Surgery: Correlation of Demographics, Comorbidities, and Insurance Status with Outcomes. J Gastrointest Surg 12, 250–255 (2008). https://doi.org/10.1007/s11605-007-0427-1

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