Obesity Surgery

, Volume 24, Issue 12, pp 2126–2132

Is Social Deprivation Associated with Weight Loss Outcomes Following Bariatric Surgery? A 10-Year Single Institutional Experience

  • Maryam Alfa Wali
  • Hutan Ashrafian
  • Kerry L. Schofield
  • Leanne Harling
  • Abdullah Alkandari
  • Ara Darzi
  • Thanos Athansiou
  • Evangelos Efthimiou
Original Contributions

Abstract

Background

Social deprivation is associated with a greater morbidity and shorter life expectancy. This study evaluates differences in weight loss following bariatric surgery and deprivation, based on UK deprivation measures in a London bariatric centre.

Methods

All patients undergoing bariatric surgery between 2002 and 2012 were retrospectively identified. Demographic details, type of surgery and percentage excess weight loss data were collected. UK Index of Multiple Deprivation (IMD, 2010) and IMD domain of the Health Deprivation and Disability (HDD) scores were used to assess deprivation (where 1 is the most deprived in rank order and 32,482 is the least deprived). Two-way between-subjects analysis of variance (ANOVA) was performed to examine the effect of IMD score, deprivation, procedure type and gender on percentage excess weight loss.

Results

Data were included from 983 patients (178 male, 805 female) involving 3,663 patient episodes. Treatments comprised laparoscopic gastric bands (n = 533), gastric bypass (n = 362) and gastric balloons (n = 88). The average percentage excess weight loss across all procedures was 38 % over a follow-up period (3 months–9 years). There was no correlation between weight loss and IMD/HDD rank scores. Gastric bypass was significantly more effective at achieving weight loss than the other two procedures at 3-, 6- and 9-month and 1-year follow-up.

Conclusions

Social deprivation does not influence weight loss after bariatric surgery, suggesting that all socioeconomic groups may equally benefit from surgical intervention. Social deprivation should not therefore negatively influence the decision for surgical intervention in these patients.

Keywords

Social deprivation Obesity Bariatric surgery Weight loss 

References

  1. 1.
    Ashrafian H, Darzi A, Athanasiou T. Bariatric surgery—can we afford to do it or deny doing it? Frontline Gastroenterol. 2011;2(2):82–9.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Ashrafian H, le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118(20):2091–102.PubMedCrossRefGoogle Scholar
  3. 3.
    Ashrafian H, le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012;67(5):442–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Ashrafian H, Ahmed K, Rowland SP, et al. Metabolic surgery and cancer: protective effects of bariatric procedures. Cancer. 2011;117(9):1788–99.PubMedCrossRefGoogle Scholar
  5. 5.
    Ashrafian H, Athanasiou T, le Roux CW. Heart remodelling and obesity: the complexities and variation of cardiac geometry. Heart. 2011;97(3):171–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Ashrafian H, Darzi A, Athanasiou T. Autobionics: a new paradigm in regenerative medicine and surgery. Regen Med. 2010;5(2):279–88.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Fenske W, Athanasiou T, Harling L, et al. Obesity-related cardiorenal disease: the benefits of bariatric surgery. Nat Rev Nephrol. 2013;9(9):539–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Ashrafian H, Harling L, Darzi A, et al. Neurodegenerative disease and obesity: what is the role of weight loss and bariatric interventions? Metab Brain Dis. 2013;28(3):341–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Ashrafian H, Athanasiou T, Li JV, et al. Diabetes resolution and hyperinsulinaemia after metabolic Roux-en-Y gastric bypass. Obes Rev : An Offic J Int Assoc Study Obes. 2011;12(5):e257–72.CrossRefGoogle Scholar
  10. 10.
    World Health Organization. Obesity and overweight, factsheet March 2013. http://www.who.int/mediacentre/factsheets/fs311/en/. 2013.
  11. 11.
    Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32(9):1431–7.CrossRefGoogle Scholar
  12. 12.
    Janssen I, Boyce WF, Simpson K, et al. Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr. 2006;83(1):139–45.PubMedGoogle Scholar
  13. 13.
    Stafford M, Brunner EJ, Head J, et al. Deprivation and the development of obesity a multilevel, longitudinal study in England. Am J Prev Med. 2010;39(2):130–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Korda RJ, Joshy G, Jorm LR, et al. Inequalities in bariatric surgery in Australia: findings from 49,364 obese participants in a prospective cohort study. Med J Aust. 2012;197(11):631–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6(1):8–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Livingston EH, Ko CY. Socioeconomic characteristics of the population eligible for obesity surgery. Surgery. 2004;135(3):288–96.PubMedCrossRefGoogle Scholar
  17. 17.
    Leiva MJ, Fuentealba C, Boggiano C, et al. Quality of life of patients subjected to gastric bypass more than one year ago: influence of socioeconomic status. Rev Med Chil. 2009;137(5):625–33.PubMedCrossRefGoogle Scholar
  18. 18.
    Martin LF, Tan TL, Holmes PA, et al. Preoperative insurance status influences postoperative complication rates for gastric bypass. Am J Surg. 1991;161(6):625–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Dallal RM, Bailey L, Guenther L, et al. Comparative analysis of short-term outcomes after bariatric surgery between two disparate populations. Surg Obes Relat Dis. 2008;4(2):110–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Hatoum IJ, Stein HK, Merrifield BF, et al. Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity (Silver Spring). 2009;17(1):92–9.CrossRefGoogle Scholar
  21. 21.
    Ketchum ES, Morton JM. Disappointing weight loss among shift workers after laparoscopic gastric bypass surgery. Obes Surg. 2007;17(5):581–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Alexander JW, Goodman HR, Martin Hawver LR, et al. The impact of medicaid status on outcome after gastric bypass. Obes Surg. 2008;18(10):1241–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Durkin AJ, Bloomston M, Murr MM, et al. Financial status does not predict weight loss after bariatric surgery. Obes Surg. 1999;9(6):524–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Bartley M, Blane D. Socioeconomic deprivation in Britain. Appropriateness of deprivation indices must be ensured. BMJ. 1994;309(6967):1479.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Townsend P. Deprivation. J Soc Pol. 1987;16(02):125–46.CrossRefGoogle Scholar
  26. 26.
    NICE. Guidance on the use of surgery to aid weight reduction for people with morbid obesity: technology appraisal guidance no. 46. 2002.Google Scholar
  27. 27.
    NICE. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. 2006.Google Scholar
  28. 28.
    Government CaL. English indices of deprivation 2010: guidance. In: government CaL, editor. 2011.Google Scholar
  29. 29.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRefGoogle Scholar
  30. 30.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.PubMedCrossRefGoogle Scholar
  33. 33.
    Ashrafian H, Bueter M, Ahmed K, et al. Metabolic surgery: an evolution through bariatric animal models. Obes Rev : An Offic J Int Assoc Study Obes. 2010;11(12):907–20.CrossRefGoogle Scholar
  34. 34.
    Ashrafian H, le Roux CW. Metabolic surgery and gut hormones—a review of bariatric entero-humoral modulation. Physiol Behav. 2009;97(5):620–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Li JV, Ashrafian H, Bueter M, et al. Metabolic surgery profoundly influences gut microbial-host metabolic cross-talk. Gut. 2011;60(9):1214–23.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Wallace AE, Young-Xu Y, Hartley D, et al. Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg. 2010;20(10):1354–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Owen-Smith A, Kipping R, Donovan J, et al. A NICE example? Variation in provision of bariatric surgery in England. BMJ. 2013;346:f2453.PubMedCrossRefGoogle Scholar
  38. 38.
    RightCare. The NHS atlas of variation in healthcare. 2011Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maryam Alfa Wali
    • 1
  • Hutan Ashrafian
    • 1
    • 2
  • Kerry L. Schofield
    • 3
  • Leanne Harling
    • 2
  • Abdullah Alkandari
    • 2
  • Ara Darzi
    • 2
  • Thanos Athansiou
    • 2
  • Evangelos Efthimiou
    • 1
  1. 1.The Department of Bariatric and Metabolic SurgeryChelsea and Westminster NHS Foundation TrustLondonUK
  2. 2.The Department of Surgery and CancerImperial College LondonLondonUK
  3. 3.The Department of Social, Genetic and Developmental PsychologyKing’s College LondonLondonUK

Personalised recommendations