Obesity Surgery

, Volume 27, Issue 1, pp 162–168 | Cite as

Low Educational Status and Childhood Obesity Associated with Insufficient Mid-Term Weight Loss After Sleeve Gastrectomy: a Retrospective Observational Cohort Study

  • Evren DilektasliEmail author
  • Mehmet Fatih Erol
  • Haci Murat Cayci
  • Guven Ozkaya
  • Mehmet Emrah Bayam
  • Ugur Duman
  • Necdet D. Tihan
  • Umut Erdogdu
  • Gurcan Kisakol
Original Contributions



Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG).

Materials and Methods

This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: <%50EWL (insufficient WL) and group 2: ≥%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed.


In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 ± 15.4 and 58.2 ± 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045).


Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population.


Sleeve gastrectomy Education level Childhood obesity Weight loss Success Failure 


Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

For this type of study, formal consent is not required.

Native English Proofreading

Native English proofreading of this text was carried out by Claire Olmez (B.Ed., M.Sc.).


  1. 1.
    Hirth DA, Jones EL, Rothchild KB, et al. Laparoscopic sleeve gastrectomy: long-term weight loss outcomes. Surg Obes Relat Dis. 2015;11(5):1004–7. Epub 2015/05/20.CrossRefPubMedGoogle Scholar
  2. 2.
    Dey A, Mittal T, Malik VK. Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center—a review of literature and initial results. Obes Surg. 2013;23(4):541–7. Epub 2012/10/27.CrossRefPubMedGoogle Scholar
  3. 3.
    de Raaff CA, Coblijn UK, de Vries N, et al. Predictive factors for insufficient weight loss after bariatric surgery: does obstructive sleep apnea influence weight loss? obesity surgery. 2015. Epub 2015/07/30.Google Scholar
  4. 4.
    White B, Doyle J, Colville S, et al. Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success. Clinical obesity. 2015;5(6):312–24. Epub 2015/11/07.CrossRefPubMedGoogle Scholar
  5. 5.
    Bobbioni-Harsch E, Huber O, Morel P, et al. Factors influencing energy intake and body weight loss after gastric bypass. Eur J Clin Nutr. 2002;56(6):551–6. Epub 2002/05/29.CrossRefPubMedGoogle Scholar
  6. 6.
    Gullick AA, Graham LA, Richman J, et al. Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(4):705–11. Epub 2014/10/12.CrossRefPubMedGoogle Scholar
  7. 7.
    van Hout GC, Verschure SK, van Heck GL. Psychosocial predictors of success following bariatric surgery. Obes Surg. 2005;15(4):552–60. Epub 2005/06/11.CrossRefPubMedGoogle Scholar
  8. 8.
    Brethauer SA. Sleeve gastrectomy. Surg Clin North Am. 2011;91(6):1265–79. ix. Epub 2011/11/08.CrossRefPubMedGoogle Scholar
  9. 9.
    Anderson B, Switzer NJ, Almamar A, et al. The impact of laparoscopic sleeve gastrectomy on plasma ghrelin levels: a systematic review. Obes Surg. 2013;23(9):1476–80. Epub 2013/06/25.CrossRefPubMedGoogle Scholar
  10. 10.
    Benaiges D, Mas-Lorenzo A, Goday A, et al. Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21(41):11804–14. Pubmed Central PMCID: 4631978, Epub 2015/11/12.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Saunders R. “Grazing”: a high-risk behavior. Obes Surg. 2004;14(1):98–102. Epub 2004/02/26.CrossRefPubMedGoogle Scholar
  12. 12.
    Jastrzebska-Mierzynska M, Ostrowska L, Wasiluk D, et al. Dietetic recommendations after bariatric procedures in the light of the new guidelines regarding metabolic and bariatric surgery. Rocz Panstw Zakl Hig. 2015;66(1):13–9. Epub 2015/03/31.PubMedGoogle Scholar
  13. 13.
    1983 metropolitan height and weight tables. Statistical bulletin. 1983 Jan-Jun;64(1):3-9. Epub 1983/01/01.Google Scholar
  14. 14.
    Centers for disease control and prevention division of nutrition pa, and obesity, national center for chronic disease prevention and health promotion. Defining childhood obesity. 2015.Google Scholar
  15. 15.
    Coleman KJ, Toussi R, Fujioka K. Do gastric bypass patient characteristics, behavior, and health differ depending upon how successful weight loss is defined? Obes Surg. 2010;20(10):1385–92. Epub 2010/07/10.CrossRefPubMedGoogle Scholar
  16. 16.
    Brown WA, Burton PR, Shaw K, et al. A pre-hospital patient education program improves outcomes of bariatric surgery. Obes Surg. 2016;6. Epub 2016/02/08.Google Scholar
  17. 17.
    Petasne Nijamkin M, Campa A, Samiri Nijamkin S, et al. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. J Nutr Educ Behav. 2013;45(6):620–6. Epub 2013/07/04.CrossRefPubMedGoogle Scholar
  18. 18.
    Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43. Epub 2010/11/06.CrossRefPubMedGoogle Scholar
  19. 19.
    Torres AJ, Rubio MA. The Endocrine Society’s Clinical Practice Guideline on endocrine and nutritional management of the post-bariatric surgery patient: commentary from a European perspective. European journal of endocrinology / European Federation of Endocrine Societies. 2011;165(2):171–6. Epub 2011/05/24.CrossRefGoogle Scholar
  20. 20.
    Albanopoulos K, Tsamis D, Natoudi M, et al. The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up. Surg Endosc. 2015;20. Epub 2015/06/21.Google Scholar
  21. 21.
    Genco A, Cipriano M, Materia A, et al. Laparoscopic sleeve gastrectomy versus intragastric balloon: a case-control study. Surg Endosc. 2009;23(8):1849–53. Epub 2009/01/27.CrossRefPubMedGoogle Scholar
  22. 22.
    Boza C, Daroch D, Barros D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure. Surgery for obesity and related diseases. 2014;10(6):1129–33. Epub 2014/12/17.CrossRefPubMedGoogle Scholar
  23. 23.
    Nikolic M, Kruljac I, Kirigin L, et al. Initial weight loss after restrictive bariatric procedures May predict Mid-term weight maintenance: results from a 12-month pilot trial. Bariatric surgical practice and patient care. 2015;10(2):68–73. Pubmed Central PMCID: 4643675, Epub 2015/11/26.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5. Epub 2008/03/05.CrossRefPubMedGoogle Scholar
  25. 25.
    Wadden TA, West DS, Neiberg RH, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity. 2009;17(4):713–22. Pubmed Central PMCID: 2690396, Epub 2009/01/31.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ogden CL, Yanovski SZ, Carroll MD, et al. The epidemiology of obesity. Gastroenterology. 2007;132(6):2087–102. Epub 2007/05/15.CrossRefPubMedGoogle Scholar
  27. 27.
    Papadimitriou A. Timing of adiposity rebound and prevalence of obesity. J Pediatr. 2015;167(2):498. Epub 2015/05/24.CrossRefPubMedGoogle Scholar
  28. 28.
    Faienza MF, Wang DQ, Fruhbeck G, et al. The dangerous link between childhood and adulthood predictors of obesity and metabolic syndrome. Intern Emerg Med. 2016;12. Epub 2016/01/14.Google Scholar
  29. 29.
    McLaughlin T, Lamendola C, Coghlan N, et al. Subcutaneous adipose cell size and distribution: relationship to insulin resistance and body fat. Obesity. 2014;22(3):673–80. Pubmed Central PMCID: 4344365, Epub 2013/05/15.CrossRefPubMedGoogle Scholar
  30. 30.
    Xu S, Xue Y. Pediatric obesity: causes, symptoms, prevention and treatment. Experimental and therapeutic medicine. 2016;11(1):15–20. Pubmed Central PMCID: 4726862, Epub 2016/02/03.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Evren Dilektasli
    • 1
    Email author
  • Mehmet Fatih Erol
    • 1
  • Haci Murat Cayci
    • 1
  • Guven Ozkaya
    • 2
  • Mehmet Emrah Bayam
    • 1
  • Ugur Duman
    • 1
  • Necdet D. Tihan
    • 1
  • Umut Erdogdu
    • 1
  • Gurcan Kisakol
    • 3
  1. 1.Department of General SurgeryBursa Yuksek Ihtisas Training and Research HospitalBursaTurkey
  2. 2.Department of BiostatisticsUludag University Faculty of MedicineBursaTurkey
  3. 3.Department of EndocrinologyBursa Yuksek Ihtisas Training and Research HospitalBursaTurkey

Personalised recommendations