Obesity Surgery

, Volume 29, Issue 11, pp 3589–3595 | Cite as

Changes in Body Composition, Comorbidities, and Nutritional Status Associated with Lower Weight Loss After Bariatric Surgery in Older Subjects

  • Pauline Faucher
  • Judith Aron-Wisnewsky
  • Cécile Ciangura
  • Laurent Genser
  • Adriana Torcivia
  • Jean-Luc Bouillot
  • Christine Poitou
  • Jean-Michel OppertEmail author
Original Contributions



To provide greater insight into bariatric surgery outcomes in aging patients, we compared changes in body weight, body composition, obesity-related comorbidities, and nutritional status between older and younger subjects.


We analyzed data collected between January 2004 and December 2014 from our prospective bariatric cohort. Older patients (OP, ≥ 60 years at the time of surgery, n = 93; 66% Roux-en-Y gastric bypass, 34% sleeve gastrectomy) were compared with younger patients (YP, < 60 years, n = 186), matched 1:2 on sex, body mass index, diabetes, and surgical procedure. Body composition was assessed by dual-energy X-ray absorptiometry.


Weight loss and excess weight loss at 12 months were lower in OP vs. YP (mean ± SD, 30.1 ± 10.1 vs. 34.1 ± 11.9 kg, 60.6 ± 21.2 vs. 66.8 ± 23.4%, respectively, p < 0.05 for both). Both lean body mass and fat mass loss were lower in OP vs. YP (8.4 ± 3.4 vs. 9.2 ± 9.0 kg, 19.4 ± 8.7 vs. 21.9 ± 9.1 kg, respectively, p < 0.05). The remission rate for type 2 diabetes was significantly lower in OP vs. YP (24 vs. 45%), as well as improvement in hypertension (14 vs. 46%), dyslipidemia (27 vs. 47%), and knee pain. There was no difference in micronutrient deficiencies between groups.


These data indicate that although bariatric surgery is not as effective for weight loss in older as in younger subjects, it is a safe option regarding a comprehensive set of nutritional variables which enables significant improvement in obesity-related outcomes.


Elderly Bariatric surgery Body composition Comorbidities Obesity 



The authors express their thanks to Sophie Festis and to Dr. Florence Marchelli, MD, both at the Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France, for technical assistance with DXA measurements and for assistance with data management, respectively.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement

The study was approved by the local ethics committee.


  1. 1.
    Flegal KM, Ogden CL. Use of projection analyses and obesity trends-reply. JAMA. 2016;316(12):1317.PubMedCentralGoogle Scholar
  2. 2.
    Obépi-Roche R. Enquête épidémiologique nationale sur le surpoids et l'obésité. Paris: Inserm/TNS Healthcare/Roche; 2012.Google Scholar
  3. 3.
    Batsis JA, Zagaria AB. Addressing obesity in aging patients. Med Clin North Am. 2018;102(1):65–85.PubMedGoogle Scholar
  4. 4.
    Mathus-Vliegen EM. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts. 2012;5(3):460–83.Google Scholar
  5. 5.
    Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging. 2015;10:1627–35.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Hassinger TE, Mehaffey JH, Johnston LE, et al. Roux-en-Y gastric bypass is safe in elderly patients: a propensity-score matched analysis. Surg Obes Relat Dis. 2018;14(8):1133–8.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Montastier E, Becouarn G, Bérard E, et al. Gastric bypass in older patients: complications, weight loss, and resolution of comorbidities at 2 years in a matched controlled study. Obes Surg. 2016;26(8):1806–13.PubMedGoogle Scholar
  8. 8.
    Thereaux J, Poitou C, Barsamian C, et al. Midterm outcomes of gastric bypass for elderly (aged >/= 60 yr) patients: a comparative study. Surg Obes Relat Dis. 2015;11(4):836–41.PubMedGoogle Scholar
  9. 9.
    Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis. World J Surg. 2014;38(5):1121–6.PubMedGoogle Scholar
  10. 10.
    Ritz, P., Topart P., Benchetrit S., Tuyeras G., Lepage B., Mouiel J., Becouarn G., Pattou F., Chevallier J.M., Benefits and risks of bariatric surgery in patients aged more than 60 years. Surg Obes Relat Dis, 2014.Google Scholar
  11. 11.
    Pequignot A, Prevot F, Dhahri A, et al. Is sleeve gastrectomy still contraindicated for patients aged>/=60 years? A case-matched study with 24 months of follow-up. Surg Obes Relat Dis. 2015;11(5):1008–13.PubMedGoogle Scholar
  12. 12.
    Ciangura C, Bouillot JL, Lloret-Linares C, et al. Dynamics of change in total and regional body composition after gastric bypass in obese patients. Obesity (Silver Spring). 2010;18(4):760–5.Google Scholar
  13. 13.
    HAS, Obesity : surgical care in adults French National Authority for Health, Good clinical pratices Service , (Accessed 3 Jan 2019) [in French], 2009.
  14. 14.
    National Task Force on the, P. and O. Treatment of, overweight, obesity, and health risk. Arch Intern Med. 2000;160(7):898–904.Google Scholar
  15. 15.
    Thereaux J, Corigliano N, Poitou C, et al. Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI >/= 50 kg/m(2). Surg Obes Relat Dis. 2015;11(4):785–90.PubMedGoogle Scholar
  16. 16.
    Oppert JM, Bellicha A, Roda C, et al. Resistance training and protein supplementation increase strength after bariatric surgery: a randomized controlled trial. Obesity (Silver Spring). 2018;26(11):1709–20.Google Scholar
  17. 17.
    Via MA, Mechanick JI. Nutritional and micronutrient care of bariatric surgery patients: current evidence update. Curr Obes Rep. 2017;6(3):286–96.PubMedGoogle Scholar
  18. 18.
    Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31(4):569–77.Google Scholar
  19. 19.
    Lloret-Linares C, Faucher P, Coupaye M, et al. Comparison of body composition, basal metabolic rate and metabolic outcomes of adults with Prader Willi syndrome or lesional hypothalamic disease, with primary obesity. Int J Obes. 2013;37(9):1198–203.Google Scholar
  20. 20.
    Verger EO, Aron-Wisnewsky J, Dao MC, et al. Micronutrient and protein deficiencies after gastric bypass and sleeve gastrectomy: a 1-year follow-up. Obes Surg. 2016;26(4):785–96.PubMedGoogle Scholar
  21. 21.
    Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.PubMedGoogle Scholar
  22. 22.
    Raynaud-Simon A, R C, Strategy for management of malnutrition in the elderly. French National Authority for Health, (Accessed 3 Jan 2019) [in French], 2007.
  23. 23.
    Gesquiere I, Aron-Wisnewsky J, Foulon V, et al. Medication cost is significantly reduced after Roux-en-Y gastric bypass in obese patients. Obes Surg. 2014;24(11):1896–903.PubMedGoogle Scholar
  24. 24.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.PubMedCentralGoogle Scholar
  25. 25.
    Aron-Wisnewsky J, Sokolovska N, Liu Y, et al. The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass. Diabetologia. 2017;60(10):1892–902.PubMedGoogle Scholar
  26. 26.
    Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2(1):38–45.PubMedCentralGoogle Scholar
  27. 27.
    Contreras JE, Santander C, Court I, et al. Correlation between age and weight loss after bariatric surgery. Obes Surg. 2013;23(8):1286–9.PubMedGoogle Scholar
  28. 28.
    Sugerman HJ, DeMaria EJ, Kellum JM, et al. Effects of bariatric surgery in older patients. Ann Surg. 2004;240(2):243–7.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Frutos MD et al. Results of laparoscopic gastric bypass in patients > or =55 years old. Obes Surg. 2006;16(4):461–4.PubMedGoogle Scholar
  30. 30.
    Dunkle-Blatter SE, St. Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3(2):163–9. discussion 169-70PubMedGoogle Scholar
  31. 31.
    Busetto L, Angrisani L, Basso N, et al. Safety and efficacy of laparoscopic adjustable gastric banding in the elderly. Obesity (Silver Spring). 2008;16(2):334–8.Google Scholar
  32. 32.
    Susmallian S, Barnea R, Weiss Y, et al. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis. 2018;14(11):1705–13.PubMedGoogle Scholar
  33. 33.
    Burchett MA, McKenna DT, Selzer DJ, et al. Laparoscopic sleeve gastrectomy is safe and effective in elderly patients: a comparative analysis. Obes Surg. 2015;25(2):222–8.PubMedGoogle Scholar
  34. 34.
    Leivonen MK, Juuti A, Jaser N, et al. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up. Obes Surg. 2011;21(8):1180–7.Google Scholar
  35. 35.
    van Rutte PW et al. Sleeve gastrectomy in older obese patients. Surg Endosc. 2013;27(6):2014–9.Google Scholar
  36. 36.
    Parmar C, Mahawar KK, Carr WRJ, et al. Bariatric surgery in septuagenarians: a comparison with <60 year olds. Obes Surg. 2017;27(12):3165–9.PubMedGoogle Scholar
  37. 37.
    Robert M, Pasquer A, Espalieu P, et al. Gastric bypass for obesity in the elderly: is it as appropriate as for young and middle-aged populations? Obes Surg. 2014;24(10):1662–9.Google Scholar
  38. 38.
    Luhrmann PM et al. Longitudinal changes in energy expenditure in an elderly German population: a 12-year follow-up. Eur J Clin Nutr. 2009;63(8):986–92.PubMedGoogle Scholar
  39. 39.
    Ochner CN, Teixeira J, Geary N, et al. Greater short-term weight loss in women 20-45 versus 55-65 years of age following bariatric surgery. Obes Surg. 2013;23(10):1650–4.PubMedCentralGoogle Scholar
  40. 40.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Alba DL, Wu L, Cawthon PM, et al. Changes in lean mass, absolute and relative muscle strength, and physical performance after gastric bypass surgery. J Clin Endocrinol Metab. 2019;104(3):711–20.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059–64.Google Scholar
  43. 43.
    Debedat J et al. Long-term relapse of type 2 diabetes after roux-en-Y gastric bypass: prediction and clinical relevance. Diabetes Care. 2018;41(10):2086–95.PubMedGoogle Scholar
  44. 44.
    Bergeat D, Lechaux D, Ghaina A, et al. Postoperative outcomes of laparoscopic bariatric surgery in older obese patients: a matched case-control study. Obes Surg. 2017;27(6):1414–22.PubMedGoogle Scholar
  45. 45.
    Piche ME et al. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update. Prog Cardiovasc Dis. 2018;61(2):103–13.Google Scholar
  46. 46.
    Pajecki D et al. Bariatric surgery in the elderly: results of a mean follow-up of five years. Arq Bras Cir Dig. 2015;28(Suppl 1):15–8.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition DepartmentSorbonne University, Institute of Cardiometabolism and Nutrition (ICAN)ParisFrance
  2. 2.NutriOmics team, INSERM UMRS U1166Sorbonne UniversitésParisFrance
  3. 3.Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Hepato-Biliary and Pancreatic SurgerySorbonne UniversityParisFrance
  4. 4.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of General, Digestive and Metabolic Surgery, Ambroise Paré HospitalVersailles-Saint-Quentin-en-Yvelines UniversityBoulogne-BillancourtFrance

Personalised recommendations