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Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

Our group has previously demonstrated that low socioeconomic status (SES) independently predicts ≤ 25th percentile weight-loss following bariatric surgery (BS). Given that sociodemographic metrics can be separated into income, education, and race, we sought to investigate how each metric independently impacted weight loss following BS.

Methods

Patients from a single academic institution who underwent bariatric surgery from 2014 to 2016 were retrospectively reviewed. Patients were stratified by income (low/high), education (≤ high school/ ≥ college), and race (black/white) then compared using univariate analysis. Variables significant on univariate analyses were subsequently used for a greedy 1:3 propensity score match with a caliper of 0.2. After matching, groups were balanced on demographics, social/medical/psychological history, and surgery type. Percent excess body weight loss for each post-operative time point was compared using appropriate univariate analyses. A p-value ≤ 0.05 was considered statistically significant.

Results

571 patients were included. Unmatched race analysis demonstrated black patients were significantly younger (p = 0.05), single (p < 0.0001), in a lower income bracket (p < 0.0001), and experienced less weight loss at 2- (p = 0.01), 6- (p = 0.007), 12- (p = 0.008) and 24- (p = 0.007) months post-op. After matching, black patients continued to experience less weight loss at 2- (p = 0.01) and 6- (p = 0.03) months, which trended at 1 year (p = 0.06). Initial income analysis demonstrated patients in the low-income group (LIG) were more likely to be black (p < 0.0001), have ≤ high school education (p = 0.004), a higher preoperative BMI (p = 0.008), and lower postoperative weight loss at 2- (p = 0.001), 6- (p = 0.01), and 12- (p = 0.04) months after surgery. After matching, no differences were observed up to 3-years post-op. Analysis of education demonstrated no effect on weight loss in both unmatched and matched analyses.

Conclusion

Unmatched analysis demonstrated that low income and race impact short-term weight loss after BS. After matching, however, race, not socioeconomic status, predicted weight loss outcomes up to 1-year.

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References

  1. Dalstra JA, Kunst AE, Borrell C et al (2005) Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 34:316–326

    Article  CAS  PubMed  Google Scholar 

  2. Stringhini S, Carmeli C, Jokela M et al (2017) Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet 389:1229–1237

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lewer D, Jayatunga W, Aldridge RW et al (2020) Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health 5:e33–e41

    Article  PubMed  Google Scholar 

  4. Muennig P, Franks P, Jia H et al (2005) The income-associated burden of disease in the United States. Soc Sci Med 61:2018–2026

    Article  PubMed  Google Scholar 

  5. Chetty R, Stepner M, Abraham S et al (2016) The association between income and life expectancy in the United States, 2001–2014. JAMA 315:1750–1766

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mohammed SH, Habtewold TD, Birhanu MM et al (2019) Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies. BMJ Open 9:e028238

    Article  PubMed  PubMed Central  Google Scholar 

  7. Adler NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 21:60–76

    Article  Google Scholar 

  8. Singh GK, Siahpush M, Hiatt RA et al (2011) Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976–2008. J Community Health 36:94–110

    Article  CAS  PubMed  Google Scholar 

  9. Wang Y, Beydoun MA (2007) The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28

    Article  CAS  PubMed  Google Scholar 

  10. Fan JX, Wen M, Li K (2020) Associations between obesity and neighborhood socioeconomic status: variations by gender and family income status. SSM Popul Health 10:100529

    Article  PubMed  Google Scholar 

  11. Livingston EH, Ko CY (2004) Socioeconomic characteristics of the population eligible for obesity surgery. Surgery 135:288–296

    Article  PubMed  Google Scholar 

  12. Martin M, Beekley A, Kjorstad R et al (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis 6:8–15

    Article  PubMed  Google Scholar 

  13. Keating C, Backholer K, Moodie M et al (2015) Differences in the rates of treatment of severe obesity using bariatric surgery across socioeconomic groups. JAMA Surg 150:367–368

    Article  PubMed  Google Scholar 

  14. Wallace AE, Young-Xu Y, Hartley D et al (2010) Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg 20:1354–1360

    Article  PubMed  Google Scholar 

  15. Bhogal SK, Reddigan JI, Rotstein OD et al (2015) Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Obes Surg 25:888–899

    Article  PubMed  Google Scholar 

  16. Hecht LM, Pester B, Braciszewski JM et al (2020) Socioeconomic and racial disparities in bariatric surgery. Obes Surg 11:1–5

    Google Scholar 

  17. Keith CJ, Gullick AA, Feng K et al (2018) Predictive factors of weight regain following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 32:2232–2238

    Article  PubMed  Google Scholar 

  18. Winkleby MA, Jatulis DE, Frank E et al (1992) Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 82:816–820

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Dilektasli E, Erol MF, Cayci HM et al (2017) Low educational status and childhood obesity associated with insufficient Mid-term weight loss after sleeve gastrectomy: a retrospective observational cohort study. Obes Surg 27:162–168

    Article  PubMed  Google Scholar 

  20. Mahoney ST, Strassle PD, Farrell TM et al (2019) Does lower level of education and health literacy affect successful outcomes in bariatric surgery? J Laparoendosc Adv Surg Tech A 29:1011–1015

    Article  PubMed  Google Scholar 

  21. Akkary E, Nerlinger A, Yu S et al (2009) Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass. Surg Endosc 23:1246–1251

    Article  PubMed  Google Scholar 

  22. Jalilvand A, Blaszczak A, Dewire J et al (2019) Laparoscopic sleeve gastrectomy is an independent predictor of poor follow-up and reaching ≤ 40% excess body weight loss at 1, 2, and 3 years after bariatric surgery. Surg Endosc 34:2572–2584

    Article  PubMed  Google Scholar 

  23. Advameg, Inc. “Columbus, OH.” City-Data.com. (2020). http://www.city-data.com/city/Columbus-Ohio.html

  24. U.S. General Services Administration TTS. IMPACT (2020). http://www.data.gov/impact/

  25. Pew Research Center. Social & Demographic Trends (2016). http://www.pewresearch.org/

  26. Doumouras AG, Lee Y, Babe G et al (2020) The hidden cost of an extensive preoperative work-up: predictors of attrition after referral for bariatric surgery in a universal healthcare system. Surg Endosc 34:988–995

    Article  PubMed  Google Scholar 

  27. Smith ED, Layden BT, Hassan C et al (2018) Surgical treatment of obesity in Latinos and African Americans: future directions and recommendations to reduce disparities in bariatric surgery. Bariatr Surg Pract Patient Care 13:2–11

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mainous AG, Johnson SP, Saxena SK et al (2013) Inpatient bariatric surgery among eligible black and white men and women in the United States, 1999–2010. Am J Gastroenterol 108:1218–1223

    Article  PubMed  Google Scholar 

  29. Palli SR, Rizzo JA, Heidrich N (2018) Bariatric surgery coverage: a comprehensive budget impact analysis from a payer perspective. Obes Surg 28:1711–1723

    Article  PubMed  Google Scholar 

  30. Altieri MS, Yang J, Yin D et al (2019) Patients insured by Medicare and Medicaid undergo lower rates of bariatric surgery. Surg Obes Relat Dis 15:2109–2114

    Article  PubMed  Google Scholar 

  31. Gould KM, Zeymo A, Chan KS et al (2019) Bariatric surgery among vulnerable populations: the effect of the affordable care act's Medicaid expansion. Surgery 166:820–828

    Article  PubMed  Google Scholar 

  32. Halloran K, Padwal RS, Johnson-Stoklossa C et al (2011) Income status and approval for bariatric surgery in a publicly funded regional obesity program. Obes Surg 21:373–378

    Article  PubMed  Google Scholar 

  33. Gullick AA, Graham LA, Richman J et al (2015) Association of race and socioeconomic status with outcomes following laparoscopic Roux-en-Y gastric bypass. Obes Surg 25:705–711

    Article  PubMed  Google Scholar 

  34. Admiraal WM, Celik F, Gerdes VE et al (2012) Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care 35:1951–1958

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kitamura R, Chen R, Trickey A et al (2020) Positive and negative independent predictive factors of weight loss after bariatric surgery in a veteran population. Obes Surg 3:1–7

    Google Scholar 

  36. Turner M, Vigneswaran Y, Dewey E et al (2019) Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass. Surg Obes Relat Dis 15:1943–1948

    Article  PubMed  Google Scholar 

  37. King RA, Patel KC, Mark VM et al (2019) Role of ethnicity on weight loss and attrition after bariatric surgery. Obes Surg 29:3577–3580

    Article  PubMed  Google Scholar 

  38. Jambhekar A, Maselli A, Robinson S et al (2018) Demographics and socioeconomic status as predictors of weight loss after laparoscopic sleeve gastrectomy: a prospective cohort study. Int J Surg 54:163–169

    Article  PubMed  Google Scholar 

  39. Wood MH, Carlin AM, Ghaferi AA et al (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154:e190029

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ofori A, Keeton J, Booker Q et al (2020) Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study. Surg Obes Relat Dis 16:786–795

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kim KH, Bursac Z, DiLillo V et al (2009) Stress, race, and body weight. Health Psychol 28:131–135

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weinsier RL, Hunter GR, Zuckerman PA et al (2000) Energy expenditure and free-living physical activity in black and white women: comparison before and after weight loss. Am J Clin Nutr 71:1138–1146

    Article  CAS  PubMed  Google Scholar 

  43. Carden A, Blum K, Arbaugh CJ et al (2019) Low socioeconomic status is associated with lower weight-loss outcomes 10-years after Roux-en-Y gastric bypass. Surg Endosc 33:454–459

    Article  PubMed  Google Scholar 

  44. Erdogdu UE, Cayci HM, Tardu A et al (2019) Health literacy and weight loss after bariatric surgery. Obes Surg 29:3948–3953

    Article  PubMed  Google Scholar 

  45. Marín-León L, Oliveira HB, Barros MB et al (2007) Social inequality and common mental disorders. Braz J Psychiatry 29:250–253

    Article  PubMed  Google Scholar 

  46. Kurspahić Mujčić A, Mujčić A (2019) The relationship between education and self-reported mental and physical health. Med Glas (Zenica) 16:102–107

    Google Scholar 

  47. Small L, Aplasca A (2016) Child obesity and mental health: a complex interaction. Child Adolesc Psychiatr Clin N Am 25:269–282

    Article  PubMed  Google Scholar 

  48. Testa G, Granero R, Siragusa C et al (2019) Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity. Eat Weight Disord. https://doi.org/10.1007/s40519-019-00800-x

    Article  PubMed  Google Scholar 

  49. Pinto-Bastos A, de Lourdes M, Brandão I et al (2019) Weight loss trajectories and psychobehavioral predictors of outcome of primary and reoperative bariatric surgery: a 2-year longitudinal study. Surg Obes Relat Dis 15:1104–1112

    Article  PubMed  Google Scholar 

  50. Pinto-Bastos A, Conceição EM, Machado PPP (2017) Reoperative bariatric surgery: a systematic review of the reasons for surgery, medical and weight loss outcomes, relevant behavioral factors. Obes Surg 27:2707–2715

    Article  PubMed  Google Scholar 

  51. Freese KE, Althouse AD, Ramanathan R et al (2017) Presurgery weight loss goals, depressive symptoms, and weight loss among women undergoing bariatric surgery. Bariatr Surg Pract Patient Care 12:67–71

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ahmed B, King WC, Gourash W et al (2018) Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study. Surgery 164:774–783

    Article  PubMed  Google Scholar 

  53. Semega J et al (2019) Income and poverty in the United States: 2018. http://www.census.gov/library/publications/2019/demo/p60-266.html

  54. Manning S, Pucci A, Carter NC et al (2015) Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 29:1484–1491

    Article  PubMed  Google Scholar 

  55. Maciejewski ML, Arterburn DE, Van Scoyoc L et al (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  56. Chu L, Howell B, Steinberg A et al (2019) Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24 months. Pediatr Obes 14:e12519

    Article  PubMed  Google Scholar 

  57. Ma Y, Pagoto SL, Olendzki BC et al (2006) Predictors of weight status following laparoscopic gastric bypass. Obes Surg 16:1227–1231

    Article  PubMed  Google Scholar 

  58. Toussi R, Fujioka K, Coleman KJ (2009) Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity (Silver Spring) 17:996–1002

    Article  Google Scholar 

  59. Vidal P, Ramón JM, Goday A et al (2014) Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg 24:179–183

    Article  PubMed  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, N718 Doan Hall, Columbus, OH, 43210, USA

    J. C. Chen, Anahita Jalilvand, Vivian Wang, Jennwood Chen, Anand Gupta, Robert Tamer, Kayla Diaz, Muna Tamimi, Bradley Needleman & Sabrena Noria

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  1. J. C. Chen
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  2. Anahita Jalilvand
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  3. Vivian Wang
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  4. Jennwood Chen
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  7. Kayla Diaz
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  8. Muna Tamimi
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  10. Sabrena Noria
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Contributions

All authors contributed to data collection. SN was involved in database and study design. AG, RT and SN performed data analysis. SN, AG, RT and JC performed data interpretation. JC and SN prepared the manuscript. All authors participated in critical review and revision of the manuscript.

Corresponding author

Correspondence to Sabrena Noria.

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Kayla Diaz, Anand Gupta, Robert Tamer, Muna Tamimi and Drs. J. C. Chen, Anahita Jalilvand, Vivian Wang, Jennwood Chen, Bradley Needleman, and Sabrena Noria have no conflicts of interest or financial ties to disclose.

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Chen, J.C., Jalilvand, A., Wang, V. et al. Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery. Surg Endosc 35, 5774–5786 (2021). https://doi.org/10.1007/s00464-020-08066-6

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