Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity
- 433 Downloads
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for morbid obesity resulting in approx. 70% excess weight loss (EWL) at 1–2 years. The aim of this study was to identify factors predictive of inadequate EWL following primary LRYGB.
Data on consecutive patients who underwent primary LRYGB between September 2009 and March 2013 were collected prospectively. The effects of age, gender, baseline body mass index (BMI), preoperative EWL, length of time between initial consultation and surgery (TtS), presence of diabetes mellitus (DM), arthritis, obstructive sleep apnea (OSA) and postoperative length of hospital stay (LOS) on EWL at 12 months were studied. General linear regression models were used to evaluate group differences in EWL and to assess independent associations between baseline variables and EWL at 12 months. Stepwise regression analyses were used to estimate individual contributions of independent variables to the variance in EWL at 12 months. In this study, inadequate EWL was defined as <50% EWL at 12 months.
LRYGB was performed in 227 patients with a mean ± SD age and BMI of 48.6 ± 11 years and 53.6 ± 7.1 kg/m2, respectively. Female to male ratio was 3:1. EWL at 12 months had an inverse correlation with age (p = 0.01), baseline BMI (p < 0.001), TtS (p = 0.001), OSA (p = 0.039) and DM (p = 0.039). Conversely, there was a significant positive association between preoperative EWL and that at 12 months (p = 0.009). There was no effect of gender, arthritis or LOS on EWL at 12 months. Multiple regression analysis demonstrated inadequate EWL at 12 months to be predicted by older age (>60 years), patients with diabetes, higher baseline BMI (>60), those who gained weight preoperatively and in patients who waited longer than 18 months for surgery (p = 0.027).
Preoperative factors that predict inadequate EWL at 12 months following primary LRYGB include higher initial BMI, older age, presence of DM and preoperative weight gain. Identification of these factors preoperatively should aid in providing intensive support to these at-risk patient groups.
KeywordsMorbid obesity Surgery Gastric bypass Laparoscopic Weight loss Outcome Risk factors
- 1.Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Centre HaSCI. Statistics on obesity, physical activity and diet—England. 2015 [27/12/2015]; Available from: http://www.hscic.gov.uk/.
- 8.Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
- 9.Li J, Lai D, Wu D. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2015 2015/12/12:1–14. English.Google Scholar
- 20.Ahmed J, Al-Khyatt W. LRYGB: the hand-sewn technique. In: Agrawal S, editor. Obesity, Bariatric and Metabolic Surgery. Cham, Switzerland: Springer International Publishing; 2016. p. 191–6.Google Scholar
- 21.Al-Khyatt W, Bull CA, Awad S, et al. Laparoscopic Roux en-Y gastric bypass using a modified retrocolic-supracolic approach: outcomes from 300 patients. World J Surg. 2016;4Google Scholar
- 24.Sczepaniak JP, Owens ML, Garner W, Dako F, Masukawa K, Wilson SE. A Simpler Method for Predicting Weight Loss in the First Year after Roux-en-Y Gastric Bypass. J Obes. 2012;2012:195251. doi:10.1155/2012/195251.
- 25.Kindel T, Lomelin D, McBride C, Kothari V, Thompson J. The time to weight-loss steady state after gastric bypass predicts weight-loss success. OBES SURG. 2015 2015/06/09:1–5. English.Google Scholar
- 27.Alfonsson S, Sundbom M, Ghaderi A. Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption? Eat Behav. 2014;15(4):644–7.Google Scholar
- 28.Wise ES, Hocking KM, Kavic SM. Prediction of excess weight loss after laparoscopic Roux-en-Y gastric bypass: data from an artificial neural network. Surg Endosc. 2016;30(2):480–8.Google Scholar
- 35.Nicklas BJ, Rogus EM, Goldberg AP. Exercise blunts declines in lipolysis and fat oxidation after dietary-induced weight loss in obese older women. Am J Phys. 1997;273(1 Pt 1):E149–55.Google Scholar
- 38.Vasas P, Al-Khyatt W, Idris I, Leeder PC, Awan AK, Awad S, et al. Mid-term remission of yype 2 diabetes mellitus after laparoscopic Roux en-Y gastric bypass. World J Surg. 2016;40(11):2719-25.Google Scholar
- 40.Kruschitz R, Luger M, Kienbacher C, Trauner M, Klammer C, Schindler K, et al. The Effect of Roux-en-Y vs. Omega-Loop Gastric Bypass on Liver, Metabolic Parameters, and Weight Loss. Obes Surg. 2016;26(9):2204–12.Google Scholar
- 41.Severino A, Castagneto-Gissey L, Raffaelli M, Gastaldelli A, Capristo E, Iaconelli A, et al. Early effect of Roux-en-Y gastric bypass on insulin sensitivity and signaling. Surg Obes Relat Dis. 2016;12(1):42–7.Google Scholar
- 43.Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA: the journal of the American Medical Association. 2013;309(21):2240–9.CrossRefPubMedGoogle Scholar