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Weight Loss After Bariatric Surgery: Do Clinical and Behavioral Factors Explain Racial Differences?

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Abstract

Background

Prior studies have suggested less weight loss among African American compared to Caucasian patients; however, few studies have been able to simultaneously account for baseline differences in other demographic, clinical, or behavioral factors.

Methods

We interviewed patients at two weight loss surgery (WLS) centers and conducted chart reviews before and after WLS. We compared weight loss post-WLS by race/ethnicity and examined baseline demographic, clinical (BMI, comorbidities, quality of life), and behavioral (eating behavior, physical activity level, alcohol intake) factors that might explain observed racial differences in weight loss at 1 and 2 years after WLS.

Results

Of 537 participants who underwent either Roux-en-Y Gastric Bypass (54%) or gastric banding (46%), 85% completed 1-year follow-up and 73% completed 2-year follow-up. Patients lost a mean of 33.00% of initial weight at year 1 and 32.43% at year 2 after bypass and 16.07% and 17.56 % respectively after banding. After adjustment for other demographic characteristics and type of surgery, African Americans lost an absolute 5.93 ± 1.49% less weight than Caucasian patients after bypass (p < 0.001) and 4.72 ± 1.96% less weight after banding. Of the other demographic, clinical, behavioral factors considered, having diabetes and perceived difficulty making dietary changes at baseline were associated with less weight loss among gastric bypass patients whereas having a diagnosis of anxiety disorder was associated with less weight loss among gastric banding patients. The association between race and weight loss did not substantially attenuate with additional adjustment for these clinical and behavioral factors, however.

Conclusion

African American patients lost significantly less weight than Caucasian patients. Racial differences could not be explained by baseline demographic, clinical, or behavioral characteristics we examined.

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Acknowledgments

The study was funded by a grant from the National Institutes of Health (R01DK073302, PI Wee). Dr. Wee is also supported by a NIH Midcareer Mentorship Award (K24DK087932). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Ms. Chiodi had full access to the data and takes responsibility for the integrity and accuracy of the data.

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Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Christina C. Wee, Sarah N. Chiodi, Roger B. Davis, Edward R. Marcantonio & Mary Beth Hamel

  2. Division of Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Daniel B. Jones, Benjamin Schneider & George L. Blackburn

  3. Evans Department of Medicine, Boston Medical Center, Boston, MA, USA

    Caroline Apovian & Ashley C. Bourland

  4. Department of Surgery, Boston Medical Center, Boston, MA, USA

    Donald T. Hess

Authors
  1. Christina C. Wee
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  2. Daniel B. Jones
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  3. Caroline Apovian
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  4. Donald T. Hess
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  5. Sarah N. Chiodi
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  6. Ashley C. Bourland
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  7. Roger B. Davis
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  8. Benjamin Schneider
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  9. George L. Blackburn
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  10. Edward R. Marcantonio
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  11. Mary Beth Hamel
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Corresponding author

Correspondence to Christina C. Wee.

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Funding

The study was funded by a grant from the National Institutes of Health (R01DK073302, PI Author 1). Author 1 is also supported by a NIH Midcareer Mentorship Award (K24DK087932).

Conflict of Interest

Author 3 reports grants from National Institutes of Health, from Myos, from Aspire Bariatrics, and from GI Dynamics; grants and personal fees from Amylin, from Sanofi-Aventis, from Orexigen, and from Takeda; personal fees from Merck, from Johnson & Johnson, from Arena, from Nutrisystem, from Zafgen, from EnteroMedics, and from NovoNordisk for work unrelated to the current project. Author 2 reports stock options as a consultant for Allurion. All other authors declare they have no conflict of interest.

Ethical Statement

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.

Consent Statement

Informed consent was obtained from all individual participants included in the study.

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Wee, C.C., Jones, D.B., Apovian, C. et al. Weight Loss After Bariatric Surgery: Do Clinical and Behavioral Factors Explain Racial Differences?. OBES SURG 27, 2873–2884 (2017). https://doi.org/10.1007/s11695-017-2701-y

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  • DOI: https://doi.org/10.1007/s11695-017-2701-y

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