Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy



Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities.

Materials and Methods

A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12 months and 36 months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes.


The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2 years. Mean pre-operative BMI was 40.7 ± 8.1 kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16–6.63, p < 0.05) and %EWL (18.55, 95% CI 10.33–26.77, p < 0.05) while the Malays had the worst outcomes. Both Chinese and Koreans had better %EWL but worse %TWL as compared to Caucasians and there were no significant differences with the Indian study group.


There are differences in weight loss outcomes following bariatric surgery between Asian ethnicities.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    (WHO) WHO. Obesity and overweight fact sheets. 2016. Available from: Accessed 20 Mar 2018.

  2. 2.

    Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease. Lancet (London, England). 2002;360(9343):1347–60.

    Google Scholar 

  3. 3.

    Ni Mhurchu C, Rodgers A, Pan WH, et al. Body mass index and cardiovascular disease in the Asia-Pacific region: an overview of 33 cohorts involving 310 000 participants. Int J Epidemiol. 2004;33(4):751–8.

    CAS  PubMed  Google Scholar 

  4. 4.

    Karter AJ, Ferrara A, Liu JY, et al. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287(19):2519–27.

    PubMed  Google Scholar 

  5. 5.

    McWilliams JM, Meara E, Zaslavsky AM, et al. Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of Medicare coverage. Ann Intern Med. 2009;150(8):505–15.

    PubMed  Google Scholar 

  6. 6.

    Finkelstein EA, DiBonaventura M, Burgess SM, et al. The costs of obesity in the workplace. J Occup Environ Med. 2010;52(10):971–6.

    PubMed  Google Scholar 

  7. 7.

    Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Skinner AC. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr. 2014;168(6):561–6.

    Google Scholar 

  9. 9.

    Freedman DS. Racial and ethnic differences in secular trends for childhood BMI, weight, and height. Obesity (Silver Spring, Md). 2006;14(2):301–8.

    Google Scholar 

  10. 10.

    Rajput NN. Overweight and obesity in 4-5-year-old children in New Zealand: results from the first 4 years (2009-2012) of the B4School Check programme. J Paediatr Child Health. 2015;51(3):334–43.

    PubMed  Google Scholar 

  11. 11.

    Division EDC, Ministry of Health S. National Health Survey 2004. 2004. Available from: Accessed 20 Mar 2018.

  12. 12.

    Division EDC, Ministry of Health S. National Health Survey 2010. 2010. Available from: Accessed 20 Mar 2018.

  13. 13.

    Registry SMI, Office NRoD, Ministry of Health S. Trends in acute myocardial infarction in Singapore 2007–2013. 2015. Available from: Accessed 20 Mar 2018.

  14. 14.

    Registry SR, Office NRoD, Ministry of Health S. Singapore Renal Registry Annual Report 2015. 2016. Available from: Accessed 20 Mar 2018.

  15. 15.

    Registry SS, Office NRoD, Ministry of Health S. Stroke Registry Report 2014. 2016. Available from: Accessed 20 Mar 2018.

  16. 16.

    Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obesity research. 1998;6 Suppl 2:51S–209S.

  17. 17.

    Poirier PP. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation (New York, NY). 2011;123(15):1683–701.

    Google Scholar 

  18. 18.

    Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Admiraal WM. Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care. 2012;35(9):1951–8.

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Admiraal WM, Bouter K, Celik F, et al. Ethnicity influences weight loss 1 year after bariatric surgery: a study in Turkish, Moroccan, South Asian, African and ethnic Dutch patients. Obes Surg. 2013;23(9):1497–500.

    CAS  PubMed  Google Scholar 

  21. 21.

    Anderson WA. Weight loss and health outcomes in African Americans and whites after gastric bypass surgery. Obesity (Silver Spring, Md). 2007;15(6):1455–63.

    Google Scholar 

  22. 22.

    Buffington CK. Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females. Obes Surg. 2006;16(2):159–65.

    PubMed  Google Scholar 

  23. 23.

    Capella RF, Capella JF. Ethnicity, type of obesity surgery and weight loss. Obes Surg. 1993;3(4):375–80.

    CAS  PubMed  Google Scholar 

  24. 24.

    Cheung LK, Lal LS, Chow DS, et al. Racial disparity in short-term outcomes after gastric bypass surgery. Obes Surg. 2013;23(12):2096–103.

    PubMed  Google Scholar 

  25. 25.

    Madan AK, Whitfield JD, Fain JN, et al. Are African–Americans as successful as Caucasians after laparoscopic gastric bypass? Obes Surg. 2007;17(4):460–4.

    PubMed  Google Scholar 

  26. 26.

    Buchwald H. Consensus conference statement. Surg Obes Relat Dis. 2005;1(3):371–81.

    PubMed  Google Scholar 

  27. 27.

    Lim KGA. Review of adult obesity research in Malaysia. Med J Malaysia. 2016;71(Suppl 1):1–19.

    CAS  PubMed  Google Scholar 

  28. 28.

    Kahn HS, Williamson DF, Stevens JA. Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health. 1991;81(3):319–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Kumanyika SK, Obarzanek E, Stevens VJ, et al. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53(6 Suppl):1631s–8S.

    CAS  PubMed  Google Scholar 

  30. 30.

    Wing RR. Effectiveness of a behavioral weight control program for blacks and whites with NIDDM. Diabetes Care. 1996;19(5):409–13.

    CAS  PubMed  Google Scholar 

  31. 31.

    Foster GD, Wadden TA, Swain RM, et al. Changes in resting energy expenditure after weight loss in obese African American and white women. Am J Clin Nutr. 1999;69(1):13–7.

    CAS  PubMed  Google Scholar 

  32. 32.

    Washburn RA. Leisure time physical activity: are there black/white differences? Prev Med. 1992;21(1):127–35.

    CAS  PubMed  Google Scholar 

  33. 33.

    Weinsier RL, Hunter GR, Zuckerman PA, et al. Energy expenditure and free-living physical activity in black and white women: comparison before and after weight loss. Am J Clin Nutr. 2000;71(5):1138–46.

    CAS  PubMed  Google Scholar 

  34. 34.

    Health Promotion Board S. Report of the National Nutrition Survey 2004. Available from: Accessed 20 Mar 2018.

  35. 35.

    Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull. 1989;105(2):260–75.

    CAS  PubMed  Google Scholar 

  36. 36.

    Ball K, Crawford D. Socioeconomic status and weight change in adults: a review. Social science & medicine (1982). 2005;60(9):1987–2010.

    Google Scholar 

  37. 37.

    Monteiro CA, Moura EC, Conde WL, et al. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004;82(12):940–6.

    PubMed  Google Scholar 

  38. 38.

    Zhang Q, Wang Y. Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000. Obes Res. 2004;12(10):1622–32.

    PubMed  Google Scholar 

  39. 39.

    Sundquist J, Johansson SE. The influence of socioeconomic status, ethnicity and lifestyle on body mass index in a longitudinal study. Int J Epidemiol. 1998;27(1):57–63.

    CAS  PubMed  Google Scholar 

  40. 40.

    Dryson E, Metcalf P, Baker J, et al. The relationship between body mass index and socioeconomic status in New Zealand: ethnic and occupational factors. N Z Med J. 1992;105(936):233–5.

    CAS  PubMed  Google Scholar 

  41. 41.

    Wang Y. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol. 2001;30(5):1129–36.

    CAS  PubMed  Google Scholar 

  42. 42.

    Singapore, Ministry of Community Development Y, Sports. Progress of the Malay community in Singapore since 1980. Singapore: Ministry of Community Development, Youth and Sports; 2007.

    Google Scholar 

  43. 43.

    Wong HZ, Lim WY, Ma SS, et al. Health screening behaviour among Singaporeans. Ann Acad Med Singap. 2015;44(9):326–34.

    PubMed  Google Scholar 

  44. 44.

    Bower JF, Deshaies Y, Pfeifer M, et al. Ethnic differences in postprandial triglyceride response to a fatty meal and lipoprotein lipase in lean and obese African American and Caucasian women. Metab Clin Exp. 2002;51(2):211–7.

    CAS  PubMed  Google Scholar 

  45. 45.

    Bower JF, Vadlamudi S, Barakat HA. Ethnic differences in in vitro glyceride synthesis in subcutaneous and omental adipose tissue. Am J Physiol Endocrinol Metab. 2002;283(5):E988–93.

    CAS  PubMed  Google Scholar 

  46. 46.

    Nicklas BJ, Dennis KE, Berman DM, et al. Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, African-American and Caucasian women. J Gerontol A Biol Sci Med Sci. 2003;58(2):181–9.

    PubMed  Google Scholar 

  47. 47.

    Nicklas BJ, Berman DM, Davis DC, et al. Racial differences in metabolic predictors of obesity among postmenopausal women. Obes Res. 1999;7(5):463–8.

    CAS  PubMed  Google Scholar 

  48. 48.

    Yoshiike N, Miyoshi M. Epidemiological aspects of overweight and obesity in Japan—international comparisons. Nihon Rinsho Jpn J Clin Med. 2013;71(2):207–16.

    Google Scholar 

  49. 49.

    Senauer B, Masahiko G. Why is the obesity rate so low in Japan and high in the U.S.? Some possible economic explanations. 2006.

  50. 50.

    Nishitani N, Sakakibara H, Akiyama I. Eating behavior related to obesity and job stress in male Japanese workers. Nutrition. 2009;25(1):45–50.

    PubMed  Google Scholar 

  51. 51.

    Otsuka R, Yatsuya H, Tamakoshi K, et al. Perceived psychological stress and serum leptin concentrations in Japanese men. Obesity. 2006;14(10):1832–8.

    CAS  PubMed  Google Scholar 

  52. 52.

    Hayashi F, Takimoto H, Yoshita K, et al. Perceived body size and desire for thinness of young Japanese women: a population-based survey. Br J Nutr. 2007;96(6):1154–62.

    Google Scholar 

  53. 53.

    Inoue M, Toyokawa S, Miyoshi Y, et al. Degree of agreement between weight perception and body mass index of Japanese workers: MY Health Up Study. J Occup Health. 2007;49(5):376–81.

    PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Zong Jie Koh.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interests.

Statement of Informed Consent

No formal consent was required as this was a retrospective study.

A Statement of Human and Animal Rights

This study has been approved by the Institutional Review Board of each institution and all procedures were conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Koh, Z.J., Tai, B.C., Kow, L. et al. Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy. OBES SURG 29, 1781–1788 (2019).

Download citation


  • Bariatric surgery
  • Asian ethnicity
  • Obesity
  • Sleeve gastrectomy
  • Weight loss outcomes