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Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients

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Abstract

Background

Following bariatric surgery, accurate charting of weight loss and regain is crucial. Various preoperative factors affect postoperative weight loss, including age, sex, ethnicity, and surgical type. These are not considered by current weight loss metrics, limiting comparison of weight loss outcomes between patients or centers and across time.

Methods

Patients (n=1022) who underwent sleeve gastrectomy (n=809) and gastric bypass (n=213) from 2008 to 2020 in a single center were reviewed. Weight loss outcomes (% total weight loss) were measured for 60 months postoperatively. Longitudinal centile lines were plotted using the post-estimation predictions of quantile regression models, adjusted for type of procedure, sex, ethnicity, and baseline BMI.

Results

Median regression showed that %TWL was 1.0% greater among males than females (β = +1.1, 95% CI: +0.6 to +1.7, P = <0.0001). Participants who underwent SG had less %TWL compared to GB (β = -1.3, 95% CI: -1.9 to -0.8, P < 0.0001). There was a trend towards less %TWL among the Indian and Malay participants compared to Chinese. Age and diabetes were not significant predictors. Reference centile charts were produced for the overall cohort, as well as specific charts adjusted for type of bariatric procedure, sex, ethnicity, and baseline BMI.

Conclusion

Centile charts provide a clinically relevant method for monitoring of weight trajectories postoperatively and aid in realistic and personalised goal setting, and the early identification of “poor responders”. This is the first study to present post-bariatric surgery centile charts for an Asian cohort.

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References

  1. National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med. 2000;160(7):898. https://doi.org/10.1001/archinte.160.7.898.

    Article  Google Scholar 

  2. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. https://doi.org/10.1111/joim.12012.

    Article  PubMed  Google Scholar 

  3. Lee PC, Tham KW, Ganguly S, et al. Ethnicity does not influence glycemic outcomes or diabetes remission after sleeve gastrectomy or gastric bypass in a multiethnic Asian cohort. Obes Surg. 2018;28(6):1511–8. https://doi.org/10.1007/s11695-017-3050-6.

    Article  PubMed  Google Scholar 

  4. Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021;397(10287):1830–41. https://doi.org/10.1016/S0140-6736(21)00591-2.

    Article  PubMed  Google Scholar 

  5. Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev. 2018;39(2):79–132. https://doi.org/10.1210/er.2017-00253.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hatoum IJ, Stein HK, Merrifield BF, et al. Capacity for physical activity predicts weight loss after roux-en-y gastric bypass. Obesity. 2009;17(1):92–9. https://doi.org/10.1038/oby.2008.507.

    Article  PubMed  Google Scholar 

  7. Contreras JE, Santander C, Court I, et al. Correlation between age and weight loss after bariatric surgery. Obes Surg. 2013;23(8):1286–9. https://doi.org/10.1007/s11695-013-0905-3.

    Article  PubMed  Google Scholar 

  8. Perrone F, Bianciardi E, Benavoli D, et al. Gender influence on long-term weight loss and comorbidities after laparoscopic sleeve gastrectomy and roux-en-y gastric bypass: a prospective study with a 5-year follow-up. Obes Surg. 2016;26(2):276–81. https://doi.org/10.1007/s11695-015-1746-z.

    Article  PubMed  Google Scholar 

  9. Lager CJ, Esfandiari NH, Subauste AR, et al. roux-en-y gastric bypass vs. sleeve gastrectomy: balancing the risks of surgery with the benefits of weight loss. Obes Surg. 2017;27(1):154–61. https://doi.org/10.1007/s11695-016-2265-2.

    Article  PubMed  Google Scholar 

  10. Li J-F, Lai D-D, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg. 2013;56(6):E158–64. https://doi.org/10.1503/cjs.026912.

    Article  PubMed  PubMed Central  Google Scholar 

  11. van de Laar AW, Nienhuijs SW, Apers JA, et al. The Dutch bariatric weight loss chart: A multicenter tool to assess weight outcome up to 7 years after sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2019;15(2):200–10. https://doi.org/10.1016/j.soard.2018.11.024.

    Article  PubMed  Google Scholar 

  12. Manning S, Pucci A, Carter NC, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1484–91. https://doi.org/10.1007/s00464-014-3829-7.

    Article  PubMed  Google Scholar 

  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. https://doi.org/10.1016/S0140-6736(03)15268-3.

  14. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. https://doi.org/10.2337/dc16-0236.

    Article  PubMed  CAS  Google Scholar 

  15. Coleman KJ, Huang Y-C, Hendee F, et al. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10(3):396–403. https://doi.org/10.1016/j.soard.2014.02.044.

    Article  PubMed  Google Scholar 

  16. Bray GA, Bouchard C, Church TS, et al. Is it time to change the way we report and discuss weight loss? Obesity. 2009;17(4):619–21. https://doi.org/10.1038/oby.2008.597.

    Article  PubMed  Google Scholar 

  17. Lee YS, Biddle S, Chan MF, et al. Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity. Singapore Med J. 2016;57(6):292–300. https://doi.org/10.11622/smedj.2016103. 

  18. Lim CH, Lee PC, Lim E, et al. Correlation between symptomatic Gastro-Esophageal Reflux Disease (GERD) and Erosive Esophagitis (EE) Post-vertical sleeve gastrectomy (VSG). Obes Surg. 2019;29(1):207–14. https://doi.org/10.1007/s11695-018-3509-0.

    Article  PubMed  Google Scholar 

  19. Lim CH, Jahansouz C, Abraham AA, et al. The future of the Roux-en-Y gastric bypass. Expert Rev Gastroenterol Hepatol. 2016;10(7):777–84. https://doi.org/10.1586/17474124.2016.1169921.

    Article  PubMed  CAS  Google Scholar 

  20. Chew CAZ, Tan IJ-W, Ng HJH, et al. Early weight loss after laparoscopic sleeve gastrectomy predicts midterm weight loss in morbidly obese Asians. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(12):1966–72. https://doi.org/10.1016/j.soard.2017.05.016.

    Article  Google Scholar 

  21. Lee PC, Dixon JB, Sim PY, et al. Treatment options for poor responders to bariatric surgery. Curr Obes Rep. 2020;9(3):364–72. https://doi.org/10.1007/s13679-020-00381-2.

    Article  PubMed  Google Scholar 

  22. Ogden J, Clementi C, Aylwin S. The impact of obesity surgery and the paradox of control: A qualitative study. Psychol Health. 2006;21(2):273–93. https://doi.org/10.1080/14768320500129064.

    Article  PubMed  Google Scholar 

  23. Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic roux-en-y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg. 2014;24(10):1617–24. https://doi.org/10.1007/s11695-014-1258-2.

    Article  PubMed  Google Scholar 

  24. Ng J, Seip R, Stone A, et al. Ethnic variation in weight loss, but not co-morbidity remission, after laparoscopic gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(1):94–100. https://doi.org/10.1016/j.soard.2014.07.013.

    Article  PubMed  Google Scholar 

  25. Wee CC, Jones DB, Apovian C, et al. Weight loss after bariatric surgery: do clinical and behavioral factors explain racial differences? Obes Surg. 2017;27(11):2873–84. https://doi.org/10.1007/s11695-017-2701-y.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Koh ZJ, Tai BC, Kow L, et al. Influence of Asian ethnicities on short- and mid-term outcomes following laparoscopic sleeve gastrectomy. Obes Surg. 2019;29(6):1781–8. https://doi.org/10.1007/s11695-019-03716-8.

    Article  PubMed  Google Scholar 

  27. Campos GM. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143(9):877–883; discussion 884. https://doi.org/10.1001/archsurg.143.9.877.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Luo Y, Eldin AWJ, Haddad R, et al. MON-590 presence of diabetes diminishes the ultimate weight loss after bariatric surgery. J Endocr Soc. 2020;4(Supplement_1):MON-590. https://doi.org/10.1210/jendso/bvaa046.813.

  29. Cazzo E, da Silva FP, Pareja JC, et al. Predictors for weight loss failure following roux-en-y gastric bypass. Arq Gastroenterol. 2014;51(4):328–30. https://doi.org/10.1590/S0004-28032014000400011.

    Article  PubMed  Google Scholar 

  30. Wei Y, Pere A, Koenker R, et al. Quantile regression methods for reference growth charts. Stat Med. 2006;25(8):1369–82. https://doi.org/10.1002/sim.2271.

    Article  PubMed  Google Scholar 

  31. Kiserud T, Piaggio G, Carroli G, et al. The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med. 2017;14(1):e1002220. https://doi.org/10.1371/journal.pmed.1002220

  32. Kiserud T, Benachi A, Hecher K, et al. The World Health Organization fetal growth charts: concept, findings, interpretation, and application. Am J Obstet Gynecol. 2018;218(2):S619–29. https://doi.org/10.1016/j.ajog.2017.12.010.

    Article  PubMed  Google Scholar 

  33. Stifel DC, Averett SL. Childhood overweight in the United States: A quantile regression approach. Econ Hum Biol. 2009;7(3):387–97. https://doi.org/10.1016/j.ehb.2009.05.005.

    Article  PubMed  Google Scholar 

  34. Ochner CN, Jochner MCE, Caruso EA, et al. Effect of preoperative body mass index on weight loss after obesity surgery. Surg Obes Relat Dis. 2013;9(3):423–7. https://doi.org/10.1016/j.soard.2012.12.009.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Author notes

  1. Sarah Ying Tse Tan, Nicholas L. Syn, and Lin J. Daryl contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Sarah Ying Tse Tan, Sonali Ganguly & Phong Ching Lee

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Nicholas L. Syn & Daryl J. Lin

  3. Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore

    Chin Hong Lim, Hock Soo Ong & Jeremy Tian Hui Tan

  4. Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore

    Chin Hong Lim, Sonali Ganguly, Jeremy Tian Hui Tan & Phong Ching Lee

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  1. Sarah Ying Tse Tan
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Contributions

Concept and design: NL Syn, PC Lee, CH Lim

Acquisition, analysis, or interpretation of data: NL Syn, SYT Tan, D Lin, PC Lee, S Ganguly, CH Lim

Interpretation of data: NL Syn, SYT Tan, D Lin, PC Lee, S Ganguly, CH Lim

Drafting of the manuscript: NL Syn, SYT Tan, D Lin, PC Lee, S Ganguly, CH Lim

Critical revision of the manuscript for important intellectual content: NL Syn, SYT Tan, D Lin, PC Lee, S Ganguly, Ong HS, J Tan, CH Lim

Study supervision: NL Syn, SYT Tan, D Lin, PC Lee, CH Lim

Corresponding author

Correspondence to Phong Ching Lee.

Ethics declarations

Ethics Approval and Consent to Participate

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.

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

Conflict of Interest

The authors declare no competing interests.

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Key Points

• Centile charts provide a clinically relevant method to monitor weight trajectories after bariatric surgery

• The use of procedure, sex, ethnicity and BMI-specific charts allow more accurate monitoring and personalised goal-setting

• Following validation, these charts can be used in both clinical and research settings

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Tan, S.Y.T., Syn, N.L., Lin, D.J. et al. Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients. OBES SURG 31, 4781–4789 (2021). https://doi.org/10.1007/s11695-021-05618-0

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  • DOI: https://doi.org/10.1007/s11695-021-05618-0

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