Skip to main content

Advertisement

Log in

The Effect of Loss of Excess Weight on the Metabolic Risk Factors after Bariatric Surgery in Morbidly and Super-Obese Patients

  • Published:
Obesity Surgery Aims and scope Submit manuscript

Background

Changes in metabolic risk factors such as dyslipidemia and hyperinsulinemia as well as levels of sex hormones and leptin were studied in morbidly obese (MO) and super-obese (SO) patients during excess weight loss (EWL), separately in males and females.

Methods

In this prospective clinical intervention study, 431 patients were included (361 females and 70 males). There were 217 patients with MO (BMI 40–49.9 kg/m2) and 214 patients with SO (BMI ≥50 kg/m2). All patients underwent restrictive bariatric operations. Metabolic parameters (lipids, insulin, leptin, hepatic transaminases, uric acid, and sex hormones) were measured before obesity surgery and at defined postoperative points of EWL (25%, 50%, 75% and 100%).

Results

Successful weight reduction of 25% EWL was achieved by 94% of patients at 2 months. With this moderate EWL, most of the patients already improved their risk profile considerably, including normalization of insulin levels. Additional EWL led to a further amelioration of risk profile in all patients, including normalization of triglyceride levels. Male MO and SO patients had a worse metabolic situation preoperatively and a greater benefit after weight loss. Even though SO patients did not lose as much excess weight as MO patients, they did profit comparably.

Conclusion

Bariatric surgery is a valuable tool not only to reduce excess weight in severely obese patients but also to improve the metabolic risk profile within a short time-frame. This benefit is most pronounced in high-risk males.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Flegal KM. Epidemiologic aspects of overweight and obesity in the United States. Physiol Behav 2005; 86: 599–602.

    Article  PubMed  CAS  Google Scholar 

  2. Wilson PW, D'Agostino RB, Sullivan L et al. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867–72.

    Article  PubMed  Google Scholar 

  3. Kim KS, Owen WL, Williams D et al. A comparison between BMI and Conicity index on predicting coronary heart disease: the Framingham Heart Study. Ann Epidemiol 2000;10: 424–31.

    Article  PubMed  CAS  Google Scholar 

  4. Mason EE, Tang S, Renquist KE et al. A decade of change in obesity surgery. National Bariatric Surgery Registry (NBSR) Contributors. Obes Surg 1997; 7: 189–97.

    Article  PubMed  CAS  Google Scholar 

  5. Busetto L. Visceral obesity and the metabolic syndrome: effects of weight loss. Nutr Metab Cardiovasc Dis 2001; 11: 195–204.

    PubMed  CAS  Google Scholar 

  6. Dixon JB, Dixon AF, O’Brien PE. Improvements in insulin sensitivity and beta-cell function (HOMA) with weight loss in the severely obese. Homeostatic model assessment. Diabet Med 2003; 20: 127–34.

    Article  PubMed  CAS  Google Scholar 

  7. Hanusch-Enserer U, Cauza E, Spak M et al. Improvement of insulin resistance and early atherosclerosis in patients after gastric banding. Obes Res 2004; 12: 284–291.

    PubMed  Google Scholar 

  8. Nedelnikova K, Svacina S, Haas T et al. Influence of metabolic state and diabetes on the outcome at the end of first year after gastric banding. Obes Surg 2000; 10: 372–5.

    Article  PubMed  CAS  Google Scholar 

  9. Ponce J, Haynes B, Paynter S et al. Effect of Lap-Bandinduced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg 2004; 14: 1335–42.

    Article  PubMed  Google Scholar 

  10. Pories WJ. Why Does the gastric bypass control ttype 2 diabetes mellitus? Obes Surg 1992; 2: 303–13.

    Article  PubMed  Google Scholar 

  11. Sjostrom CD, Lissner L, Wedel H et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 1999;7:477–484.

    PubMed  CAS  Google Scholar 

  12. Sjostrom L, Lindroos AK, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.

    Article  PubMed  Google Scholar 

  13. Wolf AM, Beisiegel U, Kortner B et al. Does gastric restriction surgery reduce the risks of metabolic diseases? Obes Surg 1998; 8: 9–13.

    Article  PubMed  CAS  Google Scholar 

  14. Wirth A. Reduction of body weight and co-morbidities by orlistat: The XXL – Primary Health Care Trial. Diabetes Obes Metab 2005; 7: 21–7.

    Article  PubMed  CAS  Google Scholar 

  15. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes 1992; 16: 397–415.

    CAS  Google Scholar 

  16. Mason EE, Doherty C, Maher JW et al. Super obesity and gastric reduction procedures. Gastroenterol Clin North Am 1987; 16: 495–502.

    PubMed  CAS  Google Scholar 

  17. MacLean LD, Rhode BM, Forse RA. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery 1990; 107: 20–7.

    PubMed  CAS  Google Scholar 

  18. Wolf AM, Buffington C, Beisiegel U. Comparison of metabolic risk factors between severely and very severely obese patients. Obesity 2006; 14: 2177–83.

    PubMed  Google Scholar 

  19. Melissas J, Christodoulakis M, Schoretsanitis G et al. Obesity-associated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs super obese individuals. Obes Surg 2001; 11: 475–81.

    Article  PubMed  CAS  Google Scholar 

  20. Bloomston M, Zervos EE, Camps MA et al. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg 1997; 7: 414–9.

    Article  PubMed  CAS  Google Scholar 

  21. Busetto L, Pisent C, Rinaldi D et al. Variation in lipid levels in morbidly obese patients operated with the LAP-BAND adjustable gastric banding system: effects of different levels of weight loss. Obes Surg 2000; 10: 569–77.

    Article  PubMed  CAS  Google Scholar 

  22. Gazzaruso C, Giordanetti S, La Manna A et al. Weight loss after Swedish Adjustable Gastric Banding: relationships to insulin resistance and metabolic syndrome. Obes Surg 2002; 12: 841–5.

    Article  PubMed  Google Scholar 

  23. Giusti V, Suter M, Heraief E et al. Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg 2004; 14: 239–45.

    Article  PubMed  CAS  Google Scholar 

  24. Guldstrand M, Ahren B, Adamson U. Improved beta-cell function after standardized weight reduction in severely obese subjects. Am J Physiol Endocrinol Metab 2003; 284: E557–E565.

    PubMed  CAS  Google Scholar 

  25. Guidelines for laparoscopic and open surgical treatment of morbid obesity. American Society for Bariatric Surgery. Obes Surg 2000; 10: 378–9.

    Google Scholar 

  26. Wenzel H. Definition, Klassifikation und Messung der Adipositas. In: Wechsler JG, ed. Adipositas - Ursachen und Therapie. Berlin Wien: Blackwall Wissenschaftsverlag 1998: 45–61.

    Google Scholar 

  27. Considine RV, Sinha MK, Heiman ML et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 1996; 334: 292–5.

    Article  PubMed  CAS  Google Scholar 

  28. Rosenbaum M, Nicolson M, Hirsch J et al. Effects of gender, body composition, and menopause on plasma concentrations of leptin. J Clin Endocrinol Metab 1996; 81: 3424–7.

    Article  PubMed  CAS  Google Scholar 

  29. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499–502.

    PubMed  CAS  Google Scholar 

  30. De Backer G, Ambrosioni E, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). Atherosclerosis 2004; 173: 381–91.

    PubMed  Google Scholar 

  31. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311: 158–61.

    PubMed  CAS  Google Scholar 

  32. Bjorntorp P. Regional patterns of fat distribution. Ann Intern Med 1985; 103: 994–95.

    PubMed  CAS  Google Scholar 

  33. Haciyanli M, Erkan N, Bora S et al. Vertical banded gastroplasty in the Aegean Region of Turkey. Obes Surg 2001; 11: 482–6.

    Article  PubMed  CAS  Google Scholar 

  34. Balsiger BM, Poggio JL, Mai J et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg 2000; 4: 598–605.

    Article  PubMed  CAS  Google Scholar 

  35. Brolin RE. Critical analysis of results: weight loss and quality of data. Am J Clin Nutr 1992; 55: 577S–581S.

    Google Scholar 

  36. Isles CG, Paterson JR. Identifying patients at risk for coronary heart disease: implications from trials of lipid-lowering drug therapy. QJM 2000; 93: 567–74.

    Article  PubMed  CAS  Google Scholar 

  37. Kannel WB. Lipids, diabetes, and coronary heart disease: insights from the Framingham Study. Am Heart J 1985; 110: 1100–7.

    Article  PubMed  CAS  Google Scholar 

  38. Luyckx FH, Scheen AJ, Desaive C et al. Effects of gastroplasty on body weight and related biological abnormalities in morbid obesity. Diabetes Metab 1998; 24: 355–61.

    PubMed  CAS  Google Scholar 

  39. Uzun H, Zengin K, Taskin M et al. Changes in leptin, plasminogen activator factor and oxidative stress in morbidly obese patients following open and laparoscopic Swedish adjustable gastric banding. Obes Surg 2004; 14: 659–65.

    Article  PubMed  Google Scholar 

  40. Corradini SG, Eramo A, Lubrano C et al. Comparison of changes in lipid profile after bilio-intestinal bypass and gastric banding in patients with morbid obesity. Obes Surg 2005; 15: 367–77.

    Article  PubMed  Google Scholar 

  41. Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res 2002; 10: 903–10.

    Article  PubMed  Google Scholar 

  42. Dolan K, Bryant R, Fielding G. Treating diabetes in the morbidly obese by laparoscopic gastric banding. Obes Surg 2003; 13: 439–43.

    Article  PubMed  Google Scholar 

  43. Closset J, Mehdi A, Barea M et al. Results of silastic ring vertical gastroplasty more than 6 years after surgery: analysis of a cohort of 214 patients. Obes Surg 2004; 14: 1233–6.

    Article  PubMed  CAS  Google Scholar 

  44. Wolf AM, Busch B, Kuhlmann HW et al. Histological changes in the liver of morbidly obese patients: correlation with metabolic parameters. Obes Surg 2005; 15: 228–37.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anna Maria Wolf MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wolf, A.M., Beisiegel, U. The Effect of Loss of Excess Weight on the Metabolic Risk Factors after Bariatric Surgery in Morbidly and Super-Obese Patients. OBES SURG 17, 910–919 (2007). https://doi.org/10.1007/s11695-007-9169-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9169-0

Key words

Navigation