Skip to main content
SpringerLink
Log in

Laparoscopic Sleeve Gastrectomy Compared to a Multidisciplinary Weight Loss Program for Obesity—Effects on Body Composition and Protein Status

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Optimal obesity therapy is a matter of debate. Besides weight reduction, other criteria such as safety and nutritional status are of relevance. Therefore, we compared a favored surgical intervention with the most effective conservative treatment regarding anthropometry and nutritional status.

Methods

Fifty-four obese patients were included who underwent laparoscopic sleeve gastrectomy (LSG, n = 27) or a 52-week multidisciplinary intervention program (MIP, n = 27) for weight loss. Body weight, body composition assessed by bioelectrical impedance analysis, and serum protein levels were measured before and within 12 months after intervention.

Results

After 1 year of observation, excess weight loss was more pronounced following LSG (65 %) compared to MIP (38 %, p < 0.001). In both groups, body fat was clearly reduced, but a higher reduction occurred in the LSG group. However, protein status deteriorated particularly in the LSG group. Within 1 year, body cell mass declined from 37.1 to 26.9 kg in the LSG group, but only from 35.7 to 32.2 kg in the MIP group. This resulted in an increased mean extracellular mass/body cell mass ratio (1.42 versus 1.00, p < 0.001), in a decreased mean phase angle (4.4° versus 6.6°, p < 0.001), and in a lower prealbumin level in serum (p < 0.02) in the LSG group compared to the MIP group.

Conclusions

LSG, compared to MIP, was more effective regarding excess weight loss and body fat loss within 1 year, however, induced more pronounced muscle mass and protein loss, possibly requiring particular interventions such as exercise or protein supplements.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11. PMID: 19885707.

    Article  PubMed  Google Scholar 

  2. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    Article  PubMed  Google Scholar 

  3. Sjöström L, Lindroos A, 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 

  4. Strain GW, Gagner M, Pomp A, et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009;5:582–7. PMID: 19560983.

    Article  PubMed  Google Scholar 

  5. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37. PMID: 15479938.

    Article  PubMed  CAS  Google Scholar 

  6. Appel LJ, Clark JM, Yeh H, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365:1959–68.

    Article  PubMed  CAS  Google Scholar 

  7. Ryan DH, Johnson WD, Myers VH, et al. Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study. Arch Intern Med. 2010;170:146–54.

    Article  PubMed  CAS  Google Scholar 

  8. Bischoff SC, Damms-Machado A, Betz C, et al. Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life—a prospective study. Int J Obes (Lond). 2012;36:614–24. PMID: 21673653.

    Article  CAS  Google Scholar 

  9. Leonetti F, Capoccia D, Coccia F, et al. Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment. Arch Surg. 2012;147:694–700. PMID: 22508671.

    Article  PubMed  CAS  Google Scholar 

  10. Mingrone G, Panunzi S, de Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.

    Article  PubMed  CAS  Google Scholar 

  11. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76. PMID: 22449319.

    Article  PubMed  CAS  Google Scholar 

  12. Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23. PMID: 18212316.

    Article  PubMed  CAS  Google Scholar 

  13. Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83:897–907. PMID: 18674474.

    PubMed  Google Scholar 

  14. Faria SL, Faria OP, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21:1798–805. PMID: 21590346.

    Article  PubMed  Google Scholar 

  15. Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:881–9. PMID: 22403000.

    Article  PubMed  Google Scholar 

  16. Faintuch J, Matsuda M, Cruz MELF, et al. Severe protein–calorie malnutrition after bariatric procedures. Obes Surg. 2004;14:175–81. PMID: 15018745.

    Article  PubMed  Google Scholar 

  17. Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54. PMID: 15802055.

    Article  PubMed  Google Scholar 

  18. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219–25. PMID: 16617238.

    Article  PubMed  Google Scholar 

  19. Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56. PMID: 22525731.

    Article  PubMed  CAS  Google Scholar 

  20. Kellum JM, Chikunguwo SM, Maher JW, et al. Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients. Surg Obes Relat Dis. 2011;7:189–93. PMID: 21145293.

    Article  PubMed  Google Scholar 

  21. Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5. PMID: 18368447.

    Article  PubMed  Google Scholar 

  22. Runkel N, Colombo-Benkmann M, Hüttl TP, et al. Bariatric surgery. Dtsch Arztebl Int. 2011;108:341–6. PMID: 21655459.

    PubMed  Google Scholar 

  23. Dörhöfer R, Pirlich M. Das BIA Kompendium. Data Input GmbH, Germany. 2007. Available from: http://www.data-input.de/_site/_data/pdf/komp_d_all.pdf. Accessed 15 Jan 2013

  24. Wang J, Zhang Y, Chen H, et al. Comparison of two bioelectrical impedance analysis devices with dual energy X-ray absorptiometry and magnetic resonance imaging in the estimation of body composition. J Strength Cond Res. 2013;27:236–43. PMID: 22344056.

    Article  PubMed  Google Scholar 

  25. Jiménez A, Omaña W, Flores L, et al. Prediction of whole-body and segmental body composition by bioelectrical impedance in morbidly obese subjects. Obes Surg. 2012;22:587–93. PMID: 22506280.

    Article  PubMed  Google Scholar 

  26. Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. Ann Nutr Metab. 2012;60:6–16. PMID: 22179189.

    Article  PubMed  CAS  Google Scholar 

  27. Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr. 2012;32:294–9. PMID: 22921419.

    Article  PubMed  Google Scholar 

  28. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.

    Article  PubMed  CAS  Google Scholar 

  29. Bray GA, Smith SR, Banerji MA, Tripathy D, Clement SC, Buchanan TA, Henry RR, Kitabchi AE, Mudaliar S, Musi N, Ratner RE, Schwenke DC, Stentz FB, Reaven PD, DeFronzo RA. Effect of pioglitazone on body composition and bone density in subjects with prediabetes in the ACT NOW trial. Diabetes Obes Metab. 2013. doi:10.1111/dom.12099

  30. Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71. PMID: 22438219.

    Article  PubMed  Google Scholar 

  31. Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–7. PMID: 20379795.

    Article  PubMed  Google Scholar 

  32. Aggarwal S, Kini SU, Herron DM. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94. PMID: 17386400.

    Article  PubMed  Google Scholar 

  33. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.

    Article  PubMed  CAS  Google Scholar 

  34. Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12:662–7. PMID: 18264685.

    Article  PubMed  CAS  Google Scholar 

  35. Du H, Feskens E. Dietary determinants of obesity. Acta Cardiol. 2010;65:377–86. PMID: 20821929.

    PubMed  Google Scholar 

  36. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297:969–77. PMID: 17341711.

    Article  PubMed  CAS  Google Scholar 

  37. Vatier C, Henegar C, Ciangura C, et al. Dynamic relations between sedentary behavior, physical activity, and body composition after bariatric surgery. Obes Surg. 2012;22:1251–6. PMID: 22351039.

    Article  PubMed  Google Scholar 

  38. Andreu A, Moizé V, Rodríguez L, et al. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg. 2010;20:1509–15. PMID: 20820937.

    Article  PubMed  Google Scholar 

  39. de Aquino LA, Pereira SE, de Souza Silva J, et al. Bariatric surgery: impact on body composition after Roux-en-Y gastric bypass. Obes Surg. 2012;22:195–200. PMID: 21881836.

    Article  PubMed  Google Scholar 

  40. Di Renzo L, Carbonelli MG, Bianchi A, et al. Body composition changes after laparoscopic adjustable gastric banding: what is the role of -174GC interleukin-6 promoter gene polymorphism in the therapeutic strategy? Int J Obes (Lond). 2012;36:369–78. PMID: 21730965.

    Article  Google Scholar 

  41. Madan AK, Kuykendall S, Orth WS, et al. Does laparoscopic gastric bypass result in a healthier body composition? An affirmative answer. Obes Surg. 2006;16:465–8. PMID: 16608612.

    Article  PubMed  Google Scholar 

  42. Dixon JB, Strauss BJG, Laurie C, et al. Changes in body composition with weight loss: obese subjects randomized to surgical and medical programs. Obesity (Silver Spring). 2007;15:1187–98. PMID: 17495195.

    Article  Google Scholar 

  43. Aarts EO, Janssen IMC, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21:207–11. PMID: 21088925.

    Article  PubMed  Google Scholar 

  44. Leivonen MK, Juuti A, Jaser N, et al. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up. Obes Surg. 2011;21:1180–7. PMID: 21625908.

    Article  PubMed  Google Scholar 

  45. Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110:600–7. PMID: 20338286.

    Article  PubMed  Google Scholar 

  46. DeLegge MH, Drake LM. Nutritional assessment. Gastroenterol Clin North Am. 2007;36:1–22. PMID: 17472872.

    Article  PubMed  Google Scholar 

  47. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a “food limiting” operation. Obes Surg. 2008;18:1251–6. PMID: 18663545.

    Article  PubMed  Google Scholar 

  48. Braghetto I, Davanzo C, Korn O, et al. Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009;19:1515–21. PMID: 19714384.

    Article  PubMed  Google Scholar 

  49. Keller U. Dietary proteins in obesity and in diabetes. Int J Vitam Nutr Res. 2011;81:125–33. PMID: 22139563.

    Article  PubMed  CAS  Google Scholar 

  50. Josse AR, Atkinson SA, Tarnopolsky MA, et al. Increased consumption of dairy foods and protein during diet- and exercise-induced weight loss promotes fat mass loss and lean mass gain in overweight and obese premenopausal women. J Nutr. 2011;141:1626–34. PMID: 21775530.

    Article  PubMed  CAS  Google Scholar 

  51. Frimel TN, Sinacore DR, Villareal DT. Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Med Sci Sports Exerc. 2008;40:1213–9. PMID: 18580399.

    Article  PubMed  Google Scholar 

  52. Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95:4823–43. PMID: 21051578.

    Article  PubMed  CAS  Google Scholar 

  53. Rinaldi Schinkel E, Pettine SM, Adams E, et al. Impact of varying levels of protein intake on protein status indicators after gastric bypass in patients with multiple complications requiring nutritional support. Obes Surg. 2006;16:24–30. PMID: 16417753.

    Article  PubMed  Google Scholar 

  54. Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13:23–8. PMID: 12630609.

    Article  PubMed  Google Scholar 

  55. Bavaresco M, Paganini S, Lima TP, et al. Nutritional course of patients submitted to bariatric surgery. Obes Surg. 2010;20:716–21. PMID: 18931884.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the “Competence Network of Obesity,” research group “Obesity and the gastrointestinal tract,” coordinated by SCB and funded by the Federal Ministry of Education and Research, Germany (No. FKZ 01GI0843).

Conflict of interest

All authors declare no conflict of interest; they are all independent from the funding institutions. The authors are part of the Competence network of obesity, which is primarily funded by a research grant of the Federal Ministry of Education and Research, Germany. Within this network, the authors are funded in part by Covidien Germany GmbH, by Johnson & Johnson, Ethicon Endo-Surgery GmbH, Germany, and by Nestlé Inc., Germany. The sponsors had no influence in study design, analysis, and interpretation of data, as well as in the writing of the manuscript. No other relationships or activities exist that could appear to have influenced the submitted work.

Author information

Authors and Affiliations

  1. Department of Nutritional Medicine, University of Hohenheim, Fruwirthstraße 12, 70593, Stuttgart, Germany

    Asja E. Friedrich, Antje Damms-Machado, Nicole Scheuing, Katrin Stingel, Maryam Basrai & Stephan C. Bischoff

  2. Department of General, Visceral and Transplant Surgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Tobias Meile, Markus A. Küper & Alfred Königsrainer

  3. Department of General and Visceral Surgery, Chirurgische Klinik Muenchen-Bogenhausen, Denninger Straße 44, 81679, Munich, Germany

    Klaus M. Kramer

Authors
  1. Asja E. Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antje Damms-Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tobias Meile
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicole Scheuing
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katrin Stingel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maryam Basrai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markus A. Küper
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Klaus M. Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alfred Königsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephan C. Bischoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan C. Bischoff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Friedrich, A.E., Damms-Machado, A., Meile, T. et al. Laparoscopic Sleeve Gastrectomy Compared to a Multidisciplinary Weight Loss Program for Obesity—Effects on Body Composition and Protein Status. OBES SURG 23, 1957–1965 (2013). https://doi.org/10.1007/s11695-013-1036-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-1036-6

Keywords

Search

Navigation