Abstract
Introduction
Sub-optimal weight loss following Roux-en-Y gastric bypass (RYGB) represents an important clinical challenge in a significant number of patients. Early identification of such patients would be advantageous, as it could aid in the selective implementation of targeted adjunct interventions during the first post-operative year.
Methods
Clinical audit data from 1137 patients undergoing RYGB between 2013 and 2016 at the Instituto Sallet in Brazil were prospectively registered in an online database (BOLD) and analyzed.
Results
Forty-eight percent of patients achieving less than 5% total weight loss after the first post-operative month achieved a 20% total weight loss at 1 year (n = 626; OR = 0.6 CI = 95%). Eighty-three percent of patients losing between 5 and 10% at 1 month and 95% of patients losing greater than 10% at 1 month had lost at least 20% of total body weight after the first post-operative year. Forty-four percent of patients achieving less than 10% total weight loss after the third post-operative month achieved 20% total weight loss at 1 year (n = 494; OR = 0.3 CI = 95%).
Conclusion
Total bodyweight reduction after RYGB of < 5% at 1 month and < 10% at 3 months is associated with suboptimal weight loss at 1 year. These results reinforce findings from other studies reporting that patients tend to follow a common weight loss trajectory. Identifying the patients with weight trajectory requiring adjunct therapies early on is crucial so appropriate adjustments can be made to post-operative care.
Similar content being viewed by others
References
Courcoulas A, King W, Belle S, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153(5):427–34.
Mor A, Sharp L, Portenier D, et al. Weight loss at first postoperative visit predicts long-term outcome of Roux-en-Y gastric bypass using Duke weight loss surgery chart. Surg Obes Relat Dis. 2012;8(5):556–60. Available from:. https://doi.org/10.1016/j.soard.2012.06.014.
Shukla A, He D, Saunders K, et al. Current concepts in management of weight regain following bariatric surgery. Expert Rev Endocrinol Metab. 2018;13(2):67–76.
Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89.
Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75. https://doi.org/10.1001/archinternmed.2010.334.
Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE maintenance randomized study. Int J Obes. 2013;37:1443–51.
Wise E, Felton J, Kligman M. Exponential decay modeling can define parameters of weight loss trajectory after laparoscopic Roux-en-Y gastric bypass. Am J Surg. 2018;216:120–3.
Welch G, Wesolowski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: finding from a support group survey. Obes Surg. 2008;18:517–24.
Van de Laar AWJM, Acherman YIZ. Weight loss percentile charts of large representative series: a benchmark defining sufficient weight loss challenging current criteria for success of bariatric surgery. Obes Surg. 2014, 24:727–34. Available from:. https://doi.org/10.1007/s11695-013-1130-9.
Hindle A, de la Piedad Garcia X, Brennan L. Early postoperative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev. 2017;18:317–34.
Manning S, Pucci A, Carter N, et al. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29:1484–91.
McNickle AG, Bonomo SR. Predictability of first-year weight loss in laparoscopic sleeve gastrectomy. Surg Endosc. 2017;31:4145–9. Available from:. https://doi.org/10.1007/s00464-017-5467-3.
Wharton S, Kuk JL, Luszczynski M, et al. Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery. Clin Obes. 2019;9:e12323. Available from:. https://doi.org/10.1111/cob.12323.
Istfan NW, Anderson WA, Hess DT, et al. The mitigating effect of phentermine and topiramate on weight regain after Roux-en-Y gastric bypass surgery [Internet]. Obesity. 2020:1023–30. Available from:. https://doi.org/10.1002/oby.22786.
Belligoli A, Bettini S, Segato G, et al. Predicting responses to bariatric and metabolic surgery. Curr Obes Rep. 2020; Available from:. https://doi.org/10.1007/s13679-020-00390-1.
Funding
No funding was allocated for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
CWlR is supported by a Science Foundation Ireland grant (ref 11/YI/B2480) and Health Research Board grant (USIRL-2016-2). The other authors declare no competing interests.
Ethical Approval
All procedures performed in this study 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
For this type of study, formal consent is not required.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Silveira, F.C., Docherty, N., Sallet, P.C. et al. Early Post-operative Weight Change After Roux-en-Y Gastric Bypass Predicts Weight Loss at 12-Month Follow-up. OBES SURG 30, 5020–5025 (2020). https://doi.org/10.1007/s11695-020-04942-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-020-04942-1