Excess Body Weight Loss is Associated with Nonpathological Gait Patterns in Women 4 to 5 Years After Bariatric Surgery

Background

This study examined relationships between excess body weight (EBW) loss and current gait and functional status in women 5 years after Roux-en-Y gastric bypass surgery.

Methods

Gait data were analyzed in nine female bariatric patients for relationships with longitudinal changes in weight, body composition, and physical function assessed by the Short Musculoskeletal Functional Assessment (SMFA) questionnaire and the timed “get-up-and-go” (TGUG) test. Gait characteristics in the bariatric sample were also compared to an age- and BMI-matched nonsurgical reference sample from the Fels Longitudinal Study.

Results

Bariatric patients lost an average of 36.4 kg (61.1 %) of EBW between preoperative and 5-year follow-up visits (P?<?0.01); SMFA function index scores and TGUG times also decreased (both P?<?0.01). Degree of EBW loss was correlated with less time spent in initial double support and more time in single support (both P?=?0.02), and for all gait variables, the bariatric sample fell within the 95 % confidence intervals of gait/EBW relationships in the reference sample.

Conclusions

Gait and function 5 years after bariatric surgery were characteristic of current weight, not preoperative obesity, suggesting that substantial, sustained recovery of physical function is possible with rapid surgical weight loss.     

Weight Loss and Comorbidity Resolution 3 Years After Bariatric Surgery—an Indian Perspective

Introduction

Bariatric surgery has seen a sharp rise in India in the last decade. India is one of the 10 most obese nations of the world, ranking second in number of type 2 diabetics.

Aims

To evaluate clinical outcomes of bariatric surgery after 3 years of follow-up in terms of weight loss, co-morbidity resolution, complaints of gastroesophageal reflux disease and weight regain.

Methodology

All patients who underwent bariatric surgery from January to December 2013 with a minimum follow-up of 3 years were included in the study. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.

Results

One hundred seventy-eight patients (157 lap. sleeve gastrectomy and 21 patients lap. RYGB) completed 3 years of follow-up. In the LSG group, patients had a pre-operative BMI 44.8?±?8.33 kg/sq. m (mean ± S.D.) and excess body weight 52.3?±?23.0 kg. In the RYGB group, pre-operative BMI was 42.7?±?8.82 kg/sq. m and excess body weight 45?±?18.7 kg. In the LSG group, % excess weight loss (EWL) at 1 year was 87.6?±?24.4% and 3 years was 71.8?±?26.7%. In the RYGB group, % EWL at 1 year was 97.2?±?27.3% and at 3 years was 85.8?±?25.3%. Diabetes resolution was seen in 32 (80%) in LSG group and 11 (91.7%) in RYGB group (Figs. 1, 2, 3, and 4).

Conclusion

Our study reflects that there is no statistically significant difference between outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass surgery in terms of weight loss and diabetes resolution at 3 years.

     

Bariatric Surgery Patients Exhibit Improved Memory Function 12 Months Postoperatively

Background

Previous work from our group demonstrated improved memory function in bariatric surgery patients at 12 weeks postoperatively relative to controls. However, no study has examined longer-term changes in cognitive functioning following bariatric surgery.

Methods

A total of 137 individuals (95 bariatric surgery patients and 42 obese controls) were followed prospectively to determine whether postsurgery cognitive improvements persist. Potential mechanisms of change were also examined. Bariatric surgery participants completed self-report measurements and a computerized cognitive test battery prior to surgery and at 12-week and 12-month follow-up; obese controls completed measures at equivalent time points.

Results

Bariatric surgery patients exhibited cognitive deficits relative to well-established standardized normative data prior to surgery, and obese controls demonstrated similar deficits. Analyses of longitudinal change indicated an interactive effect on memory indices, with bariatric surgery patients demonstrating better performance postoperatively than obese controls.

Conclusions

While memory performance was improved 12 months postbariatric surgery, the mechanisms underlying these improvements were unclear and did not appear attributable to obvious postsurgical changes, such as reductions in body mass index or comorbid medical conditions. Future studies employing neuroimaging, metabolic biomarkers, and more precise physiological measurements are needed to determine the mechanisms underlying memory improvements following bariatric surgery.     

Long-Term Effects of Bariatric Surgery on Meal Disposal and β-Cell Function in Diabetic and Nondiabetic Patients

Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (∼30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21 nonsurgical obese and lean controls). Endogenous glucose production, however, was less suppressed during the MMT as the combined result of a relative hyperglucagonemia and the rapid fall in plasma glucose and insulin levels. We conclude that in T2D, bypass surgery changes the postprandial response to a dumping-like pattern and improves glucose tolerance, β-cell function, and peripheral insulin sensitivity but worsens endogenous glucose output in response to a physiological stimulus.Mounting evidence supports bariatric surgery as a powerful intervention to induce remission in patients with type 2 diabetes (T2D) (1,2) and to prevent or delay incident T2D (3). This has engendered enthusiasm for bariatric surgery as a treatment for T2D (4) and has encouraged a broadening of the BMI range as an indication for surgery in diabetic patients (5).Although weight loss and, in the early postoperative period, caloric deficit certainly make a contribution to improve glucose tolerance, surgery itself may trigger weight-independent mechanisms eventually translating into favorable metabolic effects. This postulate is based on early animal studies (6) and, in humans, on evidence that metabolic changes sometimes precede sizeable weight loss or are disproportionate to the amount of weight lost (7). In this regard, there is evidence that different bariatric procedures (e.g., Roux-en-Y gastric bypass [RYGB], biliopancreatic diversion, and sleeve gastrectomy) may engage putative weight-independent mechanisms to different extents or involve altogether different mechanisms (8,9).A number of previous studies have documented the effects of the most popular bariatric operation, RYGB, on glycemic control and incretin hormones (10–24), and mechanistic studies have explored the ability of RYGB to enhance insulin action and β-cell function. The great majority of these studies have used methods based on fasting measurements (e.g., homeostasis model assessments), oral glucose tolerance test–based surrogate indices of insulin sensitivity and β-cell function, or euglycemic-hyperinsulinemic clamp settings (14,16–21). A recent study (24) has taken a more physiological approach by comparing the impact of RYGB and gastric banding on the disposition of a mixed meal, with the use of a double-tracer technique, in nondiabetic (ND) subjects studied before and shortly after the operation (∼20 weeks). In the current study of morbidly obese patients with T2D, we aimed at measuring the impact of RYGB on chief physiologic determinants of meal disposal long after surgery (when body weight and metabolic adaptation have stabilized) and assessing their relation to weight loss and the attendant changes in the hormonal milieu.     

A Predictive Model of Weight Loss After Roux-en-Y Gastric Bypass up to 5 Years After Surgery: a Useful Tool to Select and Manage Candidates to Bariatric Surgery

Introduction

Different factors, such as age, gender, preoperative weight but also the patient’s motivation, are known to impact outcomes after Roux-en-Y gastric bypass (RYGBP). Weight loss prediction is helpful to define realistic expectations and maintain motivation during follow-up, but also to select good candidates for surgery and limit failures. Therefore, developing a realistic predictive tool appears interesting.

Patients/Methods

A Swiss cohort (n?=?444), who underwent RYGBP, was used, with multiple linear regression models, to predict weight loss up to 60 months after surgery considering age, height, gender and weight at baseline. We then applied our model on two French cohorts and compared predicted weight to the one finally reached. Accuracy of our model was controlled using root mean square error (RMSE).

Results

Mean weight loss was 43.6?±?13.0 and 40.8?±?15.4 kg at 12 and 60 months respectively. The model was reliable to predict weight loss (0.37?<?R²?<?0.48) and RMSE between 5.0 and 12.2 kg. High preoperative weight and young age were positively correlated to weight loss, as well as male gender. Correlations between predicted weight and real weight were highly significant in both validation cohorts (R?≥?0.7 and P?<?0.01) and RMSE increased throughout follow-up between 6.2 and 15.4 kg.

Conclusion

Our statistical model to predict weight loss outcomes after RYGBP seems accurate. It could be a valuable tool to define realistic weight loss expectations and to improve patient selection and outcomes during follow-up. Further research is needed to demonstrate the interest of this model in improving patients’ motivation and results and limit the failures.

     

Bariatric Surgery Outcomes in Patients Aged 65 Years and Older at an American Society for Metabolic and Bariatric Surgery Center of Excellence

Background  

Although morbid obesity rates in patients ≥65 years of age are increasing, few centers have reported weight loss surgery outcomes in elderly patients, resulting in a paucity of literature on perioperative mortality and morbidity.     

Asymptomatic Gastric Bacterial Overgrowth After Bariatric Surgery: Are Long-Term Metabolic Consequences Possible?

Background

Patients with postbariatric bacterial overgrowth were reinvestigated after a follow-up of 15 years. It was hypothesized that systemic associations analogous to those reported for whole gut microbiome would be revealed.

Methods

Patients (n?=?37, 70.3 % females, 42.4?±?9.9 years old, preoperative BMI 53.5?±?10.6 kg/m², current BMI 32.8?±?10.8 kg/m²), all submitted to RYGB on account of morbid obesity, were followed during 176.8?±?25.7 months. Blood tests included fasting blood glucose, HbA1c, liver and pancreatic enzymes, and lipid fractions. Bacterial overgrowth was diagnosed by quantitative culture of gastric fluid in both the excluded remnant and the gastric pouch, with the help of double-balloon enteroscopy. Absolute counts of aerobes and anaerobes in both gastric reservoirs were correlated with nutritional and biochemical measurements, aiming to identify clinically meaningful associations.

Results

Patients denied diarrhea, abdominal pain, weight loss, or other symptoms related to bacterial overgrowth. Biochemical profile including enzymes was also acceptable, indicating a stable condition. Positive correlation of bacterial count in either segment of the stomach was demonstrated for BMI and gamma-glutamyl transferase, whereas negative correlation occurred regarding fasting blood glucose.

Conclusions

An antidiabetic role along with deleterious consequences for weight loss and liver function are possible in such circumstances. Such phenotype is broadly consistent with reported effects for the whole gut microbiome. Prospective controlled studies including molecular analysis of gastrointestinal fluid, and simultaneous profiling of the entire microbiome, are necessary to shed more light on these findings.     

Factors Related to Weight Loss up to 4 Years after Bariatric Surgery

Background  

Gastric bypass is the bariatric surgery most frequently performed in the world. It is responsible for sustainable weight loss, resolution of comorbidities, and improvement of quality of life. However, weight loss is not homogeneous, at times being insufficient in some patients. Our objective was to assess which factors were important in influencing this differentiated weight loss over a period of 4 years after surgery.     

Patients’ Experiences of Weight Regain After Bariatric Surgery

Obesity Surgery - Bariatric surgery is a successful obesity treatment; however, an estimated 1/5 of patients have regained more than 15% of their body weight 5&nbsp;years post-surgery. To...     

Long-Term Changes in Parathyroid Function After Subtotal Thyroidectomy for Graves’ Disease

BACKGROUND: Transient hypocalcemia is one of the postoperative complications of thyroidectomy for Graves' disease, and perioperative parathyroid hormone (PTH) assays are used to predict postoperative hypocalcemia. We evaluated long-term changes in parathyroid function after surgery for Graves' disease. METHODS: Serum PTH values were measured in Graves' patients with postoperative hypocalcemia, and those patients were followed postoperatively. RESULTS: Subtotal thyroidectomy was performed in 275 patients with Graves' disease. Their serum calcium levels were measured on postoperative day (POD) 1, and patients with transient postoperative hypocalcemia were treated with calcium and vitamin D supplementation and followed up. The amount of calcium and vitamin D supplementation was adjusted to keep the patient's serum calcium level within the normal range. Measurement of their serum intact PTH value on POD 1 revealed normal value in 18 patients, a below normal level in 22, and an above normal level in the other 2. During the follow-up period, the serum iPTH values remained normal in 12 patients, recovered to the normal level in 21 patients, and rose above the normal range in 9 patients. The serum iPTH values of all patients eventually reached the normal range during the follow-up period. A marked difference in preoperative serum alkaline phosphatase concentration was observed between the high-iPTH patients and the normocalcemic patients. CONCLUSIONS: The phenomenon of an elevated serum PTH level after surgery for Graves' disease was observed in 21% of the patients with postoperative hypocalcemia despite the achievement of normal serum calcium levels by calcium and vitamin D supplementation.     

Endoscopic Evaluation of Laparoscopic Nissen Fundoplication: 89 % Success Rate 10 Years After Surgery

Background

The surgical outcome of fundoplication can be evaluated by means of esophagogastroduodenoscopy (EGDS). The literature reveals only one prior long-term follow-up series with endoscopic evaluation of the fundoplication wraps after laparoscopic Nissen fundoplication (LNF). The results achieved at a university clinic showed LNF to be more durable than open fundoplication (ONF). Previously, in our community-based hospital, the results of ONF were somewhat poorer than those achieved at a university clinic. The objective of the present study was to describe the long-term results of LNF in our hospital as regards surgical and symptomatic outcomes.

Methods

In 1997–1999, 107 LNFs were performed in our hospital. A questionnaire with symptom evaluation was mailed to all patients. The patients who agreed to participate were interviewed and underwent EGDS.

Results

Of the 107 patients, 64 (59.8 %) participated in the study (40 men, mean age 61.9 years, range 28–85 years). The mean follow-up time was 9.8 years. Seven endoscopic examinations (10.9 %) showed a defective fundic wrap; three of the patients had undergone reoperation. Fifty-eight (90.6 %) patients had no or minimal heartburn and 61 (95.3 %) had no or minimal regurgitation. Twenty-three (35.9 %) patients had moderate or severe dysphagia, and 43 (67.2 %) patients had moderate or severe flatulence. Fifty-seven (89.1 %) patients would have opted for surgery again.

Conclusions

This study contributes to the previous notion that LNF is associated with fewer surgical failures than ONF. Our results indicate that LNF can well be performed in a community-based hospital with acceptable long-term results.     

The Outcome of Bariatric Surgery in Patients Aged 75 years and Older

Background

Bariatric surgery has been shown to be safe and effective in patients aged 60–75 years; however, outcomes in patients aged 75 or older are undocumented.

Methods

Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied.

Results

A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75–81), and the median preoperative body mass index (BMI) was 41.4 kg/m² (range 35.8–57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n?=?11, 58%), adjustable gastric band (AGB) (n?=?4, 21%), Roux-en-Y gastric bypass (RYGB) (n?=?2, 11%), banded gastric plication (n?=?1, 5%), and gastric plication (n?=?1, 5%). The median operative time was 120 min (range 75–240), and the median length of stay was 2 days (range 1–7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4–22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities.

Conclusion

Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.

     

Resting Energy Expenditure and Body Composition of Women with Weight Regain 24 Months After Bariatric Surgery

Background

Weight regain 24 months after Roux-en-Y gastric bypass (RYGB) and low protein intake in patients without protein supplementation can favor fat-free mass loss and reduce resting energy expenditure (REE). We aimed to assess REE and its association with the body composition of women with weight regain and no protein supplementation in the late postoperative period of RYGB.

Methods

We determined the body mass index (BMI), REE by indirect calorimetry, body composition by tetrapolar bioelectrical impedance analysis, and energy intake by two 24-h recalls of 34 patients with at least 5 % of weight regain and no protein supplementation. The software SPSS v.17 analyzed the data calculating measures of central tendency and dispersion and using Pearson’s correlation to test the association between the variables and the multivariate linear regression model at a p?<?0.05 significance level.

Results

Postoperative period was positively associated with weight regain (r?=?0.39; p?=?0.023). The mean percentages of fat and fat-free masses were 45.1?±?8.3 % and 54.3?±?8.1 %, respectively. The mean REE was 1424.7?±?187.2 kcal (14 kcal/kg of the current weight), mean energy intake was 1258.6?±?454.3 kcal, and mean protein intake was 0.9 g/kg of the ideal weight?±?0.3. Fat-free mass was positively associated with REE regardless of protein intake and postoperative period.

Conclusions

Female bariatric patients with weight regain and no protein supplementation lose fat-free mass, lowering their REE. Health practices that promote maintenance of BMI and body composition may lead to improved outcomes of bariatric surgery.

     

Male Patients Above Age 60 have as Good Outcomes as Male Patients 50–59 Years Old at 1-Year Follow-up After Bariatric Surgery

BACKGROUND: It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old. METHODS: We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test. RESULTS: Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients. CONCLUSION: Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively.