The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery

BackgroundAlthough cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss.SettingSingle bariatric center.MethodsPatients (N = 567) who underwent bariatric surgery from 2014–2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener.ResultsAmong participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2–4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL.DiscussionAlthough health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.     

Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit

BackgroundThere is no evidence that insurance-mandated weight loss before bariatric surgery affects outcomes.ObjectiveThis retrospective study evaluated the relationship between insurance-mandated weight management program (WMP) completion before primary bariatric surgery and postoperative outcomes.SettingSuburban academic medical center.MethodsPatients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 572) or sleeve gastrectomy (SG, n = 484) from 2014 to 2019 were dichotomized to presence (LRYGB n = 431, SG n = 348) or absence (LRYGB n = 141, SG n = 136) of insurance-mandated WMP completion. Primary endpoints included follow-up rate, percent total weight loss (%TWL), and percent excess weight loss (%EWL) through 60 months after surgery. The Mann-Whitney U test compared between-group means with significance at P < .05.ResultsFollow-up rate, %TWL, and %EWL were not different (P = NS) up to 60 months postoperation between groups for either surgery. Both LRYGB and SG patients without WMP completion maintained greater %TWL (LRYGB: 34.4 ± 11.1% versus 29.8 ± 11.0%, P = .159; SG: 21.4 ± 10.0% versus 18.2 ± 10.5%, P = .456) and %EWL (LRYGB: 71.3 ± 26.3% versus 67.6 ± 26.5%, P = .618; SG: 49.2 ± 18.8% versus 47.5 ± 28.8%, P = .753) at 36 months after surgery. Secondarily, duration of time to get to surgery was significantly greater among yes-WMP patients (LRYGB: 178 days versus 121 days, P < .001; SG: 169 days versus 95 days, P < .001).ConclusionInsurance-mandated WMP completion before bariatric surgery delays patient access to surgery without improving postoperative weight loss potential and must be abandoned.     

Anxiety predicts reduced weight loss 30 months after bariatric surgery

BackgroundThough psychosocial factors are routinely examined in presurgical psychological evaluations, the predictive value of some psychosocial factors on postsurgical weight loss is still relatively unknown. Additional research examining the predictive value of psychological constructs preoperatively and long-term weight outcomes is needed to enhance the clinical utility of the presurgical psychological evaluations.ObjectiveThis study aimed to examine psychosocial factors as predictors of weight outcomes 30 months after bariatric surgery.SettingUniversity hospital in the Appalachian region of United States.MethodsParticipants included 196 adults who underwent bariatric surgery. Psychosocial data were collected as part of a routine psychological evaluation prior to bariatric surgery. Objective weight was obtained through patients’ medical records at 12, 24, and 30 months after surgery.ResultsLinear mixed models was used to examine presurgical psychosocial factors predicting postsurgical weight loss (n at 12 months = 153, n at 24 months = 130, n at 30 months = 92). Anxiety had a significant interaction effect with time (estimate = –.01, P = .013), indicating that higher anxiety was associated with less weight loss over time. Those with severe anxiety before surgery lost the most weight 12 months after surgery but also regained the most weight 30 months after surgery. Other predictors were not statistically significant.ConclusionAnxiety assessed prior to surgery predicted reduced weight loss 30 months after bariatric surgery, after controlling for surgery type, baseline weight, sex, and age. Results highlight the importance of evaluation and treatment of anxiety in presurgical bariatric candidates.     

Relationship between depression,weight, and patient satisfaction 2 years after bariatric surgery

BackgroundFindings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking.ObjectivesThis study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery.SettingThis study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites.MethodsParticipants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015–2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery.ResultsCompared to presurgery, fewer patients’ PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points.ConclusionsThis study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.     

Influence of the BDNF Val66Met polymorphism on weight loss after bariatric surgery: a 24-month follow-up

BackgroundBariatric surgery is currently the most effective long-term treatment for severe obesity. However, interindividual variation in surgery outcome has been observed, and research suggests a moderating effect of several factors including baseline co-morbidities (e.g., type 2 diabetes [T2D] and genetic factors). No data are currently available on the interaction between T2D and variants in brain derived neurotrophic factor (BDNF) and its effect on weight loss after surgery.ObjectivesTo examine the role of the BDNF Val66Met polymorphism (rs6265) and the influence of T2D and their interaction on weight loss after bariatric surgery in a cohort of patients with severe obesity.SettingUniversity hospital in Spain.MethodsThe present study evaluated a cohort of 158 patients with obesity submitted to bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) followed up for 24 months (loss to follow-up: 0%). During the postoperative period, percentage of excess body mass index loss (%EBMIL), percentage of excess weight loss (%EWL), and total weight loss (%TWL) were evaluated.ResultsLongitudinal analyses showed a suggestive effect of BDNF genotype on the %EWL (P = .056) and indicated that individuals carrying the methionine (Met) allele may experience a better outcome after bariatric surgery than those with the valine/valine (Val/Val) genotype. We found a negative effect of a T2D diagnosis at baseline on %EBMIL (P = .004). Additionally, we found an interaction between BDNF genotype and T2D on %EWL and %EBMIL (P = .027 and P = .0004, respectively), whereby individuals with the Met allele without T2D displayed a greater %EWL and greater %EBMIL at 12 months and 24 months than their counterparts with T2D or patients with the Val/Val genotype with or without T2D.ConclusionOur data showed an association between the Met variant and greater weight loss after bariatric surgery in patients without T2D. The presence of T2D seems to counteract this positive effect.     

Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass

Background

Currently, there is no agreement on the best method to describe weight loss (WL) after bariatric surgery. The aim of this study is to evaluate short-term outcomes using percent of total body weight loss (%TWL).

Methods

A single-institution retrospective study of 2420 patients undergoing Roux-en-Y gastric bypass (RYGB) was performed. Suboptimal WL was defined as %TWL?<?20 % at 12 months.

Results

Mean preoperative BMI was 46.8?±?7.8 kg/m². One year after surgery, patients lost an average 14.1 kg/m² units of body mass index (BMI), 30.0?±?8.5 %TWL, and 68.5?±?22.9 %EWL. At 6 and 12 months after RYGB, mean BMI and percent excess WL (%EWL) significantly improved for all baseline BMI groups (p?<?0.01, BMI; p?=?0.01, %EWL), whereas mean %TWL was not significantly different among baseline BMI groups (p?=?0.9). The regression analysis between each metric outcome and preoperative BMI demonstrated that preoperative BMI did not significantly correlate with %TWL at 1 year (r?=?0.04, p?=?0.3). On the contrary, preoperative BMI was strongly but negatively associated with the %EWL (r?=??0.52, p?<?0.01) and positively associated with the BMI units lost at 1 year (r?=?0.56, p?<?0.01). In total, 11.3 % of subjects achieved <20 %TWL at 12 months and were considered as suboptimal WL patients.

Conclusion

The results of our study confirm that %TWL should be the metric of choice when reporting WL because it is less influenced by preoperative BMI. Eleven percent of patients failed to achieve successful WL during the in the first year after RYGB based on our definition.

     

Sensitivity and Specificity of 50% Excess Weight Loss (50%EWL) and Twelve Other Bariatric Criteria for Weight Loss Success

Background

Criteria for bariatric weight loss success are numerous. Most of them are arbitrary. None of them is evidence-based. Our objective was to determine their sensitivity and specificity.

Methods

Thirteen common bariatric weight loss criteria were compared to a benchmark reflecting the gold standard in bariatric surgery. We used an elaborate baseline BMI-independent weight loss percentile chart, based on retrospective data after laparoscopic Roux-en-Y gastric bypass (LRYGB), performed between 2007 and 2017. Percentile curves p31.6 (patients’ expectation), p25 (interquartile range), p15.9 (1 standard deviation (SD) below median), and p10.9 (surgeons’ goal) were used as possible cutoff for success to determine true or false positive and negative results beyond 1 year.

Results

We operated 4497 primary LRYGB patients, with mean follow-up 22 (±?1 SD 19; range 0–109) months, 3031 patients with last result ≥?1 year, 518?≥?5 years. For all four cutoff percentile curves for success, specificities were low (2–72%) for criteria <?35 body mass index (BMI), ≥?25percentage excess BMI loss (%EBMIL), ≥?50%EBMIL, ≥?15 percentage total weight loss (%TWL), ≥?20%TWL, ≥?25 percentage excess weight loss (%EWL), and high (83–96%) for <?30 BMI. No criterion had >?80% specificity and sensitivity for a cutoff above p15.9. For p15.9, they were both >?80% for criteria ≥?10 BMI reduction and ≥?50%EWL, both >?90% for ≥?25%TWL and ≥?35 percentage alterable weight loss (%AWL). All criteria had high sensitivities for all cutoff percentile curves (87–100%), except <?30 BMI (65–78%).

Conclusions

For the first time, common bariatric criteria for weight loss success were systematically validated. Most criteria recognized success very well (high sensitivities), but ≥?15%TWL, ≥?20%TWL, <?35BMI, ≥?25%EWL, ≥?25%EBMIL, and ≥?50%EBMIL left too many poor responders unnoticed (low specificities). Bariatric weight loss success is best assessed by comparing results to percentile curve 1 SD below median (p15.9) in a bariatric baseline BMI-independent weight loss percentile chart. Criteria ≥?35%AWL and ≥?25%TWL came close to that curve, both with >?90% sensitivity and specificity. Among others, criterion ≥?50%EBMIL did not.

     

Depression subtypes,binge eating,and weight loss in bariatric surgery candidates

BackgroundDepression and binge eating disorder (BED) are prevalent among bariatric surgery candidates. Depression subtypes may be differentially related to obesity, such that the atypical subtype predicts poorer outcomes. However, no research has examined depression subtypes, BED, and weight loss in bariatric candidates.ObjectiveTo examine whether presurgical atypical depressive symptoms, compared with no depressive and melancholic depressive symptoms, were associated with higher rates of presurgical BED, binge eating severity, and poorer postsurgical weight loss trajectories among bariatric candidates.SettingAn outpatient Midwest bariatric clinic.MethodsParticipants were 345 adults (aged 46.27 ± 12.78 yr, 76% female; body mass index = 49.84 ± 8.51 kg/m²) who received a presurgical evaluation. Depression subtypes (melancholic, atypical, and no depressive symptoms) were categorized using the Beck Depression Inventory-II. BED diagnosis and severity were evaluated using the Eating Disorder Diagnostic Scale and Binge Eating Scale, respectively. Weight loss trajectories were calculated as percent total weight loss postsurgery.ResultsUsing no depression as the referent, participants reporting melancholic symptoms (odds ratio = 7.60, P < .001 confidence interval₉₅ [2.59–22.28]) and atypical symptoms (odds ratio = 10.11, P < .01 confidence interval₉₅ [2.69–37.94]) were more likely to meet criteria for BED. Patients with atypical depressive symptoms exhibited the highest binge eating severity scores (mean = 23.03). Depression subtypes did not predict percent total weight loss trajectories within 18-months postbariatric surgery.ConclusionsPatients reporting preoperative atypical depressive symptoms were more likely to meet criteria for co-morbid BED diagnosis and have greater binge eating severity but did not have poorer weight loss within 18 months postsurgery. Future studies with longer-term follow-up and corresponding measures of postsurgical depression and binge eating pathology are warranted.     

Reporting of weight loss outcomes in bariatric surgery following introduction of 2015 ASMBS guidelines

BackgroundHeterogeneity in reporting weight loss (WL) outcomes within the bariatric surgery literature limits synthesis and meta-analysis. In 2015, the American Society for Metabolic and Bariatric Surgery (ASMBS) published reporting guidelines to achieve consistency in the literature.ObjectivesWe aimed to assess the effect of the ASMBS guidelines in the bariatric surgery literature.MethodsNine PubMed-indexed bariatric surgery journals were screened for articles published in the first 6 months of 2015 and 2021. Of 1807 articles, 105 and 158 articles in 2015 and 2021, respectively, reported primarily on WL outcomes following surgery.ResultsOverall ASMBS compliance increased from 5% to 20%, P < .05. Initial weight and body mass index (BMI) was reported in all studies, but specification of this as the immediate preoperative weight reduced from 15% to 6%, P < .05. The percent total WL (%TWL) increased from 17% to 61%, P < .05. Change in the BMI (DBMI) remained 41%. The percent excess BMI or WL (%EBMIL or %EWL) did not significantly change from 76% to 69%, P = .203. In 2021, 2 of the 9 journals gave guidance on reporting WL in their instructions to authors. Thirty percent (42/142) of articles did not comply with the journals’ WL reporting guidance. The number of unique WL outcomes used increased from 45 to 54.ConclusionsSignificant heterogeneity in reporting WL outcomes remains, hindering robust meta-analysis of articles. Use of referral weight instead of preoperative weight can inflate WL in those with mandated preoperative WL, clarifying initial weight is needed. Use of nonstandard measures of WL remains high.     

Weight loss after bariatric surgery: a comparison between delayed and immediate qualification according to the last resort criterion

BackgroundIn the Netherlands, patients only qualify for bariatric surgery when they have followed a 6-month mandatory weight loss program (MWP), also called the “last resort” criterion. One of the rationales for this is that MWPs result in greater weight loss.ObjectivesTo determine weight loss during MWPs and the effect of delayed versus immediate qualification on weight loss 3 years after bariatric surgery.SettingOutpatient clinic.MethodsThis is a nationwide, retrospective study with prospectively collected data. All patients who underwent a primary bariatric procedure in 2016 were included. We compared weight loss between patients who did not qualify according to the last resort criterion at screening (delayed group) with patients that qualified (immediate group).ResultsIn total 2628 patients were included. Mean age was 44.4 years, 81.3% were female, and baseline BMI was 42.3 kg/m². Roux-en-Y gastric bypass (RYGB) was the most frequently performed surgery (77.0%), followed by sleeve gastrectomy (15.8%) and banded RYGB (7.3%). The delayed group (n = 831; 32%) compared with immediate group (n = 1797; 68%), showed less percentage of total weight loss (%TWL) during the MWP (1.7% versus 3.9%, P < .001) and time between screening and surgery was longer (42.3 versus 17.5 wk, P < .001). Linear mixed model analysis showed no significant difference in %TWL at 18- (P = .291, n = 2077), 24- (P = .580, n = 1993) and 36-month (P = .325, n = 1743) follow-up.ConclusionThis study shows that delayed qualification for bariatric surgery compared with immediate qualification does not have a clinically relevant impact on postoperative weight loss 3 years after bariatric surgery.     

Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss

BackgroundMany insurance companies have mandated that bariatric surgery candidates already satisfying the National Institutes of Health criteria make an additional attempt at medically supervised weight loss. The objective of this study was to determine whether a correlation exists between the number of weight loss attempts (WLAs) or maximal preoperative weight loss (MWL) and the percentage of excess weight loss (%EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.MethodsThe WLAs and MWL data were collected by bariatric medical record review. The postoperative %EWL was obtained by retrospective review of a prospectively enrolled bariatric database. Patients whose records contained 1 year of follow-up data and either the WLAs or MWL were included in the study. The data were analyzed using Pearson correlations and odds ratios.ResultsFrom September 2001 to 2006, 530 patients underwent LRYGB. Of these, 384 met the study criteria (82.6% were women). The mean WLAs was 4.3 ± 1.8. The mean MWL was 46.6 ± 31.2 lb (21.2 ± 14.2 kg). At surgery, the mean patient age was 43.3 ± 9.3 years, and the mean body mass index was 48.0 ± 5.9 kg/m². At 1 year after LRYGB, the mean body mass index was 30.2 ± 5.0 kg/m², and the mean %EWL was 72.3% ± 15.3%. Statistical analysis revealed no correlations between the %EWL at 1 year after LRYGB and the WLAs (R² = .011) or MWL (R² = .005).ConclusionNeither the WLAs nor the MWL correlated with the %EWL at 1 year after LRYGB. Our results showed no evidence that the WLAs or MWL before surgery correlates with the %EWL in patients undergoing LRYGB.     

Factors influencing long-term weight loss after bariatric surgery

BackgroundBariatric surgery provides sustained weight loss and improves comorbidities. However, long term data has shown that patients gradually regain weight after 1 year. Several factors have been associated with poor weight loss after bariatric surgery.ObjectiveOur goal is to investigate factors associated with poor weight loss following laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).SettingMilitary academic medical center.MethodsRetrospective review of 247 patients who underwent laparoscopic SG or RYGB between 2010–2012 at Eisenhower Army Medical Center and followed for 5 years postoperatively. Factors of age, type of surgery, sex, hypertension, depression, and type 2 diabetes (T2D) are analyzed in univariate and multivariate analysis with percent total weight loss (%TWL) and Body Mass Index (BMI) change as primary endpoints measured at 3 and 5 years.ResultsAverage BMI change are maximized at 1 year and decreased at 3 and 5 years post-surgery. Age, diabetes, hypertension and type of surgery significantly influenced weight loss at 3 and 5 years on univariate analysis. However, patients with diabetes, hypertension and sleeve gastrectomy were significantly older than comparable control group. Multivariable analysis showed that age and type of surgery, not diabetes or hypertension, were associated with poor %TWL and BMI change at 3 and 5 years.ConclusionWhile presence of hypertension and diabetes initially appeared to be associated with weight recidivism, their impacts were negligible on multivariable analysis. However, age and sleeve gastrectomy are independent risk factors. Our data can be used to counsel patients on expected weight loss after bariatric surgery.     

Eating expectancies before bariatric surgery: assessment and associations with weight loss trajectories

BackgroundWhile presurgical eating behaviors have demonstrated limited prognostic value, cognitions regarding the effects of eating may serve as important predictors of weight loss outcomes after bariatric surgery. The Eating Expectancies Inventory (EEI) is a commonly used, self-report measure of expected consequences of eating; however, its psychometric and predictive properties have not yet been evaluated among bariatric surgery patients.ObjectivesThis study sought to examine the factor structure and internal consistency of the EEI among bariatric surgery candidates, to examine relationships between EEI factors and measures of eating psychopathology, and to explore the effects of eating expectancies on postsurgical weight loss.SettingData originated from an interdisciplinary bariatric surgery center in the Midwest United States.MethodsTwo hundred sixty-two women completed self-report questionnaires before bariatric surgery. Presurgical data and available postsurgical weights (at 6, 12, and 18 mo) were obtained from medical records.ResultsAnalyses indicated that the original 5-factor model was a good-to-excellent fit for the EEI data. All EEI factors demonstrated good reliability and were significantly associated with eating disorder symptoms and behaviors at baseline. Higher scores on EEI Factor 1 (negative affect) and Factor 5 (alleviates boredom) predicted poorer weight loss at 18 months postsurgery (n = 132).ConclusionsFindings support the reliability and validity of the EEI among female bariatric candidates. Presurgical eating expectancies were linked to pathologic eating patterns and also predicted postsurgical weight loss trajectories, suggesting that eating expectancies may have prognostic value as predictors of bariatric surgery outcomes.     

Algorithm for weight loss after gastric bypass surgery considering body mass index,gender, and age from the Bariatric Outcome Longitudinal Database (BOLD)

BackgroundInsight into the effects of gender and age on bariatric weight loss can be disturbed by the well-known influence of initial body mass index (BMI) on excess weight loss (%EWL). Alternative metrics can be found that eliminate this influence. Their formulas can be used to construct an algorithm in which mean weight loss becomes a constant value, describing the effectiveness of the operation independent of the initial BMI. The objective of this study was to create an algorithm describing weight loss after LRYGB in search for a better outcome metric to demonstrate unequivocally the influence of patient characteristics on bariatric results.MethodsNadir weight loss results of BOLD patients, grouped by gender and age (<40 yr and ≥40 yr), with ≥2 years follow-up after LRYGB and initial BMI ≥30 and<80 kg/m², are expressed in 26 different metrics with formula: 100%×(initial BMI – nadir BMI)/(initial BMI – a) with “reference BMI” a = 0–25 kg/m². For each subgroup, the “optimal reference BMI” (a) generating the smallest deviation and without significant difference in outcome between lighter and heavier patients is used to construct an algorithm (Mann-Whitney U test; P<.0002). Mean nadir relative weight loss results (b) are compared.ResultsA total of 8945 patients met inclusion criteria (mean initial BMI, 47.7 kg/m²; median age, 48 yr; 20.0% male). Both female subgroups had optimal reference BMI: a = 10 kg/m²; both male subgroups: a = 17 kg/m². LRYGB effectiveness (b) was significantly higher for younger patients and for female patients. The %EWL metric rendered different significances.ConclusionsBoth genders have age-independent metrics for which nadir relative weight loss after LRYGB is not influenced by initial BMI. The resulting algorithm nadir BMI = a + (100%−b) × (initial BMI−a) consists of an inert part (a = 10–17 kg/m²) on which the bariatric effectiveness (b) does not act and an alterable part (initial BMI−a) on which it does. The proposed metric percentage alterable weight loss (%AWL) reduces results to constant values for bariatric effectiveness (b), facilitating research on the precise effect of patient characteristics and surgical variables on postoperative weight loss better than %EWL, a metric able to produce false conclusions. Women and younger patients had significantly more weight loss; initial BMI had no effect.     

Early-phase insulin hypersecretion associated with weight loss outcome after LSG: a prospective cohort study in Asian patients with BMI ≥28 kg/m2

BackgroundObesity has become a global problem that poses a serious threat to human health. Laparoscopic sleeve gastrectomy (LSG) is an effective long-term treatment. However, the weight loss of some patients after LSG is still insufficient. It is necessary to investigate the factors associated with inadequate weight loss after LSG.ObjectiveThe objective of this study was to explore whether preoperative insulin secretion could be associated with weight loss after LSG in patients with obesity.SettingThis is a single-center prospective cohort study conducted in a university hospital.MethodsPatients from a prospective database who underwent LSG were analyzed. All 178 participants underwent a 75-g oral glucose tolerance test (OGTT) to assess preoperative insulin and c-peptide secretion before LSG. The areas under the curve (AUCs) for glucose, insulin, and c-peptide were determined in the OGTT. The percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were used to estimate the effect of weight loss after LSG. Regression models were used to assess the correlation between preoperative insulin and c-peptide secretion with %EWL ≥75% and TWL ≥35% at 12 months after LSG.ResultsThe AUCs of insulin and c-peptide were significantly lower in the %EWL ≥75% and %TWL ≥35% groups at 0–30 minutes, 0–60 minutes, and 0–120 minutes during the OGTT. At 30, 60, and 120 minutes during the OGTT, c-peptide levels were significantly lower in the %EWL ≥75% group and %TWL ≥35% group. The preoperative c-peptide level at 30 minutes during the OGTT (C₃₀) was significantly negatively correlated with %EWL (β = ?.37, P < .001) and %TWL (β = ?.28, P = .011). Univariate logistic regression analysis showed that preoperative C₃₀ was associated with %EWL ≥75% and %TWL ≥35% after LSG. According to multiple logistic regression analysis, patients with a low preoperative C₃₀ had an 8-fold higher %TWL ≥35% after LSG than those with a high C₃₀ (odds ratio: 8.41 [95% confidence interval: 1.46–48.58], P = .017). Similarly, patients with a low preoperative C₃₀ had a 7-fold higher EWL% ≥75% after LSG than patients with a high C₃₀ (odds ratio: 7.25 [95% confidence interval: 1.11–47.50], P = .039).ConclusionsThe rate of weight loss after LSG is low among patients with preoperative hyperinsulinemia. The preoperative c-peptide level at 30 minutes during the OGTT is associated with weight loss after LSG.     

Does patient compliance with preoperative bariatric office visits affect postoperative excess weight loss?

BackgroundThe amount of excess weight loss (EWL) achieved after bariatric surgery has varied considerably. Reliable preoperative predictors of the postoperative %EWL do not exist. Patient compliance with the physician recommendations has generally been believed to be important for long-term success after bariatric surgery, especially after gastric banding. We hypothesized that poor preoperative patient compliance with office visits, a likely indicator of overall compliance, would be associated with lower %EWL after bariatric surgery at a teaching hospital in the United States.MethodsWe performed an institutional review board-approved review of prospectively collected data from all patients undergoing bariatric surgery from 2007 to 2009. The patients were categorized into 2 groups: those who had missed <25% of all preoperative appointments at our bariatric center and those who had missed >25%. The average %EWL at 12 months between the 2 groups was compared using the unpaired t test separately for the gastric bypass and gastric banding patients.ResultsThe gastric band patients with >25% missed appointments had lost 23% EWL at 12 months compared with 32% EWL for the gastric band patients who had missed <25% of their appointments (P = .01). No difference was found in the %EWL for the gastric bypass patients according to the missed preoperative appointments. The postoperative compliance was significantly poorer than preoperatively.ConclusionThe patients with a greater percentage of missed preoperative appointments had a lower postoperative %EWL at 1 year after gastric banding but not after gastric bypass. This information could prove useful during patient selection or when counseling patients about the type of bariatric surgery to pursue.     

The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record,census, and county data

BackgroundWhile social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss.ObjectiveTo integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio.SettingSeven hundred seventy-two patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015 to 2019 at Ohio State University.MethodsEHR variables included race, insurance, procedure, and percent total weight lost (%TWL) at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between-subjects factor; race, census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within-group differences for Black and White patients.ResultsAccess to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (P = .029). Black patients with access to more food stores within a 10-minute (P = .017) and White patients with more access within a 5-minute walk (P = .015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (P = .036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas.ConclusionsClose proximity to food stores is associated with better weight loss 2 years after bariatric surgery. Lower poverty levels did not negatively affect weight loss in Black patients.     

Long-term outcomes of bariatric surgery in patients with bi-allelic mutations in the POMC,LEPR, and MC4R genes

BackgroundGene mutations in the leptin-melanocortin signaling cascade lead to hyperphagia and severe early onset obesity. In most cases, multimodal conservative treatment (increased physical activity, reduced caloric intake) is not successful to stabilize body weight and control hyperphagia.ObjectivesTo examine bariatric surgery as a therapeutic option for patients with genetic obesity.SettingThree major academic, specialized medical centers.MethodsIn 3 clinical centers, we retrospectively analyzed the outcomes of bariatric surgery performed in 8 patients with monogenic forms of obesity with bi-allelic variants in the genes LEPR (n = 5), POMC (n = 2), and MC4R (n = 1).ResultsIn this group of patients with monogenic obesity, initial bariatric surgery was performed at a median age of 19 years (interquartile range [IQR], 16–23.8 yr). All patients initially experienced weight loss after each bariatric surgery, which was followed by substantial weight regain. In total, bariatric surgery led to a median maximum reduction of body weight of ?21.5 kg (IQR, ?36.3 to ?2.9 kg), median percent excess weight loss (%EWL) of ?47.5 %EWL (IQR, ?57.6 to ?28.9 %EWL). This body weight reduction was followed by median weight regain of 24.1 kg (IQR: 10.0 to 42.0 kg), leading to a final weight change of ?24.2 % EWL (IQR: ?37.6 to ?5.4 %EWL) after a maximum duration of 19 years post surgery. In one patient, bariatric surgery was accompanied by significant complications, including vitamin deficiencies and hernia development.ConclusionThe indication for bariatric surgery in patients with monogenic obesity based on bi-allelic gene mutations and its benefit/risk balance has to be evaluated very cautiously by specialized centers. Furthermore, to avoid an unsuccessful operation, preoperative genetic testing of patients with a history of early onset obesity might be essential, even more since novel pharmacological treatment options are expected.     

Cognitive function predicts weight loss after bariatric surgery

BackgroundClinically significant cognitive impairment is found in a subset of patients undergoing bariatric surgery. These difficulties could contribute to a reduced adherence to postoperative lifestyle changes and decreased weight loss. The present study is the first to prospectively examine the independent contribution of cognitive function to weight loss after bariatric surgery. Executive function/attention and verbal memory at baseline were expected to negatively predict the percentage of excess weight loss (%EWL) and body mass index (BMI) at follow-up. Three sites of the Longitudinal Assessment of Bariatric Surgery parent project were used: Columbia (New York, NY), Cornell (Princeton, NJ), and the Neuropsychiatric Research Institute (Fargo, ND).MethodsA total of 84 individuals enrolled in the Longitudinal Assessment of Bariatric Surgery project undergoing bariatric surgery completed a cognitive evaluation at baseline. The BMI and %EWL were calculated at the 12-week and 12-month postoperative follow-up visits.ResultsClinical impairment in task performance was most prominent in tasks associated with verbal recall and recognition (14.3–15.5% of the sample) and perseverative errors (15.5%). After accounting for demographic and medical variables, the baseline test results of attention/executive function and memory predicted the BMI and %EWL at 12 months but not at 12 weeks.ConclusionsThese results have demonstrated that baseline cognition predicts for greater %EWL and lower BMI 12 months after bariatric surgery. Additional work is needed to clarify the degree to which cognition contributes to adherence and the potential mediation of cognition on the relationship between adherence and weight loss in this group.     

Reporting Results After Bariatric Surgery: Reproducibility of Predicted Body Mass Index

Background  

There is a controversy about the best way to report results after bariatric surgery. Several indices have been proposed over the years such as percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess body mass index loss (%EBMIL). More recently, it has been suggested to individualize the body mass index (BMI) goal to be achieved by the patients (predicted BMI—PBMI). The objective was to assess the reproducibility of this PBMI in our service.