Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study

Abstract

Objective: Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

Research design and methods: The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37-60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25-29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

Results: There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

Conclusions: The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.

Trial registration: ClinicalTrials.gov NCT01479452.

© 2020 by the American Diabetes Association.

Figures

Figure 1

Body weight changes over 10 years after bariatric surgery or usual care in subgroups with normal BMI, overweight, or obesity at 20 years of age. Error bars represent 95% CIs. P = 0.032 for interaction between the treatment (bariatric surgery vs. control) and the three subgroups based on self-reported BMI at 20 years old on body weight changes.

Figure 2

Type 2 diabetes incidence (A) and type 2 diabetes remission (B) after bariatric surgery or usual care after 2 and 10 years in subgroups with normal BMI, overweight, or obesity at 20 years of age. Type 2 diabetes was defined as fasting blood glucose >6.1 mmol/L or plasma fasting glucose >7.0 mmol/L or self-reported glucose-lowering medication. P = 0.905 and P = 0.972 for test of interaction between the treatment (bariatric surgery vs. control) and the three subgroups based on self-reported BMI at 20 years of age on type 2 diabetes incidence over 2 and 10 years, respectively. P = 0.201 and P = 0.951 for test of interaction between the treatment (bariatric surgery vs. control) and the three subgroups based on self-reported BMI at 20 years old on type 2 diabetes remission over 2 and 10 years, respectively.

Figure 3

Cumulative incidence of microvascular type 2 diabetes complications after bariatric surgery or usual care in subgroups with normal BMI, overweight, or obesity at 20 years of age. A shows patients without type 2 diabetes at baseline, and B shows patients with type 2 diabetes at baseline. P = 0.682 and P = 0.698 for test of interaction between treatment (bariatric surgery vs. control) and the three subgroups based on self-reported BMI at 20 years of age on incidence of microvascular complications in individuals without and with type 2 diabetes at baseline, respectively.