Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery

Christopher D Still, G Craig Wood, Xin Chu, Christina Manney, William Strodel, Anthony Petrick, Jon Gabrielsen, Tooraj Mirshahi, George Argyropoulos, Jamie Seiler, Marco Yung, Peter Benotti, Glenn S Gerhard, Christopher D Still, G Craig Wood, Xin Chu, Christina Manney, William Strodel, Anthony Petrick, Jon Gabrielsen, Tooraj Mirshahi, George Argyropoulos, Jamie Seiler, Marco Yung, Peter Benotti, Glenn S Gerhard

Abstract

Objective: Gastric bypass surgery is an effective therapy for extreme obesity. However, substantial variability in weight loss outcomes exists that remains largely unexplained. Our objective was to determine whether any commonly collected preoperative clinical variables were associated with weight loss following Roux-en-Y gastric bypass (RYGB) surgery.

Methods: The analysis was based on a prospectively recruited observational cohort of 2,365 patients who underwent Roux-en-Y gastric bypass surgery from 2004 to 2009. Weight loss was stratified into three major phases, early (0-6 months), nadir, and long-term (>36 months). Multivariate regression models were constructed using a database of over 350 variables.

Results: A total of 12-14 preoperative variables were independently associated (P < 0.05) with each of the temporal weight loss phases. Preoperative variables associated with poorer nadir and long-term weight loss included higher baseline BMI, higher preoperative weight loss, iron deficiency, use of any diabetes medication, nonuse of bupropion medication, no history of smoking, age >50 years, and the presence of fibrosis on liver biopsy.

Conclusions: Several variables previously associated with poorer weight loss after RYGB surgery including age, baseline BMI, and type 2 diabetes were replicated. Several others suggest possible clinical interventions for postoperative management of RYGB patients to improve weight loss outcomes.

Copyright © 2013 The Obesity Society.

Figures

Figure 1
Figure 1
Linear mixed model of the percent of initial excess body weight after RYGB surgery. Based upon the shape of the weight loss curve, the post-surgical weight loss was divided into three phases: early weight loss (0-6 months), weight loss nadir (maximum weight loss achieved), and long term weight loss (weight measured at 36+ months). The model was generated using 51,822 weight measurements from 2444 patients occurring between surgery and 60 months after RYGB surgery.

References

    1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association. 2004;292:1724–37.
    1. Sjostrom CD. Systematic review of bariatric surgery. JAMA : the journal of the American Medical Association. 2005;293:1726. author reply.
    1. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. The New England journal of medicine. 2007;357:753–61.
    1. Clegg A, Colquitt J, Sidhu M, Royle P, Walker A. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 2003;27:1167–77.
    1. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. The New England journal of medicine. 2004;351:2683–93.
    1. Ali MR, Fuller WD, Choi MP, Wolfe BM. Bariatric surgical outcomes. The Surgical clinics of North America. 2005;85:835–52. vii.
    1. Dixon JB, Straznicky NE, Lambert EA, Schlaich MP, Lambert GW. Surgical approaches to the treatment of obesity. Nature reviews. Gastroenterology & hepatology. 2011;8:429–37.
    1. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Annals of surgery. 1995;222:339–50. discussion 50-2.
    1. Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Annals of surgery. 2006;244:734–40.
    1. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Annals of internal medicine. 2005;142:547–59.
    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA : the journal of the American Medical Association. 2012;307:491–7.
    1. Services CfMaM Services DoHH, editor. National Coverage Determination (NCD) for BARIATRIC SURGERY for Treatment of Morbid Obesity. 2009. 2009.
    1. Hatoum IJ, Stein HK, Merrifield BF, Kaplan LM. Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity (Silver Spring. 2009;17:92–9.
    1. Junior WS, do Amaral JL, Nonino-Borges CB. Factors related to weight loss up to 4 years after bariatric surgery. Obesity surgery. 2011;21:1724–30.
    1. Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obesity surgery. 2012;22:70–89.
    1. van de Laar A, de Caluwe L, Dillemans B. Relative outcome measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obesity surgery. 2011;21:763–7.
    1. Bray GA, Bouchard C, Church TS, et al. Is it time to change the way we report and discuss weight loss? Obesity (Silver Spring) 2009;17:619–21.
    1. Still CD, Wood GC, Chu X, et al. High allelic burden of four obesity SNPs is associated with poorer weight loss outcomes following gastric bypass surgery. Obesity (Silver Spring) 2011;19:1676–83.
    1. Wood G, Chu X, Manney C, et al. An electronic health record-enabled obesity database. BMC Bioinformatics and Medical Decision MAking. 2012 In Press.
    1. Koenker R, Bassett GW. Regression quantiles. Econometrica. 1978;46:33–50.
    1. Matzko ME, Argyropoulos G, Wood GC, et al. Association of Ghrelin Receptor Promoter Polymorphisms with Weight Loss Following Roux-en-Y Gastric Bypass Surgery. Obesity surgery. 2012;22:783–90.
    1. Dallal RM, Quebbemann BB, Hunt LH, Braitman LE. Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obesity surgery. 2009;19:732–7.
    1. Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.
    1. Melton GB, Steele KE, Schweitzer MA, Lidor AO, Magnuson TH. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2008;12:250–5.
    1. Cassie S, Menezes C, Birch DW, Shi X, Karmali S. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2011;7:760–7. discussion 7.
    1. Guajardo-Salinas GE, Hilmy A, Martinez-Ugarte ML. Predictors of weight loss and effectiveness of Roux-en-Y gastric bypass in the morbidly obese Hispano-American population. Obesity surgery. 2008;18:1369–75.
    1. Finks JF, Kole KL, Yenumula PR, et al. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Annals of surgery. 2011;254:633–40.
    1. Forbush S, Nof L, Echternach J, Hill C, Rainey J. Influence of activity levels and energy intake on percent excess weight loss after Roux-en-Y gastric bypass. Obesity surgery. 2011;21:1731–8.
    1. Dhillon S, Yang LP, Curran MP. Bupropion: a review of its use in the management of major depressive disorder. Drugs. 2008;68:653–89.
    1. King WC, Bond DS. The importance of preoperative and postoperative physical activity counseling in bariatric surgery. Exercise and sport sciences reviews. 2013;41:26–35.
    1. Billes SK, Greenway FL. Combination therapy with naltrexone and bupropion for obesity. Expert Opin Pharmacother. 2011;12:1813–26.
    1. Plodkowski RA, Nguyen Q, Sundaram U, Nguyen L, Chau DL, St Jeor S. Bupropion and naltrexone: a review of their use individually and in combination for the treatment of obesity. Expert Opin Pharmacother. 2009;10:1069–81.
    1. Greenway FL, Whitehouse MJ, Guttadauria M, et al. Rational design of a combination medication for the treatment of obesity. Obesity (Silver Spring) 2009;17:30–9.
    1. Mineur YS, Abizaid A, Rao Y, et al. Nicotine decreases food intake through activation of POMC neurons. Science. 2011;332:1330–2.
    1. Mirshahi UL, Still CD, Masker KK, Gerhard GS, Carey DJ, Mirshahi T. The MC4R(I251L) allele is associated with better metabolic status and more weight loss after gastric bypass surgery. J Clin Endocrinol Metab. 2011;96:E2088–96.

Source: PubMed

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