Weight Change and Health Outcomes at 3 Years After Bariatric Surgery Among Individuals With Severe Obesity

Study Questions:

What is the 3-year change in weight and other select health parameters after common bariatric surgical procedures, as documented by the Longitudinal Assessment of Bariatric Surgery Consortium (LABS-2 study)?

Methods:

Adults undergoing first-time bariatric surgical procedures as part of routine clinical care by participating surgeons were recruited between 2006 and 2009, and followed up until September 2012. Three years after Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), the authors assessed percent weight change from baseline and the percentage of participants with diabetes achieving hemoglobin A1c levels <6.5% or fasting plasma glucose values <126 mg/dl without pharmacologic therapy. Dyslipidemia and hypertension resolution at 3 years was also assessed.

Results:

At baseline, participants (n = 2,458) were 18-78 years old, 79% were women, median body mass index was 45.9 kg/m2 (interquartile range [IQR], 41.7-51.5), and median weight was 129 kg (IQR, 115-147). For their first bariatric surgical procedure, 1,738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1,252 (63%) dyslipidemia, and 1,601 (68%) hypertension. Three years after surgery, median actual weight loss for RYGB participants was 41 kg (IQR, 31-52), corresponding to 31.5% (IQR, 24.6%-38.4%). For LAGB participants, actual weight loss was 20 kg (IQR, 10-29), corresponding to 15.9% (IQR, 7.9%-23.0%). The majority of weight loss was evident 1 year after surgery for both procedures. Among participants who had diabetes at baseline, 216 RYGB participants (67.5%) and 28 LAGB participants (28.6%) experienced partial remission at 3 years. Dyslipidemia resolved in 237 RYGB participants (61.9%) and 39 LAGB participants (27.1%); remission of hypertension occurred in 269 RYGB participants (38.2%) and 43 LAGB participants (17.4%).

Conclusions:

Among participants with severe obesity, there was substantial weight loss 3 years after bariatric surgery, with the majority experiencing maximum weight change during the first year. However, there was variability in the amount and trajectories of weight loss and in diabetes, blood pressure, and lipid outcomes.

Perspective:

The rationale for the choice of procedures was not described in the manuscript. There was a highly significant greater weight loss with RYGB compared to LAGB at each 6-month time point. While the degree of weight loss with RYGB (31%) is similar to other reports, the weight loss in the LAGB group (16%) was considerably less than the 20-25% in published studies. Similarly, the 28% remission of diabetes is considerably lower than the >70% previously reported. It is likely that selection bias and severity of diabetes have influenced the results in this rich database.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Hypertension

Keywords: Hemoglobin A, Glycosylated, Dyslipidemias, Bariatric Surgery, Body Mass Index, Gastric Bypass, Weight Loss, Obesity, Morbid, Blood Pressure, Hypertension, Diabetes Mellitus


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