Weight Change and Health Outcomes at Three Years After Bariatric Surgery Among Patients with Severe Obesity

By A. Courcoulas, N. Christian, S. Belle, P. Berk, D. Flum, L. Garcia, M. Horlick, M. Kalarchian, W. King, James E Mitchell and 7 more. Journal of the American Medical Association (JAMA), 2013

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IMPORTANCE Severe obesity (Body Mass Index, BMI ≥35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements but little is known about long term outcomes of these operations. OBJECTIVE Report 3 year change in weight and select health parameters following common bariatric surgical procedures. DESIGN and SETTING The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium is a multi-center observational cohort study at ten hospitals in six geographically diverse clinical centers in the United States. PARTICIPANTS and EXPOSURE Adults undergoing first-time bariatric surgical procedure as part of routine clinical care by participating surgeons were recruited between 2006 and 2009 and followed until September 2012. Participants completed research assessments utilizing standardized and detailed data collection prior to surgery and 6 months, 12 months, and then annually post-surgery. MAIN OUTCOMES Three years following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) we assessed percent weight change from baseline and the percentage of patients with diabetes achieving HbA1c <6.5 or FPG < 126 mg/dL without pharmacologic therapy. Dyslipidemia or hypertension resolution at 3 years was also assessed. RESULTS At baseline, participants (n=2458) ranged in age from 18 to 78 years, 79% were women, the median BMI was 45.9 (interquartile range (IQR) 41.7–51.5) kg/m2 and median baseline weight was 129 (115, 147) kg. 1738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1252 (63%) dyslipidemia, and 1601 (68%) hypertension. 3 years post-surgery, the median actual weight loss for RYGB participants was 41 (IQR: 31, 52) kg corresponding to percent of baseline weight lost of 31.5% (IQR: 24.6%–38.4%). For LAGB participants, actual weight loss was 20 (IQR: 10, 29) kg which results in 15.9% (IQR: 7.8%–23.0%) weight loss. The majority of weight loss was evident one year post-surgery for both procedures. Five distinct weight change trajectory groups were identified for each procedure. 216(67.5%) of RYGB and 28(28.6%) of LAGB participants who had diabetes at baseline experienced partial remission at three years. The incidence of diabetes was 0.9% after RYGB and 3.2% following LAGB. Dyslipidemia resolved in 237 (61.9%) of RYGB and 39 (27.1%) of LAGB participants, remission of hypertension occurred in 269(38.2%) and 43(17.4%) of RYGB and LAGB participants, respectively. CONCLUSIONS and RELEVANCE Among patients with severe obesity, there was substantial weight loss 3 years following 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. NCT00465829, ClinicalTrials.gov

Subfields: Cardiology and Cardiovascular Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/cfc7d09b3c140d6cdfd7e8cb5630c360c2408f7b

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