Top

Journal of Endocrinological Investigation

Published in:

Open Access 01-05-2021 | Bariatric Surgery | Original Article

What predicts the unsuccess of bariatric surgery? An observational retrospective study

Authors: C. D’Eusebio, S. Boschetti, F. Rahimi, G. Fanni, A. De Francesco, M. Toppino, M. Morino, E. Ghigo, S. Bo

Published in: Journal of Endocrinological Investigation | Issue 5/2021

Abstract

Purpose

Bariatric surgery (BS) has been recognized as an effective treatment for most patients with morbid obesity, but a variable range of patients failed to achieve a successful weight-loss. Controversial data are available about predictors of unsuccess. We aimed to retrospectively assess whether clinical baseline characteristics of patients submitted to sleeve gastrectomy (SL) or gastric bypass (GBP) were associated with unsuccessful weight-loss after 12 and 24-month follow-up.

Methods

Three hundred patients who underwent BS from the 1st January 2016, with at least 24-months follow-up, were enrolled. Patients were divided according to their percentage of excess weight-loss (%EWL) either < 50% or ≥ 50% after 12 and 24-month follow-up.

Results

None of the patients was lost at follow-up; 56 (18.7%) patients showed a %EWL < 50% at 24 months. Age, neck circumference, obstructive sleep apnea (OSA) were significantly higher, while total cholesterol and %EWL 6-months lower in those with %EWL < 50% at 12-months. Age, neck circumference, male and OSA rates were increased, while %EWL at 6-months lower in patients with %EWL < 50% at 24-months. In a multiple regression model, age (OR = 1.076; 95% CI 1.029–1.125; p = 0.001; OR = 1.066; 1.027–1.107; p < 0.001) and %EWL at 6-months (OR = 0.876; 0.840–0.913; p < 0.001; OR = 0.950; 0.928–0.972; p < 0.001) were associated with %EWL < 50% both at 12- and 24-months, respectively, and neck circumference (OR = 1.142; 1.011–1.289; p = 0.032) with %EWL < 50% at 24-months.

Conclusion

Older age, larger neck circumference, and %EWL at 6-months were significantly associated with BS unsuccess, showing almost 90% of those patients an unsuccessful weight-loss early after surgery. Further larger studies with longer follow-up are needed to confirm these results.

Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres AJ, Weiner R, Yashkov Y, Frühbeck G, European Association for the Study of Obesity, International Federation for the Surgery of Obesity (2013) European Chapter Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts 6:449–468. https://doi.org/10.1159/000355480CrossRefPubMedPubMedCentral

Bastos EC, Barbosa EM, Soriano GM, dos Santos EA, Vasconcelos SM (2013) Determinants of weight regain after bariatric surgery. Arq Bras Cir Dig 26:26–32. https://doi.org/10.1590/s0102-67202013000600007CrossRefPubMed

Diab AF, Abdurasul EM, Diab FH (2019) The effect of age, gender, and baseline BMI on weight loss outcomes in obese patients undergoing intragastric balloon therapy. Obes Surg 29:3542–3546. https://doi.org/10.1007/s11695-019-04023-yCrossRefPubMed

Masrur M, Bustos R, Sanchez-Johnsen L, Gonzalez-Ciccarelli L, Mangano A, Gonzalez-Heredia R, Patel R, Danielson KK, Gangemi A, Elli EF (2020) Factors associated with weight loss after metabolic surgery in a multiethnic sample of 1012 patients. Obes Surg 30:975–981. https://doi.org/10.1007/s11695-019-04338-wCrossRefPubMed

Puzziferri N, Roshek TB 3rd, Mayo HG, Gallagher R, Belle SH, Livingston EH (2014) Long-term follow-up after bariatric surgery: a systematic review. JAMA 312:934–942. https://doi.org/10.1001/jama.2014.10706CrossRefPubMedPubMedCentral

Sans A, Bailly L, Anty R, Sielezenef I, Gugenheim J, Tran A, Gual P, Iannelli A (2017) Baseline anthropometric and metabolic parameters correlate with weight loss in women 1-year after laparoscopic Roux-En-Y gastric bypass. Obes Surg 27:2940–2949. https://doi.org/10.1007/s11695-017-2720-8CrossRefPubMed

van de Laar AW, van Rijswijk AS, Kakar H, Bruin SC (2018) Sensitivity and specificity of 50% excess weight loss (50%EWL) and twelve other bariatric criteria for weight loss success. Obes Surg 28:2297–2304. https://doi.org/10.1007/s11695-018-3173-4CrossRefPubMed

O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, Crosthwaite G, Brown W (2019) Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg 29:3–14. https://doi.org/10.1007/s11695-018-3525-0CrossRefPubMed

Faria G, Preto J, Almeida AB, Guimarães JT, Calhau C, Taveira-Gomes A (2014) Fasting glycemia: a good predictor of weight loss after RYGB. Surg Obes Relat Dis 10:419–424. https://doi.org/10.1016/j.soard.2013.11.005CrossRefPubMed

10.

Casas-Tapia C, Araujo-Castillo RV, Saavedra-Tafur L, Bert-Dulanto A, Piscoya A, Casas-Lucich A (2020) Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI ≥ 35kg/m² after vertical gastrectomy. Cir Esp 98:328–335. https://doi.org/10.1016/j.ciresp.2019.12.002CrossRefPubMed

11.

Barhouch AS, Padoin AV, Casagrande DS, Chatkin R, Süssenbach SP, Pufal MA, Rossoni C, Mottin CC (2016) Predictors of excess weight loss in obese patients after gastric bypass: a 60-month follow-up. Obes Surg 26:1178–1185. https://doi.org/10.1007/s11695-015-1911-4CrossRefPubMed

12.

Hindle A, de la Piedad GX, Brennan L (2017) Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 18:317–334. https://doi.org/10.1111/obr.12496CrossRefPubMed

13.

Chen EY, McCloskey MS, Doyle P, Roehrig J, Berona J, Alverdy J, le Grange D (2009) Body mass index as a predictor of 1-year outcome in gastric bypass surgery. Obes Surg 19:1240–1242. https://doi.org/10.1007/s11695-008-9724-3CrossRefPubMed

14.

Riess KP, Baker MT, Lambert PJ, Mathiason MA, Kothari SN (2008) Effect of preoperative weight loss on laparoscopic gastric bypass outcomes. Surg Obes Relat Dis 4:704–708. https://doi.org/10.1016/j.soard.2008.05.007CrossRefPubMed

15.

Alvarado R, Alami RS, Hsu G, Safadi BY, Sanchez BR, Morton JM, Curet MJ (2005) The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg 15:1282–1286. https://doi.org/10.1381/096089205774512429CrossRefPubMed

16.

Kinzl JF, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W (2006) Psychosocial predictors of weight loss after bariatric surgery. Obes Surg 16:1609–1614. https://doi.org/10.1381/096089206779319301CrossRefPubMed

17.

Carlin AM, O'Connor EA, Genaw JA, Kawar S (2008) Preoperative weight loss is not a predictor of postoperative weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:481–485. https://doi.org/10.1016/j.soard.2007.09.010CrossRefPubMed

18.

Sarela AI, Dexter SP, O'Kane M, Menon A, McMahon MJ (2012) Long-term follow-up after laparoscopic sleeve gastrectomy: 8–9-year results. Surg Obes Relat Dis 8:679–684. https://doi.org/10.1016/j.soard.2011.06.020CrossRefPubMed

19.

Krimpuri RD, Yokley JM, Seeholzer EL, Horwath EL, Thomas CL, Bardaro SJ (2018) Qualifying for bariatric surgery: is preoperative weight loss a reliable predictor of postoperative weight loss? Surg Obes Relat Dis 14:60–64. https://doi.org/10.1016/j.soard.2017.07.012CrossRefPubMed

20.

Ansar H, Zamaninour N, Pazouki A, Kabir A (2020) Weight loss after one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB): patient-related perioperative predictive factors. Obes Surg 30:1316–1323. https://doi.org/10.1007/s11695-019-04270-zCrossRefPubMed

21.

Colles SL, Dixon JB, O'Brien PE (2008) Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding. Obes Surg 18:833–840. https://doi.org/10.1007/s11695-007-9409-3CrossRefPubMed

22.

Black DW, Goldstein RB, Mason EE (2003) Psychiatric diagnosis and weight loss following gastric surgery for obesity. Obes Surg 13:746–751. https://doi.org/10.1381/096089203322509327CrossRefPubMed

23.

Topart P, Becouarn G, Delarue J (2017) Weight loss and nutritional outcomes 10 years after biliopancreatic diversion with duodenal switch. Obes Surg 27:1645–1650. https://doi.org/10.1007/s11695-016-2537-xCrossRefPubMed

24.

Chung F, Yang Y, Liao P (2013) Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg 23:2050–2057. https://doi.org/10.1007/s11695-013-1006-zCrossRefPubMed

25.

Reinders I, Visser M, Schaap L (2017) Body weight and body composition in old age and their relationship with frailty. Curr Opin Clin Nutr Metab Care 20:11–15. https://doi.org/10.1097/MCO.0000000000000332CrossRefPubMed

26.

Ten Haaf T, Verreijen AM, Memelink RG, Tieland M, Weijs P (2018) Reduction in energy expenditure during weight loss is higher than predicted based on fat free mass and fat mass in older adults. Clin Nutr 37:250–253. https://doi.org/10.1016/j.clnu.2016.12.014CrossRefPubMed

27.

Toth MJ, Tchernof A (2000) Lipid metabolism in the elderly. Eur J Clin Nutr 54:S121–S125. https://doi.org/10.1038/sj.ejcn.1601033CrossRefPubMed

28.

Manini TM (2013) Mobility decline in old age: a time to intervene. Exerc Sport Sci Rev 41:2. https://doi.org/10.1097/JES.0b013e318279fdc5CrossRefPubMedPubMedCentral

29.

Mor A, Sharp L, Portenier D, Sudan R, Torquati A (2012) Weight loss at first postoperative visit predicts long-term outcome of Roux-en-Y gastric bypass using Duke weight loss surgery chart. Surg Obes Relat Dis 8:556–560. https://doi.org/10.1016/j.soard.2012.06.014CrossRefPubMedPubMedCentral

30.

Obeidat F, Shanti H (2016) Early weight loss as a predictor of 2-year weight loss and resolution of comorbidities after sleeve gastrectomy. Obes Surg 26:1173–1177. https://doi.org/10.1007/s11695-015-1903-4CrossRefPubMed

31.

Ritz P, Caiazzo R, Becouarn G, Arnalsteen L, Andrieu S, Topart P, Pattou F (2013) Early prediction of failure to lose weight after obesity surgery. Surg Obes Relat Dis 9:118–121. https://doi.org/10.1016/j.soard.2011.10.022CrossRefPubMed

32.

Vuolo G, Voglino C, Tirone A, Colasanto G, Gaggelli I, Ciuoli C, Ferrara F, Marrelli D (2016) Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg 30:48–55. https://doi.org/10.1016/j.ijsu.2016.04.026CrossRefPubMed

33.

Puzziferri N, Nakonezny PA, Livingston EH, Carmody TJ, Provost DA, Rush AJ (2008) Variations of weight loss following gastric bypass and gastric band. Ann Surg 248:233–242. https://doi.org/10.1097/SLA.0b013e3181820cbcCrossRefPubMed

34.

Sarwer DB, Wadden TA, Moore RH, Baker AW, Gibbons LM, Raper SE, Williams NN (2008) Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis 4:640–646. https://doi.org/10.1016/j.soard.2008.04.013CrossRefPubMedPubMedCentral

35.

Spaniolas K, Kasten KR, Celio A, Burruss MB, Pories WJ (2016) Postoperative follow-up after bariatric surgery: effect on weight loss. Obes Surg 26:900–903. https://doi.org/10.1007/s11695-016-2059-6CrossRefPubMed

36.

Metcalf B, Rabkin RA, Rabkin JM, Metcalf LJ, Lehman-Becker LB (2005) Weight loss composition: the effects of exercise following obesity surgery as measured by bioelectrical impedance analysis. Obes Surg 15:183–186. https://doi.org/10.1381/0960892053268381CrossRefPubMed

37.

Svane MS, Bojsen-Møller KN, Martinussen C, Dirksen C, Madsen JL, Reitelseder S, Holm L, Rehfeld JF, Kristiansen VB, van Hall G, Holst JJ, Madsbad S (2019) Postprandial nutrient handling and gastrointestinal hormone secretion after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology 156:1627–1641.e1. https://doi.org/10.1053/j.gastro.2019.01.262CrossRefPubMed

38.

Lopez-Nava G, Negi A, Bautista-Castaño I, Rubio MA, Asokkumar R (2020) Gut and metabolic hormones changes after endoscopic sleeve gastroplasty (ESG) vs. laparoscopic sleeve gastrectomy (LSG). Obes Surg 30:2642–2651. https://doi.org/10.1007/s11695-020-04541-0CrossRefPubMed

39.

Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ (2019) Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol (Lausanne) 10:626. https://doi.org/10.3389/fendo.2019.00626CrossRef

40.

Khorgami Z, Arheart KL, Zhang C, Messiah SE, de la Cruz-Muñoz N (2015) Effect of ethnicity on weight loss after bariatric surgery. Obes Surg 25:769–776. https://doi.org/10.1007/s11695-014-1474-9CrossRefPubMed

41.

Sheets CS, Peat CM, Berg KC, White EK, Bocchieri-Ricciardi L, Chen EY, Mitchell JE (2015) Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg 25:330–345. https://doi.org/10.1007/s11695-014-1490-9CrossRefPubMedPubMedCentral

42.

Hecht LM, Pester B, Braciszewski JM, Graham AE, Mayer K, Martens K, Hamann A, Carlin AM, Miller-Matero LR (2020) Socioeconomic and racial disparities in bariatric surgery. Obes Surg 30:2445–2449. https://doi.org/10.1007/s11695-020-04394-7CrossRefPubMed

43.

Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, Purnell JQ (2002) Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Eng J Med 346:1623–1630. https://doi.org/10.1056/NEJMoa012908CrossRef

44.

Ademi Z, Tomonaga Y, van Stiphout J, Glinz D, Gloy V, Raatz H, Bucher HC, Schwenkglenks M (2018) Adaptation of cost-effectiveness analyses to a single country: the case of bariatric surgery for obesity and overweight. Swiss Med Wkly 148:w14626. https://doi.org/10.4414/smw.2018.14626CrossRefPubMed

45.

Jirapinyo P, Jin DX, Qazi T, Mishra N, Thompson CC (2018) A meta-analysis of GLP-1 after Roux-En-Y gastric bypass: impact of surgical technique and measurement strategy. Obes Surg 28:615–626. https://doi.org/10.1007/s11695-017-2913-1CrossRefPubMed

46.

Caro P, Guerra X, Canals A, Weisstaub G, Sandaña C (2019) Is neck circumference an appropriate tool to predict cardiovascular risk in clinical practice? A cross-sectional study in Chilean population. BMJ Open 9:e028305. https://doi.org/10.1136/bmjopen-2018-028305CrossRefPubMedPubMedCentral

47.

Zhang J, Guo Q, Peng L, Li J, Gao Y, Yan B, Fang B, Wang G (2018) The association of neck circumference with incident congestive heart failure and coronary heart disease mortality in a community-based population with or without sleep-disordered breathing. BMC Cardiovasc Disord 18:108. https://doi.org/10.1186/s12872-018-0846-9CrossRefPubMedPubMedCentral

48.

Eriksson Hogling D, Rydén M, Bäckdahl J, Thorell A, Arner P, Andersson DP (2018) Body fat mass and distribution as predictors of metabolic outcome and weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis 14:936–942. https://doi.org/10.1016/j.soard.2018.03.012CrossRefPubMed

49.

Michalik M, Bobowicz M, Buchwald H (2015) A numerical scale to assess the outcomes of metabolic/bariatric surgery (NOMS). Wideochir Inne Tech Maloinwazyjne 10:359–362. https://doi.org/10.5114/wiitm.2015.54085CrossRefPubMedPubMedCentral

50.

Bhandari M, Fobi M, Buchwald JN, Bariatric Metabolic Surgery Standardization (BMSS) Working Group (2019) Standardization of bariatric metabolic procedures: World Consensus Meeting Statement. Obes Surg 29:309–345. https://doi.org/10.1007/s11695-019-04032-xCrossRefPubMed

Title: What predicts the unsuccess of bariatric surgery? An observational retrospective study
Authors: C. D’Eusebio
S. Boschetti
F. Rahimi
G. Fanni
A. De Francesco
M. Toppino
M. Morino
E. Ghigo
S. Bo
Publication date: 01-05-2021
Publisher: Springer International Publishing
Keywords: Bariatric Surgery
Bariatric Surgery
Sleeve Gastrectomy
Published in: Journal of Endocrinological Investigation / Issue 5/2021
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-020-01398-z

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2021

Gender susceptibility to COVID-19: a review of the putative role of sex hormones and X chromosome

Sperm cryopreservation during the SARS-CoV-2 pandemic

Familial non-medullary thyroid cancer: a critical review

Circulating dipeptidyl peptidase-4 is independently associated with the presence and severity of NAFLD/NASH in individuals with and without obesity and metabolic disease

Profiling retrospective thyroid function data in complete thyroidectomy patients to investigate the HPT axis set point (PREDICT-IT)

The androgyny of Christ

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials