Skip to main content
Top
Published in: Obesity Surgery 4/2013

01-04-2013 | Clinical Report

Preoperative Fat-Free Mass: A Predictive Factor of Weight Loss after Gastric Bypass

Authors: Maud Robert, Elise Pelascini, Emmanuel Disse, Philippe Espalieu, Gilles Poncet, Martine Laville, Christian Gouillat

Published in: Obesity Surgery | Issue 4/2013

Login to get access

Abstract

Weight loss failure occurs in 8 % to 40 % of patients after gastric bypass (GBP). The aim of our study was to analyse the predictive factors of weight loss at 1 year so as to select the best candidates for this surgery and reduce the failures. We included 73 patients treated by laparoscopic GBP. We retrospectively analysed the predictive factors of weight loss in kilograms as well as excess weight loss in percentage (EWL%) at 1 year. The population was divided into tertiles so as to compare the sub-group with the highest weight loss with the sub-group with the least satisfactory results. The significantly predictive factors of a better weight loss in kilograms were male, higher initial weight (144 versus 118 kg, p = 0.002), a significant early weight loss and a higher preoperative percentage of fat-free mass (FFM%; p = 0.03). A higher FFM% was also associated with a better EWL% (p = 0.004). The preoperative FFM (in kilograms) was the principal factor accounting for the weight loss at 1 year regardless of age, gender, height and initial body mass index (BMI; p < 0.0001). There was a better correlation between FFM and weight loss (Spearman test, p = 0.0001) than between initial BMI and weight loss (p = 0.016). We estimated weight loss at 1 year according to initial FFM using the formula: 0.5 kg of lost weight per kilogram of initial FFM. The initial FFM appears to be a decisive factor in the success of GBP. Thus, the sarcopoenic patients would appear to be less suitable candidates for this surgery.
Literature
1.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
2.
go back to reference Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRef Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRef
3.
go back to reference White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass. Obes Surg. 2005;15:155–63.PubMedCrossRef White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass. Obes Surg. 2005;15:155–63.PubMedCrossRef
4.
go back to reference O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.PubMedCrossRef O'Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–40.PubMedCrossRef
5.
go back to reference Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.PubMedCrossRef Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.PubMedCrossRef
6.
go back to reference Mali JJ, Valezi AC, de Menezes MC. Weight loss outcome after silastic ring Roux-en-Y gastric bypass: five years of follow-up. Obes Surg. 2007;17:1287–91.PubMedCrossRef Mali JJ, Valezi AC, de Menezes MC. Weight loss outcome after silastic ring Roux-en-Y gastric bypass: five years of follow-up. Obes Surg. 2007;17:1287–91.PubMedCrossRef
7.
go back to reference Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.PubMed Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60:338–46.PubMed
8.
go back to reference Fobi MA, Lee H, Igwe Jr D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11:190–5.PubMedCrossRef Fobi MA, Lee H, Igwe Jr D, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11:190–5.PubMedCrossRef
9.
go back to reference Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18:648–51.PubMedCrossRef Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18:648–51.PubMedCrossRef
10.
go back to reference Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized. Surg Obes Relat Dis. 2007;3:127–32.PubMedCrossRef Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized. Surg Obes Relat Dis. 2007;3:127–32.PubMedCrossRef
11.
go back to reference Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20 % complication related to PYY. Nutrition. 2008;24:832–42.PubMedCrossRef Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20 % complication related to PYY. Nutrition. 2008;24:832–42.PubMedCrossRef
12.
go back to reference Bloomston M, Zervos EE, Camps MA, et al. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg. 1997;7:414–9.PubMedCrossRef Bloomston M, Zervos EE, Camps MA, et al. Outcome following bariatric surgery in super versus morbidly obese patients: does weight matter? Obes Surg. 1997;7:414–9.PubMedCrossRef
13.
go back to reference Malone M, Alger-Mayer S. Binge status and quality of life after gastric bypass surgery: a one-year study. Obes Res. 2004;12:473–81.PubMedCrossRef Malone M, Alger-Mayer S. Binge status and quality of life after gastric bypass surgery: a one-year study. Obes Res. 2004;12:473–81.PubMedCrossRef
14.
go back to reference Hsu LK, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J Eat Disord. 1996;19:23–34.PubMedCrossRef Hsu LK, Betancourt S, Sullivan SP. Eating disturbances before and after vertical banded gastroplasty: a pilot study. Int J Eat Disord. 1996;19:23–34.PubMedCrossRef
15.
go back to reference Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402.PubMedCrossRef Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402.PubMedCrossRef
16.
go back to reference Stegen S, Derave W, Calders P, et al. Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training. Obes Surg. 2011;21:61–70.PubMedCrossRef Stegen S, Derave W, Calders P, et al. Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training. Obes Surg. 2011;21:61–70.PubMedCrossRef
17.
go back to reference Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19:856–9.PubMedCrossRef Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19:856–9.PubMedCrossRef
18.
go back to reference Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.PubMedCrossRef Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16:1602–8.PubMedCrossRef
19.
go back to reference Lonroth H, Dalenback J, Haglind E, et al. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc. 1996;10:636–8.PubMedCrossRef Lonroth H, Dalenback J, Haglind E, et al. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc. 1996;10:636–8.PubMedCrossRef
20.
21.
go back to reference Reinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.PubMed Reinhold RB. Critical analysis of long-term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.PubMed
22.
go back to reference Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;23:279–89.CrossRef Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;23:279–89.CrossRef
23.
go back to reference Suter M, Giusti V, Héraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.PubMedCrossRef Suter M, Giusti V, Héraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9.PubMedCrossRef
24.
go back to reference Cadière GB, Himpens J, Bazi M, et al. Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results? Obes Surg. 2011;21:692–8.PubMedCrossRef Cadière GB, Himpens J, Bazi M, et al. Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results? Obes Surg. 2011;21:692–8.PubMedCrossRef
25.
go back to reference Slegtenhorst BR, van der Harst E, Demirkiran A, et al. Effect of primary versus revisional Roux-en-Y gastric bypass: inferior weight loss of revisional surgery after gastric banding. Surg Obes Relat Dis. 2012 (in press). Slegtenhorst BR, van der Harst E, Demirkiran A, et al. Effect of primary versus revisional Roux-en-Y gastric bypass: inferior weight loss of revisional surgery after gastric banding. Surg Obes Relat Dis. 2012 (in press).
26.
go back to reference Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.PubMedCrossRef Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.PubMedCrossRef
27.
go back to reference Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.PubMedCrossRef Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30.PubMedCrossRef
28.
go back to reference Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.PubMedCrossRef Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5.PubMedCrossRef
29.
go back to reference Suter M, Ralea S, Millo P, et al. Laparoscopic Roux-en-Y gastric bypass after failed vertical banded gastroplasty: a multicenter experience with 203 patients. Obes Surg. 2012;22:1554–61.PubMedCrossRef Suter M, Ralea S, Millo P, et al. Laparoscopic Roux-en-Y gastric bypass after failed vertical banded gastroplasty: a multicenter experience with 203 patients. Obes Surg. 2012;22:1554–61.PubMedCrossRef
30.
go back to reference Zingg U, McQuinn A, DiValentino D, et al. Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg. 2010;20:1627–32.PubMedCrossRef Zingg U, McQuinn A, DiValentino D, et al. Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg. 2010;20:1627–32.PubMedCrossRef
31.
go back to reference Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMed Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMed
32.
go back to reference Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005;15:316–22.PubMedCrossRef Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005;15:316–22.PubMedCrossRef
33.
go back to reference MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231:524–8.PubMedCrossRef MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass. Ann Surg. 2000;231:524–8.PubMedCrossRef
34.
go back to reference Diniz Mde F, Passos VM, Barreto SM, et al. Different criteria for assessment of Roux-en-Y gastric bypass success: does only weight matter? Obes Surg. 2009;19:1384–92.PubMedCrossRef Diniz Mde F, Passos VM, Barreto SM, et al. Different criteria for assessment of Roux-en-Y gastric bypass success: does only weight matter? Obes Surg. 2009;19:1384–92.PubMedCrossRef
35.
go back to reference Freire RH, Borges MC, Alvarez-Leite JI, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28:53–8.PubMedCrossRef Freire RH, Borges MC, Alvarez-Leite JI, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28:53–8.PubMedCrossRef
36.
37.
go back to reference Fobi MA, Lee H. The surgical technique of the Fobi-Pouch operation for obesity (the transectedsilastic vertical gastric bypass). Obes Surg. 1998;8:283–8.PubMedCrossRef Fobi MA, Lee H. The surgical technique of the Fobi-Pouch operation for obesity (the transectedsilastic vertical gastric bypass). Obes Surg. 1998;8:283–8.PubMedCrossRef
38.
go back to reference Gobble RM, Parikh MS, Greives MR, et al. Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Endosc. 2008;22:1019–22.PubMedCrossRef Gobble RM, Parikh MS, Greives MR, et al. Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Endosc. 2008;22:1019–22.PubMedCrossRef
39.
go back to reference Müller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.PubMedCrossRef Müller MK, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes Surg. 2005;15:1089–95.PubMedCrossRef
40.
go back to reference Ma Y, Patago SL, Olendzki BC, et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg. 2006;16:1227–31.PubMedCrossRef Ma Y, Patago SL, Olendzki BC, et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg. 2006;16:1227–31.PubMedCrossRef
41.
go back to reference Hatoum IJ, Stein HK, Merrifield BF, et al. Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity. 2009;17:92–9.PubMedCrossRef Hatoum IJ, Stein HK, Merrifield BF, et al. Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity. 2009;17:92–9.PubMedCrossRef
42.
go back to reference Melton GB, Steele KE, Schweitzer M, et al. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities and insurance status with outcomes. J Gastrointest Surg. 2008;12:250–5.PubMedCrossRef Melton GB, Steele KE, Schweitzer M, et al. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities and insurance status with outcomes. J Gastrointest Surg. 2008;12:250–5.PubMedCrossRef
43.
go back to reference Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–83.PubMedCrossRef Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–83.PubMedCrossRef
44.
go back to reference Carbonell AM, Wolfe LG, Meador JG, et al. Does diabetes affect weight loss after gastric bypass? Surg Obes Relat Dis. 2008;4:441–4.PubMedCrossRef Carbonell AM, Wolfe LG, Meador JG, et al. Does diabetes affect weight loss after gastric bypass? Surg Obes Relat Dis. 2008;4:441–4.PubMedCrossRef
45.
go back to reference Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass. Arch Surg. 2003;138:541–6.PubMedCrossRef Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass. Arch Surg. 2003;138:541–6.PubMedCrossRef
46.
go back to reference Coupaye M, Sabaté JM, Castel B, et al. Predictive factors of weight loss 1 year after laparoscopic gastric bypass in obese patients. Obes Surg. 2010;20:1671–7.PubMedCrossRef Coupaye M, Sabaté JM, Castel B, et al. Predictive factors of weight loss 1 year after laparoscopic gastric bypass in obese patients. Obes Surg. 2010;20:1671–7.PubMedCrossRef
47.
go back to reference Yip K, Heinberg L, Giegerich V, et al. Equivalent weight loss with marked metabolic benefit observed in a matched cohort with and without type 2 diabetes 12 months following gastric bypass surgery. Obes Surg. 2012 (in press). Yip K, Heinberg L, Giegerich V, et al. Equivalent weight loss with marked metabolic benefit observed in a matched cohort with and without type 2 diabetes 12 months following gastric bypass surgery. Obes Surg. 2012 (in press).
48.
go back to reference Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr. 2003;78:22–30.PubMed Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr. 2003;78:22–30.PubMed
49.
go back to reference van de Laar A, de Caluwé 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. Obes Surg. 2011;21:763–7.PubMedCrossRef van de Laar A, de Caluwé 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. Obes Surg. 2011;21:763–7.PubMedCrossRef
50.
go back to reference Brolin RE, Kenler HA, Gorman RC, et al. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105:337–46.PubMed Brolin RE, Kenler HA, Gorman RC, et al. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989;105:337–46.PubMed
51.
go back to reference Biron S, Hould FS, Lebel S, et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg. 2004;14:160–4.PubMedCrossRef Biron S, Hould FS, Lebel S, et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg. 2004;14:160–4.PubMedCrossRef
52.
go back to reference Dallal RM, Quebbemann BB, Hunt LH, et al. Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obes Surg. 2009;19:732–7.PubMedCrossRef Dallal RM, Quebbemann BB, Hunt LH, et al. Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obes Surg. 2009;19:732–7.PubMedCrossRef
53.
go back to reference Strain GW, Gagner M, Inabnet WB, et al. Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1–2 years after surgery. Surg Obes Relat Dis. 2007;3:31–6.PubMedCrossRef Strain GW, Gagner M, Inabnet WB, et al. Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1–2 years after surgery. Surg Obes Relat Dis. 2007;3:31–6.PubMedCrossRef
54.
go back to reference Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3:521–5.PubMedCrossRef Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3:521–5.PubMedCrossRef
Metadata
Title
Preoperative Fat-Free Mass: A Predictive Factor of Weight Loss after Gastric Bypass
Authors
Maud Robert
Elise Pelascini
Emmanuel Disse
Philippe Espalieu
Gilles Poncet
Martine Laville
Christian Gouillat
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 4/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0781-2

Other articles of this Issue 4/2013

Obesity Surgery 4/2013 Go to the issue