Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

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.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 12/2016

01-12-2016 | Original Contributions

Weight-Independent Percentile Chart of 2880 Gastric Bypass Patients: a New Look at Bariatric Weight Loss Results

Authors: Arnold W. van de Laar, Maurits de Brauw, Sjoerd C. Bruin, Yair I. Acherman

Published in: Obesity Surgery | Issue 12/2016

Login to get access

Abstract

Background

Percentile charts would be ideal for assessing sufficient weight loss in bariatric surgery. They allow comparing individual results to the outcome of many others, at any postoperative time. Unfortunately, percentile charts can be problematic when comparing unequally heavy peers, a circumstance not uncommon among bariatric patients. We investigate the relevance of this disadvantage and combine new insights to improve the practical use of percentile charts in bariatric surgery.

Methods

Laparoscopic Roux-en-Y gastric bypass outcome expressed with body mass index (BMI), excess weight loss (%EWL), total weight loss (%TWL), and alterable weight loss (%AWL), a new metric rendering outcome independent of baseline BMI, is used to build percentile curves p97/p90/p75/p50/p25/p10/p03 with the lambda–mu–sigma method. We used the %AWL p25 curve as baseline BMI-independent reference for sufficient weight loss and compared it to p25 curves based on common metrics and to traditional criteria ≥50 % EWL, <25 % EWL, and BMI < 35 kg/m2.

Results

We operated 2880 patients, with baseline BMI of 43.4 kg/m2, follow-up 71 %, and mean of 23.3 (0–87.6) months. Independent %AWL outcome is presented in one percentile chart. Percentile curves p25/p50/p75 show 40/48/57 % AWL at nadir 15/16/19 months, 35/45/54 % AWL at 3 years, and 30/38/47 % AWL at 7 years. Traditional criteria and p25 curves based on %EWL and BMI match with most sufficient results (high sensitivities), but overlook many insufficient results (low specificities).

Conclusions

We present the first baseline BMI-independent bariatric weight loss percentile chart. It allows comparing heavier patients to lighter peers and vice versa, at any postoperative time, up to 7 years. With these advantages, we compared it to traditional bariatric criteria like ≥50 % EWL and found that they are weak in recognizing insufficient weight loss. The visual aspect of consecutive results plotted on a chart among the percentile curves of peers conveys a strong, intuitive message on the personal progress of postoperative weight loss.
Literature
1.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
2.
O’Brien P, McDonald L, Anderson M, et al. Long term outcomes after bariatric surgery: fifteen year follow up after gastric banding and a systematic review of the literature. Ann Surg. 2013;257:87–94.CrossRefPubMed
3.
Hsieh T, Zurita L, Grover H, et al. 10-Year outcomes of the vertical transected gastric bypass for obesity: a systematic review. Obes Surg. 2014;24:456–61.CrossRefPubMed
4.
van de Laar AW, Acherman YI. Weight loss percentile charts of large representative series: a benchmark defining sufficient weight loss challenging current criteria for success of bariatric surgery. Obes Surg. 2014;24(5):727–34.CrossRefPubMed
5.
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(5):734–40.CrossRefPubMedPubMedCentral
6.
DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6(4):347–55.CrossRefPubMed
7.
MacLean L, Rhode B, Sampalis J, et al. Results of the surgical treatment of obesity. Am J Surg. 1993;165:155–60.CrossRefPubMed
8.
9.
Mor A, Sharp L, Portenier D, et al. 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. 2012;8(5):556–60.CrossRefPubMedPubMedCentral
10.
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(6):763–7.CrossRefPubMed
11.
Hatoum IJ, Kaplan LM. Advantages of percent weight-loss as a method of reporting weight-loss after Roux-en-Y gastric bypass. Obesity. 2013;21(8):1519–25.CrossRefPubMedPubMedCentral
12.
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.CrossRefPubMed
13.
van de Laar A. Bariatric Outcomes Longitudinal Database (BOLD) suggests excess weight loss and excess BMI loss to be inappropriate outcome measures, demonstrating better alternatives. Obes Surg. 2012;22(12):1843–7.CrossRefPubMed
14.
15.
van de Laar AW. Algorithm for weight-loss after gastric bypass surgery considering body mass index, gender, and age from the Bariatric Outcome Longitudinal Database (BOLD). Surg Obes Relat Dis. 2014;10(1):55–61.CrossRefPubMed
16.
van de Laar AW, Dollé MH, de Brauw LM, et al. Which baseline weight should be preferred as reference for weight loss results? Insights in bariatric weight loss mechanisms by comparing primary and revision gastric bypass patients. Obes Surg. 2015;25(4):687–93.CrossRefPubMed
17.
Park JY, Kim YJ. Reply to the Letter to Editor entitled “The %EBMIL/%EWL double-booby trap. A comment on studies that compare the effect of bariatric surgery between heavier and lighter patients”. Obes Surg. 2016;26:614–6 (no abstract available).CrossRefPubMed
18.
van de Laar AW, de Brauw LM, Meesters EW. Relationships between type-2 diabetes remission after gastric bypass and different weight loss metrics: arguments against excess weight loss in metabolic surgery. Surg Obes Relat Dis. 2016;12:274–82.CrossRefPubMed
19.
van de Laar AW, Dollé MH, de Brauw LM, et al. Validating the alterable weight loss (AWL) metric with 2-year weight loss outcome of 500 patients after gastric bypass. Obes Surg. 2014;24(7):1085–9.CrossRefPubMed
20.
Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;14:565–8.CrossRef
21.
Cole TJ. The LMS, method for constructing normalized growth standards. Eur J Clin Nutr. 1990;44(1):45–60.PubMed
22.
DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3(2):134–40.CrossRefPubMed
23.
Dixon JB, McPhail T, O’Brien PE. Minimal reporting requirements for weight loss: current methods not ideal. Obes Surg. 2005;15(7):1034–9.CrossRefPubMed
24.
Brethauer SA, Kim J, El Chaar M, et al. ASMBS Clinical Issues Committee. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606.CrossRefPubMed
25.
van de Laar AW. The %EBMIL/%EWL double booby-trap. A comment on studies that compare the effect of bariatric surgery between heavier and lighter patients. Obes Surg. 2015;26:612–3.CrossRef
26.
Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6.PubMedPubMedCentral
27.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMed
28.
Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.CrossRefPubMed
Metadata
Title
Weight-Independent Percentile Chart of 2880 Gastric Bypass Patients: a New Look at Bariatric Weight Loss Results
Authors
Arnold W. van de Laar
Maurits de Brauw
Sjoerd C. Bruin
Yair I. Acherman
Publication date
01-12-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 12/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2200-6

Other articles of this Issue 12/2016

Obesity Surgery 12/2016 Go to the issue

Letter to the Editor

Comment on: “Prediction of Diabetes Remission in Morbidly Obese Patients After Roux-en-Y Gastric Bypass.”

Original Contributions

Changes on Adipose Tissue Distribution After Laparoscopic Roux-en-Y Gastric Bypass in Obese Göttingen Minipig. Effects on Glucose Metabolism

Review Article

The Effectiveness and Safety of Sleeve Gastrectomy in the Obese Elderly Patients: a Systematic Review and Meta-Analysis

Letter to Editor/LED Reply

Malabsorption “Non Olet”

Original Contributions

Perioperative Risks of Untreated Obstructive Sleep Apnea in the Bariatric Surgery Patient: a Retrospective Study

How I Do It

Tips and Tricks of Converting Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in one Stage