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Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study

Markus Brissman Orcid Logo, Andrew Beamish, Torsten Olbers, Claude Marcus

BMJ Open, Volume: 11, Issue: 3, Start page: e046407

Swansea University Author: Andrew Beamish

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DOI (Published version): 10.1136/bmjopen-2020-046407

Abstract

Objective: The study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates of surgical treatment failure. Design: Retrospective analysis of prospectively collected d...

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ 2021
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Setting: 29 surgical units from the whole of Sweden contributed data. Inclusion was restricted to surgical units with a retention rate of &gt;60% five years postsurgery. Participants: 10 633 patients were extracted from SOReg. In total 5936 participants were included in the final sample, 79.1% females. The mean age of participants before surgery was 39.4&#xB1;9 years and mean body mass index (BMI) 42.9&#xB1;5.1. 2322 were excluded (death before the 5-year follow-up (n=148), other types of surgery or reoperations (n=637), age at surgery &lt;18 or &gt;55 years (n=1329), presurgery BMI &lt;35 kg/m2 (n=208)). In total, 2375 (29%) of eligible individuals were lost to the 5-year follow-up. Main outcome: The occurrence of surgical treatment failure 5 years after surgery was based on the three previously published definitions: per cent excess BMI loss &lt;50%, total weight loss &lt;20% or BMI &gt;35 where initial BMI was &lt;50, or &gt;40 where initial BMI was &gt;50. In addition, we report the association between surgical treatment failure and biochemical markers of obesity-related comorbidity. We also developed predictive models to identify patients with a high risk of surgical treatment failure 5 years postsurgery. Results: In total, 23.1% met at least one definition of surgical treatment failure at year 5 which was associated with (adjusted OR) with 95% CI): type 2 diabetes (T2D, OR 2.1; 95% CI 1.6 to 2.7), dyslipidaemia (OR 1.8; 95% CI 1.6 to 2.1) and hypertension (OR 1.9; 95% CI 1.6 to 2.2). Surgical treatment failure at 5 years was predicted by combined demographic and anthropometric measures from baseline, 1 and 2 years postsurgery (area under the curve=0.874). Conclusion: Laparoscopic RYGB leads to a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure, which was associated with a greater risk of relapse and a higher incidence of T2D, dyslipidaemia and hypertension 5 years after surgery. 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spelling 2022-02-04T12:31:49.8467707 v2 59240 2022-01-25 Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study 43134a38044f65aaa75b552062981b81 Andrew Beamish Andrew Beamish true false 2022-01-25 MEDS Objective: The study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates of surgical treatment failure. Design: Retrospective analysis of prospectively collected data from the Scandinavian Obesity Surgery Registry (SOReg). Setting: 29 surgical units from the whole of Sweden contributed data. Inclusion was restricted to surgical units with a retention rate of >60% five years postsurgery. Participants: 10 633 patients were extracted from SOReg. In total 5936 participants were included in the final sample, 79.1% females. The mean age of participants before surgery was 39.4±9 years and mean body mass index (BMI) 42.9±5.1. 2322 were excluded (death before the 5-year follow-up (n=148), other types of surgery or reoperations (n=637), age at surgery <18 or >55 years (n=1329), presurgery BMI <35 kg/m2 (n=208)). In total, 2375 (29%) of eligible individuals were lost to the 5-year follow-up. Main outcome: The occurrence of surgical treatment failure 5 years after surgery was based on the three previously published definitions: per cent excess BMI loss <50%, total weight loss <20% or BMI >35 where initial BMI was <50, or >40 where initial BMI was >50. In addition, we report the association between surgical treatment failure and biochemical markers of obesity-related comorbidity. We also developed predictive models to identify patients with a high risk of surgical treatment failure 5 years postsurgery. Results: In total, 23.1% met at least one definition of surgical treatment failure at year 5 which was associated with (adjusted OR) with 95% CI): type 2 diabetes (T2D, OR 2.1; 95% CI 1.6 to 2.7), dyslipidaemia (OR 1.8; 95% CI 1.6 to 2.1) and hypertension (OR 1.9; 95% CI 1.6 to 2.2). Surgical treatment failure at 5 years was predicted by combined demographic and anthropometric measures from baseline, 1 and 2 years postsurgery (area under the curve=0.874). Conclusion: Laparoscopic RYGB leads to a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure, which was associated with a greater risk of relapse and a higher incidence of T2D, dyslipidaemia and hypertension 5 years after surgery. Poor initial weight loss and early weight regain are strong predictors of long-term treatment failure and may be used for early identification of patients who require additional weight loss support. Journal Article BMJ Open 11 3 e046407 BMJ 2044-6055 2044-6055 2 3 2021 2021-03-02 10.1136/bmjopen-2020-046407 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University This work was funded by the Swedish order of Freemasons (grant no: not applicable), the Swedish Heart- Lung Foundation (grant no: 20180581), the Samariten foundation for pediatric research (grant no: not applicable) and AnnaLisa and Arne Gustafssons foundation (grant no: not applicable). 2022-02-04T12:31:49.8467707 2022-01-25T11:14:12.5866686 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Markus Brissman 0000-0003-1971-6431 1 Andrew Beamish 2 Torsten Olbers 3 Claude Marcus 4 59240__22212__e201b713e1954f1ebf457d6294b80d26.pdf bmjopen-2020-046407.pdf 2022-01-25T11:14:12.5866229 Output 367500 application/pdf Version of Record true This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license true eng https://creativecommons.org/licenses/by/4.0/
title Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
spellingShingle Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
Andrew Beamish
title_short Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
title_full Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
title_fullStr Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
title_full_unstemmed Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
title_sort Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study
author_id_str_mv 43134a38044f65aaa75b552062981b81
author_id_fullname_str_mv 43134a38044f65aaa75b552062981b81_***_Andrew Beamish
author Andrew Beamish
author2 Markus Brissman
Andrew Beamish
Torsten Olbers
Claude Marcus
format Journal article
container_title BMJ Open
container_volume 11
container_issue 3
container_start_page e046407
publishDate 2021
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2020-046407
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
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description Objective: The study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates of surgical treatment failure. Design: Retrospective analysis of prospectively collected data from the Scandinavian Obesity Surgery Registry (SOReg). Setting: 29 surgical units from the whole of Sweden contributed data. Inclusion was restricted to surgical units with a retention rate of >60% five years postsurgery. Participants: 10 633 patients were extracted from SOReg. In total 5936 participants were included in the final sample, 79.1% females. The mean age of participants before surgery was 39.4±9 years and mean body mass index (BMI) 42.9±5.1. 2322 were excluded (death before the 5-year follow-up (n=148), other types of surgery or reoperations (n=637), age at surgery <18 or >55 years (n=1329), presurgery BMI <35 kg/m2 (n=208)). In total, 2375 (29%) of eligible individuals were lost to the 5-year follow-up. Main outcome: The occurrence of surgical treatment failure 5 years after surgery was based on the three previously published definitions: per cent excess BMI loss <50%, total weight loss <20% or BMI >35 where initial BMI was <50, or >40 where initial BMI was >50. In addition, we report the association between surgical treatment failure and biochemical markers of obesity-related comorbidity. We also developed predictive models to identify patients with a high risk of surgical treatment failure 5 years postsurgery. Results: In total, 23.1% met at least one definition of surgical treatment failure at year 5 which was associated with (adjusted OR) with 95% CI): type 2 diabetes (T2D, OR 2.1; 95% CI 1.6 to 2.7), dyslipidaemia (OR 1.8; 95% CI 1.6 to 2.1) and hypertension (OR 1.9; 95% CI 1.6 to 2.2). Surgical treatment failure at 5 years was predicted by combined demographic and anthropometric measures from baseline, 1 and 2 years postsurgery (area under the curve=0.874). Conclusion: Laparoscopic RYGB leads to a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure, which was associated with a greater risk of relapse and a higher incidence of T2D, dyslipidaemia and hypertension 5 years after surgery. Poor initial weight loss and early weight regain are strong predictors of long-term treatment failure and may be used for early identification of patients who require additional weight loss support.
published_date 2021-03-02T14:12:35Z
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