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Significant weight loss observed 3 years after bariatric surgery
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Patients who underwent bariatric surgery demonstrated significant weight loss and health improvements to diabetes, blood pressure and lipids after 3 years, according to data published in JAMA and featured in a presentation at Obesity Week 2013.
Anita P. Courcoulas, MD, MPH, of the University of Pittsburgh Medical Center, and colleagues from the Longitudinal Assessment of Bariatric Surgery (LABS) study group followed 2,458 patients (aged 18 to 78 years, 79% women; BMI 45.9) who underwent first-time bariatric surgical procedures between 2006 and 2009, with follow-up until 2012.
Anita P. Courcoulas
“This is one of the first main outcome studies from the LABS group and it looks specifically at weight change and specific health outcomes at 3 years after surgery,” Courcoulas told Endocrine Today.
Results from LABS
Three years after Roux-en-Y gastric bypass (RYGB; n=1,738) or laparoscopic adjustable gastric banding (LAGB; n=610), percent weight change from baseline and the percentage of patients with diabetes with HbA1c <6.5% or fasting plasma glucose values <126 mg/dL without pharmacologic therapy were assessed. An additional 110 patients underwent other procedures, according to data.
“What we found is that bariatric procedures are associated with substantial weight loss at 3 years and there are also improvements in the health conditions of diabetes, hypertension and hyperlipidemia,” Courcoulas said.
Baseline data indicate 33% (n=774) patients had diabetes, 63% (n=1,252) patients had dyslipidemia and 68% (n=1,601) had hypertension.
Most of the weight loss was apparent 1 year after surgery in both groups, according to data. At 3 years, patients who underwent RYGB yielded a percentage of baseline weight loss of 31.5% (41 kg). Those who underwent LAGB demonstrated an actual weight loss of 20 kg (15.9%).
Of those who had diabetes at baseline, 216 patients who underwent RYGB (67.5%) and 28 who underwent LAGB (28.6%) showed partial remission of the disease after 3 years. Further, the incidence of diabetes after RYGB was 0.9% and 3.2% after LAGB, according to researchers. Assessments of lipid profiles established that dyslipidemia was resolved among 237 patients in the RYGB group (61.9%) and 39 in the LAGB group (27.1%); remission of hypertension was evident among 269 patients in the RYGB group (38.2%) and 43 patients in the LAGB group (17.4%), according to data.
There was a tremendous amount of variability in weight change after surgery, according to Courcoulas.
“This study shows that bariatric surgery leads to both significant and substantial weight change, and also fairly high rates of diabetes remission. At least in the severely obese, we can say that gastric bypass is a treatment that should be considered in those that have type 2 diabetes due to the 67% remission rate,” she said.
Related topics and viewpoints
Nicholas J. Christian, PhD, of University of Pittsburgh Medical Center, and other researchers from the LABS study group published a research paper concurrently in JAMA, which was presented as a poster presentation during Obesity Week 2013. The study evaluates the validity of self-reported weights after bariatric surgery.
The group found that small differences exist and may be due to differences in clothing, inaccurate personal scales, and time between measurements, or intentional misrepresentation, according to data.
“In [Christian’s] paper, we looked at how close weights are vs. those that are reported to us by the participants. At least in those undergoing bariatric surgery as part of a research study, those weights are very close — within a kilogram — and that’s a bit different from what the previous literature has reported in that people have underreported their weight,” Courcoulas said.
In an accompanying editorial in JAMA, Sayeed Ikramuddin, MD, of the University of Minnesota, and Edward H. Livingston, MD, deputy editor of JAMA, wrote that the reports provide new and important information about short- and medium-term outcomes of bariatric surgery.
“More rigorous data are needed to elucidate the role of bariatric surgery in obesity treatment,” they wrote. “By filling important knowledge gaps, LABS has demonstrated a good return on investment in bariatric surgery research. More research is needed to know if the metabolic improvements associated with bariatric surgery result in better cardiovascular outcomes and better quality of life.” – by Samantha Costa
For more information:
Christian NJ. JAMA. 2013;doi:10.1001/jama.2013.281043.
Christian NJ. A-196-P. Presented at: Obesity Week; Nov. 11-15, 2013; Atlanta.
Courcoulas AP. JAMA. 2013;doi:10.1001/jama.2013.280928.
Courcoulas AP. Special JAMA Network Symposium: Examining heterogeneity to better understand the benefits and consequences of treatment. Presented at: Obesity Week; Nov. 11-15, 2013; Atlanta.
Ikramuddin S. JAMA. 2013;doi:10.1001/jama.2013.280927.
Disclosure: Courcoulas reports financial ties with Allergan, Covidien, EndoGastric Solutions, Ethicon, Nutrisystem and Pfizer. Ikramuddin reports financial ties with Covidien, EnteroMedics, Medica, MetaModix, Novo Nordisk, ReShape Medical and USGI Medical. See the study for a full list of disclosures.