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Bariatric surgery type may predict postoperative BMI
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Adults who undergo bariatric surgery have a greater chance of reducing BMI to less than 30 kg/m2 if they undergo a sleeve gastrectomy, gastric bypass or duodenal switch procedure instead of gastric banding, study data show.
Oliver A. Varban, MD, FACS, FASMBS, assistant professor of surgery in the division of minimally invasive surgery, section of general surgery at the University of Michigan in Ann Arbor, and colleagues evaluated data from the Michigan Bariatric Surgery Collaborative on 27,320 adults undergoing primary bariatric surgery (mean preoperative BMI, 48 kg/m2) between June 2006 and May 2015 to determine predictors for achieving a BMI less than 30 kg/m2 after bariatric surgery. Mean BMI 1 year after surgery was 33 kg/m2.
The most common bariatric surgery procedure performed was Roux-en-Y gastric bypass (RYGB; 44%), followed by laparoscopic sleeve gastrectomy (LSG; 38%), laparoscopic adjustable gastric banding (LABG; 16%) and biliopancreatic diversion with duodenal switch (BPD/DS; 1%).
Overall, 36% of participants achieved a BMI of less than 30 kg/m2 at 1 year after surgery; mean age of the participants was 46.9 years, mean preoperative BMI was 42.66 kg/m2 and the most common surgery performed was RYGB (57%), followed by LSG (36%).
A preoperative BMI of less than 40 kg/m2 (OR = 12.88; 95% CI, 11.71-14.16) and private insurance (OR = 1.09; 95% CI, 1.02-1.16) were significant predictors for achieving the target BMI. A BMI of less than 30 kg/m2 was achieved by 8.5% of participants with preoperative BMI of 50 kg/m2. Achieving a BMI less than 30 kg/m2 was more likely among participants who underwent LSG (OR = 8.37; 95% CI, 7.44-9.43), RYGB (OR = 21.43; 95% CI, 18.98-21.19) and BPD/DS (OR = 82.93; 95% CI, 59.78-115.03) compared with those who underwent LAGB.
Compared with participants who did not reduce their BMI to less than 30 kg/m2, those who did were more likely to discontinue treatment for hyperlipidemia (P < .001), diabetes (insulin, P < .001; oral medications, P < .001) and hypertension (P < .001) and to achieve sleep apnea remission (P < .001) and to report feeling highly satisfied with their surgery (P < .001). Similar overall and serious risk-adjusted 30-day complication rates were observed between participants who did and did not achieve a BMI less than 30 kg/m2.
“Despite its proven safety and efficacy, bariatric surgery remains highly regulated and can be misunderstood by referring physicians and patients alike,” Varban told Endocrine Today. “This study provides additional data to help counsel patients appropriately about weight-loss expectations after bariatric surgery. The findings could help surgical teams counsel prospective patients about realistic expectations and the best timing for surgery. The authors say their results also have implications for how insurers cover weight-loss surgery, including requirements that patients fail to achieve a specific BMI under medically supervised non-surgical options before plans will approve coverage for surgery.”
In an accompanying editorial, Bruce M. Wolfe, MD, and Elizaveta Walker, MPH, both of the division of bariatric surgery, department of surgery at Oregon Health & Science University, wrote that a strength of the study is “that it is a clinical database.”
“However, 50% of attrition of the follow-up weight-loss data at 1 year is potentially problematic,” they wrote. “The authors’ conclusion that bariatric surgery should be more liberally applied to patients with less severe obesity is consistent with multiple reports of improved control of type 2 diabetes, if not remission, among lower-BMI patient populations following [metabolic and bariatric surgery]. However, these reports generally do not refute the importance of weight loss in achieving important clinical benefit among patients with obesity-related comorbid disease.” – by Amber Cox
For more information:
Oliver A. Varban , MD, can be reached at Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
Disclosures: Varban reports obtaining salary support from Blue Cross Blue Shield for participating in quality improvement initiatives and the Executive Committee of the Michigan Bariatric Surgery Collaborative. Please see the study for all other authors’ relevant financial disclosures.
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