Obesity at younger age does not diminish bariatric surgery benefits
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Adults who develop obesity by age 20 years and undergo bariatric surgery later in life may experience some more beneficial outcomes of the procedure, but, at the least, will not experience less benefit than those with lower BMI at age 20 years, according to findings published in Diabetes Care.
“For many diseases it is beneficial to treat early; however, individuals with early-onset obesity have usually had their disease a long time when considering surgery. There has been some discussion in the past that since these individuals have had a longer exposure to obesity, bariatric surgery might not be as effective in terms of weight loss or prevention of obesity comorbidities as it is in individuals who became obese as adults,” Johanna C. Andersson-Assarsson, PhD, research coordinator in the department of molecular and clinical medicine at the Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden, told Healio. “Here we show that this is not true, and we believe that this information is relevant for individuals with early-onset obesity considering treatment options for obesity.”
Establishing early-onset obesity
Andersson-Assarsson and colleagues assessed weight loss and the development of type 2 diabetes, microvascular and cardiovascular complications among 2,007 adults who underwent bariatric surgery between age 37 and 60 years and 2,040 matched adults who did not. Participants self-reported their weight at age 20 years, and the researchers used these data to separate those who had surgery into groups with early obesity (BMI 30 kg/m2; n = 528; mean age, 44.9 years; 68.6% women), early overweight (BMI 25-29.99 kg/m2; n = 744; mean age, 47 years; 69.5%) and early normal weight (BMI < 25 kg/m2; n = 725; mean age, 49 years; 73.8% women). The same categories of early obesity (n = 439; mean age, 46.1 years; 70.2% women), early overweight (n = 721; mean age, 48.7 years; 68.9% women) and early normal weight (n = 869; mean age, 50 years; 73.2% women) were created for those who did not undergo surgery.
The researchers followed up with the participants 6 months after surgery and then annually for 4 years and biennially for 6 years, using the Swedish Cause of Death Register and National Patient Register to determine diagnoses of type 2 diabetes, microvascular and CV complications while assessing body weight at each follow-up.
The researchers wrote that 1-year weight loss was about 25% for all participants who had surgery and no more than 3% during the entire study period for those who did not. The researchers also noted that “relative weight loss was largest among those with obesity at 20 years old.”
Effects on diabetes development
Participants with early obesity who underwent surgery were 87% less likely to develop type 2 diabetes in the 10 years after surgery vs. those without surgery (OR = 0.13; 95% CI, 0.07-0.025) while those with early overweight (OR = 0.13; 95% CI, 0.08-0.22) and early normal weight (OR = 0.15; 95% CI, 0.09-0.24) were less likely to develop the condition as well.
On the reverse side, participants with early obesity who underwent surgery and had type 2 diabetes were more likely to go into diabetes remission in the 10 years after surgery vs. those without surgery (OR = 5.58; 95% CI, 1.11-27.96), and the same was true for those with early overweight (OR = 4.9; 95% CI, 1.69-14.17) and early normal weight (OR = 4.51; 95% CI, 1.58-12.86).
According to the researchers, for those with early obesity who had surgery, there was also a reduction in microvascular complication risk regardless of whether type 2 diabetes was present (HR = 0.4; 95% CI, 0.22-0.73) or not (HR = 0.39; 95% CI, 0.23-0.66) vs. those who did not have surgery. Reduced microvascular risks were also observed among those who had surgery for participants with early overweight and type 2 diabetes (HR = 0.58; 95% CI, 0.37-0.9) or without type 2 diabetes (HR = 0.38; 95% CI, 0.25-0.56) and participants with early normal weight and type 2 diabetes (HR = 0.49; 95% CI, 0.32-0.77) or without type 2 diabetes (HR = 0.52; 95% CI, 0.35-0.78).
“We would have expected to find less weight loss and reduced prevention of obesity comorbidities after bariatric surgery in the group with early-onset obesity, but we did not,” Andersson-Assarsson said. “If anything, the weight loss was even slightly higher in the early-onset obesity group, and there was no difference in diabetes remission, microvascular complications, or incidence of diabetes, cardiovascular disease and cancer, compared to individuals who became obese as adults.” – by Phil Neuffer
For more information:
Johanna C. Andersson-Assarsson, PhD, can be reached at johanna.andersson@medic.gu.se.
Disclosures: Andersson-Assarsson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Steven B. Heymsfield, MD, FTOS
Do metabolic and cardiovascular outcomes following bariatric surgery differ according to age of obesity onset? One hypothesis is that because of long duration and the possibility of underlying genetic disturbances in energy balance regulation, people with early onset obesity may have less favorable weight and health outcomes following bariatric surgery compared with those whose excessive weight gain appeared later in life. Kristensson and colleagues explored this question in a prospective controlled Swedish Obese Subjects (SOS) Study.
At 1 year of follow-up, those with early-onset obesity had the largest reductions in body weight, and the control group’s weight losses were minimal. In addition, the larger relative weight loss in the early-onset obesity group persisted out to year 10. Among those without type 2 diabetes at baseline, disease incidence was substantially and similarly lower over a 10-year evaluation interval in all of the surgically treated BMI groups. Remission of type 2 diabetes was also greater and similar in magnitude at the 10-year follow-up among the three surgical BMI groups compared with controls. No between surgical BMI group differences in the incidence of microvascular complications or cardiovascular disease were present with up to 26 years of follow-up.
These important observations of Kristensson and colleagues garnered from the classic SOS Study firmly establish the beneficial metabolic and chronic disease effects of bariatric surgery independent of age at obesity onset.
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