The amount of weight found after bariatric surgery predicts health risks

Measuring the percentage of weight recovered after maximal weight loss after bariatric surgery can help predict the risk of several serious health problems in a patient, according to a long-term multicenter study conducted by Graduate researchers School of Public Health of the University of Pittsburgh.

The results, published today in JAMA, also found that while study participants averaged maximum weight loss two years after surgery, they varied considerably and that about 20% continued to lose weight more than four years after the surgery. surgery. Regardless of the time of maximum weight loss, the rate of weight recovery was highest in the first year following the maximum weight loss. This indicates that early detection and treatment of weight recovery could be important.

"Clinicians and patients want to know the extent of weight recovery after bariatric surgery and how this could affect their health." However, the lack of a standard measure of weight gain and of a variable follow-up led to inconsistent results from one study to another, "said the manager. author Wendy C. King, Ph.D., associate professor in the Department of Epidemiology at Pitt Public Health. "Our study will help clinicians and patients understand the timing, scale and impact of weight recovery, and will lead to new studies on how best to avoid and manage the disease. weight recovery for better health outcomes. "

King and his colleagues followed 1,406 adults with gastric bypass in Roux-en-Y, measuring an average of 8.3 times over an average of 6.6 years. Participants were enrolled in the Longitudinal Evaluation of Bariatric Surgery-2 (LABS-2) funded by the National Institutes of Health, a prospective observational study of patients undergoing weight loss surgery in one of the 10 hospitals in the United States.

In addition to the percentage weight loss found, the team looked at several other ways to characterize weight recovery after maximal weight loss, such as body mass index, as a percentage of weight before surgery, as a percentage of weight the number of kilograms recovered. To evaluate health outcomes, they examined the course of diabetes, hypercholesterolemia and high blood pressure; and declining quality of life related to physical and mental health and satisfaction with surgery.

When each of the ways to measure weight gain was assessed based on each of the health outcomes, the researchers found that the percentage of maximum weight loss had the strongest associations with the different health outcomes.

To understand how to calculate weight gain in this way, let's take someone who lost 150 pounds after bariatric surgery, then took back 28 pounds. This person found 19% of his maximum weight lost. This level of weight recovery was associated with an increased risk of diabetes progression of 51% and a 28% higher risk of deterioration in quality of life related to physical health, which indicates to a clinician that this level of weight recovery can lead to progression or development of various health problems.

"Our study can help service providers identify the best way to calculate weight gain after bariatric surgery in order to more specifically identify patients at risk of recurrence or new health problems." ", said lead author Anita P. Courcoulas, MD, MPH, Invasive Bariatric Surgery at UPMC. "It highlights the importance of close long-term follow-up to help optimize weight and health outcomes following bariatric surgery."

In the first year after maximal weight loss, 10% of participants experienced diabetes progression, 26% high cholesterol, and 46% high blood pressure. A clinically significant decline in quality of life related to physical and mental health was observed by 20% and 28% of participants, respectively, and 12% reported a decrease in satisfaction with their weight loss surgery.

Five years after the maximum weight loss, the proportion of participants with negative health outcomes increased to 35% for diabetes, 68% for high cholesterol, 72% for high blood pressure, 42% for % and 33% for the deterioration of the quality of physical and mental health. life, respectively, and 28% for decreased satisfaction with surgery.

Although the rate of weight regain decreased over time, participants continued to regain weight throughout the LABS-2 follow-up, indicating that health professionals should be careful over time, and not not just measure at a standard post-surgery time. The researchers noted that future work would be needed to develop tools that allow patients and providers to better recognize and understand the impact of weight recovery. To contribute to this effort, they created an online supplement containing numbers showing the recovery and decrease in weight of clinical outcomes over time after maximum weight loss.

King noted that five years after achieving maximum weight loss, participants maintained an average of 73% of their maximum weight loss. "Thus, despite regaining weight, in general, patients who have had surgery are healthier," she said.

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More information:
"Comparison of performance of common measures of weight recovery after bariatric surgery for association with clinical outcomes", jamanetwork.com/journals/jama/… 1001 / jama.2018.14619