Obesity Subtype May Determine Outcomes After Bariatric Surgery

There are distinct subgroups or subtypes of obesity and some of these groups, including adults with disordered eating, may derive more benefit from bariatric surgery than other individuals, according to findings published in Obesity.

Although it is the most effective method for losing weight, there is considerable variability for weight loss in patients who undergo bariatric surgery. This suggests that obesity is a heterogeneous disease and equal success should not be expected from all individuals treated with surgery. In this study, researchers sought to identify subgroups of patients with obesity and investigate the association between obesity subtype and weight change following bariatric surgery. A cohort of 2458 adults who participated in the Longitudinal Assessment of Bariatric Surgery study was followed for up to 7 years.

A total of 4 different subtypes of obesity were identified in this population: diabetes with low rates of high-density lipoprotein (Class 1), disordered eating (Class 2), mixed (Class 3), and early-onset extreme obesity (Class 4). Median body mass index was much higher in Class 4 vs other classes, while Class 1 had elevated glucose, triglyceride levels, and diabetes incidence and the lowest high-density lipoprotein of the 4 groups.

Subtype was found to be predictive of 3-year weight change. Class 4 participants had an average change of -25% (men) and -30.3% (women) in their baseline weight during the 3-year study period. Participants in Class 2 (men, -3.41%; women, -3.0%) and Class 3 (men, -3.05%; women, -1.97%) achieved significantly greater 3-year weight loss vs patients with early-onset extreme obesity in Class 4. Weight loss in Class 1 did not significantly differ from Class 4.

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The researchers noted that “identifying subgroups of people who are undergoing bariatric surgery may help to identify those who would most benefit from bariatric surgery, as well as identify those in need of additional modalities to achieve an optimal postoperative weight change.”

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Field AE, Inge TH, Belle SH, et al. Association of obesity subtypes in the Longitudinal Assessment of Bariatric Surgery Study and 3-year postoperative weight change. Obesity. 2018;26(12):1931-1937.