In examining factors that may be predictive of successful weight loss after bariatric surgery, researchers found that characteristics such as employment status and age may be linked to weight regain over the long term, according to study results published in BMC Endocrine Disorders. Nevertheless, they concluded that more research is needed to evaluate what factors most closely align to successful long-term outcomes.
Approximately 15% to 35% of patients who undergo bariatric surgery do not achieve their goal of losing ≥50% of excess body weight in the first 2 years after surgery. Studies have consistently shown that older patients and patients with a higher body mass index (BMI) are less likely to reach a normal weight after surgery, but factors that indicate a need for early interventions after surgery for patients who are not losing enough weight have not yet been determined.
To examine potential early predictors of achieving a postsurgical weight loss goal, a retrospective analysis of data from the medical files of 130 patients who underwent bariatric surgery between 2012 and 2017 was performed. The average age of the patients was 48±9 years. Most patients were women (81.5%), 52% had an education of ≥9 years (equivalent to high school), 67% were married or living with a partner, and 35% did not have a full-time job. The median BMI at the first evaluation was 48 kg/m2 (interquartile range, 44-52 kg/m2), and 40% of the population had a BMI of ≥50 kg/m2. At initial evaluation, 57% of patients had hypertension and 29% had dyslipidemia.
One year after bariatric surgery, 80% of patients had lost ≥50% of their excess body weight, which the researchers defined as a successful outcome. Patients in the successful outcome group were younger than those in the unsuccessful outcome group (46±9 vs 52±8 years; P =.005); had lower rates of previous abdominal surgeries (46% vs 69%; P =.03), anxiety and depression (11% vs 27%; P =.03), and hypertension (52% vs 77%; P =.02); and were less likely to have a full-time job (P =.05). Presence of a higher number of obesity-related comorbidities was also correlated with a lower likelihood of a successful outcome (P =.02). Of all procedures, laparoscopic one-anastomosis gastric bypass surgery was the most likely to end in a successful outcome (57%), and gastric sleeve surgery was the least likely (9%; P =.001). Of all the factors examined, lack of full-time employment, procedure type, and previous abdominal surgery were the only persistent negative predictors for a successful surgery.
There was no significant difference in initial BMIs, percentage of excess body weight lost before surgery, amount of exercise or calories registered, or dietary content after surgery between the successful and unsuccessful groups.
Although bariatric surgery is considered the most effective therapy for weight loss and obesity-related comorbidities in patients with severe disability, not all patients are equally good candidates. “In this study we found that 1 out of every 5 patients that underwent bariatric surgery did not achieve the goal of losing 50% of the excess weight during the first 12 months of surgery,” the researchers noted. “This translates to the fact that 20% of all the patients that fulfilled the selection criteria will end up being considered to be a failed surgery and nothing more.”
“[This] is really an area of opportunity to implement additional weight loss strategies that will keep the patient motivated and in better health, instead of waiting for them to regain weight,” they added. To account for the variety in individuals who undergo bariatric surgery, some nuance in long-term treatment design may be necessary, and success may mean different things for different patient populations.
Further investigation is required to establish the best diagnostic, therapeutic, and follow-up strategy for each center that provides bariatric surgery care.
Cadena-Obando D, Ramírez-Rentería C, Ferriera-Hermosillo A, et al. Are there really any predictive factors for a successful weight loss after bariatric surgery? BMC Endocr Disord. 2020;20(20).