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Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity

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Abstract

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for morbid obesity resulting in approx. 70% excess weight loss (EWL) at 1–2 years. The aim of this study was to identify factors predictive of inadequate EWL following primary LRYGB.

Methods

Data on consecutive patients who underwent primary LRYGB between September 2009 and March 2013 were collected prospectively. The effects of age, gender, baseline body mass index (BMI), preoperative EWL, length of time between initial consultation and surgery (TtS), presence of diabetes mellitus (DM), arthritis, obstructive sleep apnea (OSA) and postoperative length of hospital stay (LOS) on EWL at 12 months were studied. General linear regression models were used to evaluate group differences in EWL and to assess independent associations between baseline variables and EWL at 12 months. Stepwise regression analyses were used to estimate individual contributions of independent variables to the variance in EWL at 12 months. In this study, inadequate EWL was defined as <50% EWL at 12 months.

Results

LRYGB was performed in 227 patients with a mean ± SD age and BMI of 48.6 ± 11 years and 53.6 ± 7.1 kg/m2, respectively. Female to male ratio was 3:1. EWL at 12 months had an inverse correlation with age (p = 0.01), baseline BMI (p < 0.001), TtS (p = 0.001), OSA (p = 0.039) and DM (p = 0.039). Conversely, there was a significant positive association between preoperative EWL and that at 12 months (p = 0.009). There was no effect of gender, arthritis or LOS on EWL at 12 months. Multiple regression analysis demonstrated inadequate EWL at 12 months to be predicted by older age (>60 years), patients with diabetes, higher baseline BMI (>60), those who gained weight preoperatively and in patients who waited longer than 18 months for surgery (p = 0.027).

Conclusions

Preoperative factors that predict inadequate EWL at 12 months following primary LRYGB include higher initial BMI, older age, presence of DM and preoperative weight gain. Identification of these factors preoperatively should aid in providing intensive support to these at-risk patient groups.

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Acknowledgements

Preliminary findings from this paper were presented at the 32nd American Society of Metabolic and Bariatric Surgery annual meeting (ASMBS), Los Angeles, USA, and published in abstract form (SOARD 2015; 11: S61).

Author information

Authors and Affiliations

  1. The East-Midlands Bariatric & Metabolic Institute (EMBMI), Royal Derby Hospital, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, UK

    Waleed Al-Khyatt, Rebecca Ryall, Paul Leeder & Sherif Awad

  2. Cleveland Clinic, Digestive Diseases Institute, Abu Dhabi, United Arab Emirates

    Javed Ahmed

  3. School of Medicine, University of Nottingham, Derby, DE22 3DT, UK

    Sherif Awad

Authors
  1. Waleed Al-Khyatt
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  2. Rebecca Ryall
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  3. Paul Leeder
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  4. Javed Ahmed
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  5. Sherif Awad
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Corresponding author

Correspondence to Sherif Awad.

Ethics declarations

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this was a retrospective study, formal consent was not required.

Conflict of Interest

The authors have no direct conflict of interest to declare. Author 5 has received unrestricted educational and travel grants from Fresenius Kabi, Nestle Nutrition, Medtronic, Ethicon EndoSurgery, Merck Sharp & Dohme, Fischer & Paykel Healthcare Ltd. and BBraun. He has received honoraria and consultancy fees from Apollo Endosurgery, Merck Sharp & Dohme and Fischer & Paykel Healthcare Ltd. He has also completed a bariatric fellowship funded via an educational grant from Ethicon EndoSurgery (paid to the institution). Author 3 has received unrestricted educational grants from Ethicon, Medtronic and Allergan. He has received honoraria from Karl Storz and Allergan.

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There was no funding source for this study.

Additional information

Javed Ahmed and Sherif Awad are joint senior authors

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Al-Khyatt, W., Ryall, R., Leeder, P. et al. Predictors of Inadequate Weight Loss After Laparoscopic Gastric Bypass for Morbid Obesity. OBES SURG 27, 1446–1452 (2017). https://doi.org/10.1007/s11695-016-2500-x

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  • DOI: https://doi.org/10.1007/s11695-016-2500-x

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