Weight Change and Health Outcomes at 3 Years After Bariatric Surgery Among Individuals With Severe Obesity

IMPORTANCE Severe obesity (body mass index [BMI] ≥35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements, but little is known about long-term outcomes of these operations. OBJECTIVE To report 3-year change in weight and select h...

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Published in:JAMA : the journal of the American Medical Association 2013-12, Vol.310 (22), p.2416-2425
Main Authors: Courcoulas, Anita P, Christian, Nicholas J, Belle, Steven H, Berk, Paul D, Flum, David R, Garcia, Luis, Horlick, Mary, Kalarchian, Melissa A, King, Wendy C, Mitchell, James E, Patterson, Emma J, Pender, John R, Pomp, Alfons, Pories, Walter J, Thirlby, Richard C, Yanovski, Susan Z, Wolfe, Bruce M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Bariatric Surgery
Biological and medical sciences
Cohort Studies
Diabetes
Diabetes Complications
Dyslipidemias - complications
Female
Follow-Up Studies
Gastrointestinal surgery
General aspects
Humans
Hypertension
Hypertension - complications
Male
Medical sciences
Middle Aged
Miscellaneous
Obesity
Obesity - complications
Obesity - surgery
Public health. Hygiene
Public health. Hygiene-occupational medicine
Severity of Illness Index
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Treatment Outcome
Weight control
Weight Loss
Womens health
Young Adult
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Summary:IMPORTANCE Severe obesity (body mass index [BMI] ≥35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements, but little is known about long-term outcomes of these operations. OBJECTIVE To report 3-year change in weight and select health parameters after common bariatric surgical procedures. DESIGN AND SETTING The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. PARTICIPANTS AND EXPOSURE Adults undergoing first-time bariatric surgical procedures as part of routine clinical care by participating surgeons were recruited between 2006 and 2009 and followed up until September 2012. Participants completed research assessments prior to surgery and 6 months, 12 months, and then annually after surgery. MAIN OUTCOMES AND MEASURES Three years after Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), we assessed percent weight change from baseline and the percentage of participants with diabetes achieving hemoglobin A1c levels less than 6.5% or fasting plasma glucose values less than 126 mg/dL without pharmacologic therapy. Dyslipidemia and hypertension resolution at 3 years was also assessed. RESULTS At baseline, participants (N = 2458) were 18 to 78 years old, 79% were women, median BMI was 45.9 (IQR, 41.7-51.5), and median weight was 129 kg (IQR, 115-147). For their first bariatric surgical procedure, 1738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1252 (63%) dyslipidemia, and 1601 (68%) hypertension. Three years after surgery, median actual weight loss for RYGB participants was 41 kg (IQR, 31-52), corresponding to a percentage of baseline weight lost of 31.5% (IQR, 24.6%-38.4%). For LAGB participants, actual weight loss was 20 kg (IQR, 10-29), corresponding to 15.9% (IQR, 7.9%-23.0%). The majority of weight loss was evident 1 year after surgery for both procedures. Five distinct weight change trajectory groups were identified for each procedure. Among participants who had diabetes at baseline, 216 RYGB participants (67.5%) and 28 LAGB participants (28.6%) experienced partial remission at 3 years. The incidence of diabetes was 0.9% after RYGB and 3.2% after LAGB. Dyslipidemia resolved in 237 RYGB participants (61.9%) and 39 LAGB participants (27.1%); remission of hypertension occurred in 2
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2013.280928