Background characteristics and postoperative outcomes of insufficient weight loss after laparoscopic sleeve gastrectomy in Japanese patients

Abstract

AimLaparoscopic sleeve gastrectomy (LSG) is becoming popular in Japan, but insufficient weight loss is often observed in patients after LSG. We investigated the effect of LSG on obesity‐related comorbidities and identified the background characteristics of Japanese patients with insufficient weight loss after LSG.MethodsIn this multi‐institutional retrospective study at 10 certified bariatric institutions, 322 Japanese patients who underwent LSG with a follow‐up period of more than 2 years were analyzed. Anthropometry, obesity‐related comorbidities and psychosocial background data were collected. Weight loss was expressed as 2‐year percent total weight loss (%TWL).ResultsMean age, body weight, body mass index (BMI) and glycated hemoglobin were 46.9 years, 119.2 kg, 43.7 kg/m2 and 7.1%, respectively. Prevalence of mental disorders was 26.3%. Mean BMI declined to 30.3 kg/m2 at 2 years and %TWL was 29.9%. Improvements in the markers and prevalence of obesity‐related comorbidities were observed. Remission rates of diabetes, dyslipidemia and hypertension were 75.6%, 59.7% and 41.8%, respectively. %TWL at the respective cut‐off level of diabetes remission was 20.8%. Lower remission rates of diabetes in patients with %TWL <20%, and less calorie restriction and higher prevalence of mental disorders (46.9%) in patients with %TWL <15% were observed. Frequencies of %TWL <15% and <20% were 6.5% and 18.5%, respectively.Conclusion%TWL 20% was a candidate cut‐off point of insufficient weight loss for diabetes remission after LSG, and mental disorders might be relevant to intractable obesity in Japanese patients.

Impact of Mental Health Background and Nutrition Intake on Medium-Term Weight Loss in Japanese Patients Undergoing Laparoscopic Sleeve Gastrectomy

“…The U-shaped relationship between frequency of mental disorders and %TWL was reported for the first time by J-SMART [6], and their finding is supported by the present study. A previous study reported that mood disorders were the most common mental disorder in obese individuals, followed by binge eating disorder and anxiety disorders [15].…”

“…A previous review concluded that one study found no difference in weight loss at 1 year but less weight loss at 4 years in patients with preoperative depression, but 4 other studies found no difference in postoperative weight loss between patients with and those without preoperative depression [14]. The U-shaped relationship between frequency of mental disorders and %TWL was reported for the first time by J-SMART [6], and their finding is supported by the present study. A previous study reported that mood disorders were the most common mental disorder in obese individuals, followed by binge eating disorder and anxiety disorders [15].…”

“…The prevalence of mental disorders at the time of preoperative evaluation in the J-SMART study was 26.3%, compared with the prevalence of 20.9–37.8% reported by previous studies [7-9]. One of the notable findings of the J-SMART study was a high prevalence of mental disorders in patients with <15% total weight loss and in those with ≥45% [6]. In other words, the relationship between frequency of mental disorders and %TWL was a U-shaped curve.…”

“…However, the evidence regarding the association between preoperative mental health conditions and postoperative weight loss remains controversial. In Japan, the multicenter J-SMART study was the first to investigate the relationship between the prevalence of mental disorders and %TWL in patients undergoing LSG [6]. The J-SMART study revealed that the prevalence of mental disorders was significantly higher both in the extremely low and high %TWL groups.…”

“…LSG has become a popular treatment option also in Japan, because LSG is the only bariatric procedure covered by the national health insurance. A nationwide survey conducted by the retrospective study group Japanese Survey of Morbid and Treatment-Resistant Obesity (J-SMART) reported that percent total weight loss (%TWL) was 29.9% and complete diabetes remission rate was 75.6% after 2 years of LSG [6]. The prevalence of mental disorders at the time of preoperative evaluation in the J-SMART study was 26.3%, compared with the prevalence of 20.9-37.8% reported by previous studies [7][8][9].…”