Polygenic risk score for predicting weight loss after bariatric surgery

Toro‐Martín, Juan de; Guénard, Frédéric; Tchernof, André; Pérusse, Louis; Marceau, Simon; Vohl, Marie‐Claude

doi:10.1172/jci.insight.122011

Cited by 34 publications

(27 citation statements)

References 37 publications

(57 reference statements)

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“…There are multiple factors influencing weight loss outcomes after surgery. Among them, genetics in the form of single nucleotide polymorphisms (SNPs), [11] gender and race have been found to influence weight loss outcomes. [10] Future studies may identify ways that patient care can be optimised for patients with these different characteristics to improve outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Factors such as gender, race and genetics have been investigated, [10][11][12] but with an aim to improving surgical outcomes, these characteristics are not readily modifiable parameters and clinical application of these contributors remains to be determined. [12] Other interventions may yet be possible, however, given the observation that early post-surgical results during the time of greatest patient contact have been shown to be a reliable predictor of longer term results [10] and a retrospective audit identified missing post-surgical clinical attendance as a main predictor of poor long-term weight loss.…”

Section: Introductionmentioning

confidence: 99%

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Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Davis¹,

Saunders²

2019

Preprint

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Background Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories . The present analysis explores how improving a patient’s post-surgical weight change could impact co‑morbidity prevalence, treatment and associated costs in the Canadian setting. Methods Published data were used to derive statistical models to predict weight loss and co‑morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1,710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Davis¹,

Saunders²

2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Some differences are expected, as different types of surgery offer varying degrees of weight loss and morbidity resolution. 2,4,5 Different weight trajectories have been observed after the same type of surgery, [6][7][8] with corresponding differences in comorbidity resolution. 6,7 Barriers to reaching surgery may also exist, including patient perceptions and health care system impediments such as capacity and meeting surgical criteria.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

Davis

Saunders

2020

JAMA Netw Open

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IMPORTANCE Information on the associations between barriers to delivery of bariatric surgery and poor weight trajectory afterward is lacking. Estimates are needed to inform decisions by administrators and clinicians to improve care. OBJECTIVE To estimate the difference in patient-years of treatment for diabetes, hypertension, and dyslipidemia and public-payer cost between the Canadian standard and an improved bariatric surgery care pathway. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation of a decision analytic model comparing the outcomes of the standard care in Canada with an improved bariatric care pathway with earlier sleeve gastrectomy delivery and better postsurgical weight trajectory. The model was informed by published clinical data (101 studies) and meta-analyses (11 studies) between January and May 2019. Participants were a hypothetical 100-patient cohort with demographic characteristics derived from a Canadian study. INTERVENTIONS Reduction of Canadian mean bariatric surgery wait time by 2.5 years following referral and improvement of patient postsurgery weight trajectory to levels observed in other countries. MAIN OUTCOMES AND MEASURES Modeling weight trajectory after sleeve gastrectomy and resolution rates for comorbidities in Canada in comparison with an improved care pathway to estimate differences in patient-years of comorbidity treatment over 10 years following referral and the associated costs. RESULTS For the 100-patient cohort (mean [SD] 88.2% [1.4%] female; mean [SD] age, 43.6 [9.2] years; mean [SD] body mass index, 49.4 [8.2]; and mean [SD] comorbidity prevalence of 50.0% [4.1%], 66.0% [3.9%], and 59.3% [4.0%] for diabetes, hypertension, and dyslipidemia, respectively) over 10 years following referral, the improved vs standard care pathway was associated with median reduction in patient-years of treatment of 324 (95% credibility interval [CrI], 249-396) for diabetes, 245 (95% CrI, 163-356) for hypertension, and 255 (95% CrI, 169-352

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“…Among patients who do receive surgery, there is a wide range of outcomes for weight loss and comorbidity resolution. Differences occur between surgery types, and within the same surgical cohort, where some patients experience good trajectories with considerable early and sustained weight loss with concomitant co-morbidity resolution, while others follow poorer trajectories of lower weight loss and persistent co-morbidities [10,11]. The latter, poorer weight loss may result in insufficient improvement in weight status to reduce co-morbidity risks, both extending the risks to patient health and maintaining a high burden of care for payers.…”

Section: Introductionmentioning

confidence: 99%

“…The reasons for different weight trajectories after the same type of surgery remain to be elucidated. Factors such as sex or gender, race and genetics have been investigated, [10][11][12] but with an aim to improving surgical outcomes, these characteristics are not readily modifiable parameters and clinical application of these contributors remains to be determined [12]. Other interventions may yet be possible, however, given the observation that early post-surgical results during the time of greatest patient contact have been shown to be a reliable predictor of longer term results [10] and a retrospective audit identified missing post-surgical clinical attendance as a main predictor of poor long-term weight loss [13].…”

Section: Introductionmentioning

confidence: 99%

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Davis

Saunders

2020

BMC Health Serv Res

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Background: Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories. The present analysis explores how improving a patient's post-surgical weight change could impact co-morbidity prevalence, treatment and associated costs in the Canadian setting. Methods: Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results: Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions: Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

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Polygenic risk score for predicting weight loss after bariatric surgery

Abstract: Heart and Stroke Foundation of Canada (G-17-0016627) and Canada Research Chair in Genomics Applied to Nutrition and Metabolic Health (no. 950-231-580).

Cited by 34 publications

References 37 publications

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

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