Prevalence of insufficient weight loss 5 years after Roux-en-Y gastric bypass: metabolic consequences and prediction estimates: a prospective registry study

Abstract

ObjectiveThe study aimed to investigate the heterogeneity of weight loss 5 years after Roux-en-Y gastric bypass (RYGB) and the association with cardiometabolic health as well as to model prediction estimates of surgical treatment failure.DesignRetrospective analysis of prospectively collected data from the Scandinavian Obesity Surgery Registry (SOReg).Setting29 surgical units from the whole of Sweden contributed data. Inclusion was restricted to surgical units with a retention rate of >60% five years postsurgery.Participants10 633 patients were extracted from SOReg. In total 5936 participants were included in the final sample, 79.1% females. The mean age of participants before surgery was 39.4±9 years and mean body mass index (BMI) 42.9±5.1. 2322 were excluded (death before the 5-year follow-up (n=148), other types of surgery or reoperations (n=637), age at surgery <18 or >55 years (n=1329), presurgery BMI <35 kg/m2 (n=208)). In total, 2375 (29%) of eligible individuals were lost to the 5-year follow-up.Main outcomeThe occurrence of surgical treatment failure 5 years after surgery was based on the three previously published definitions: per cent excess BMI loss <50%, total weight loss <20% or BMI >35 where initial BMI was <50, or >40 where initial BMI was >50. In addition, we report the association between surgical treatment failure and biochemical markers of obesity-related comorbidity. We also developed predictive models to identify patients with a high risk of surgical treatment failure 5 years postsurgery.ResultsIn total, 23.1% met at least one definition of surgical treatment failure at year 5 which was associated with (adjusted OR) with 95% CI): type 2 diabetes (T2D, OR 2.1; 95% CI 1.6 to 2.7), dyslipidaemia (OR 1.8; 95% CI 1.6 to 2.1) and hypertension (OR 1.9; 95% CI 1.6 to 2.2). Surgical treatment failure at 5 years was predicted by combined demographic and anthropometric measures from baseline, 1 and 2 years postsurgery (area under the curve=0.874).ConclusionLaparoscopic RYGB leads to a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure, which was associated with a greater risk of relapse and a higher incidence of T2D, dyslipidaemia and hypertension 5 years after surgery. Poor initial weight loss and early weight regain are strong predictors of long-term treatment failure and may be used for early identification of patients who require additional weight loss support.

Comparison of one anastomosis gastric bypass versus standard Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion, in a case-matched, non-superobese population: 6 years of follow-up

“…mon after this procedure; Brissman et al reported that 23.1% of cases met the definition of surgical treatment failure at 5 years[23]. Our results are consistent with these published data.…”

Development and validation of a scoring system for pre-surgical and early post-surgical prediction of bariatric surgery unsuccess at 2 years

“…The use of %EWL for the evaluation of BS weight-outcome has been recently questioned, mostly due to its dependency on pre-BS weight excess 37 , 38 , with the percentage of total-weight-loss (%TWL), calculated as: being proposed as an alternative parameter 37 , 38 . However, there is still no consensus in literature about which threshold to adopt for the definition of BS unsuccess, since %TWL < 20% was proposed by some authors 37 – 39 , while %TWL < 25% was suggested by others 40 . Therefore, to the scope of this study, we opted to use %EWL as the reference parameter for model development, due to the availability of an unanimously recognized cut-off for the definition of BS unsuccess; nevertheless, in order to further strengthen the consistency of our results, final model performances were also assessed considering %TWL as the outcome of choice.…”

Patients’ Experiences of Weight Regain After Bariatric Surgery

“…The Longitudinal Assessment of Bariatric Surgery study (LABS) shows mean weight regain of about 4% after Roux-en-Y gastric bypass (RYGB) 3 to 7 years after surgery [5], while other studies e.g. from Sweden [6] and the Netherlands [4] report that 20 to 24% of patients have regained more than 15% of their body weight 5 years after RYGB or sleeve gastrectomy. The exact prevalence of weight regain is difficult to estimate, since a definition for weight regain has not been established [4,7].…”