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Weight Loss Is Not All That Matters after Bariatric Surgery

May 11, 2009

Roux-en-Y gastric bypass (RYGBP) corrects comorbidities and quality of life similarly in superobese and morbidly obese patients despite higher residual weight in superobese patients, according to the results of a prospective cohort study.

Michel Suter, MD, PD, from Hôpital du Chablais, Aigle-Monthey, Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, writes, “Several recent studies have shown that bariatric surgery not only provides weight loss and relief from comorbidities but also decreases mortality, especially from cardiovascular and cancer causes…. The aim of this prospective study was to compare the results of RYGBP in a large group of SO [superobese] and MO [morbidly obese] patients during a 5-year period, regarding not only weight loss but also correction of comorbidities and improvement of quality of life.”

Between January 1, 1999, and June 30, 2006, at a university hospital and community hospital with common bariatric programs, 492 morbidly obese and 133 superobese patients were treated consecutively with primary laparoscopic RYGBP. Primary endpoints of the study were operative morbidity, weight loss, residual body mass index (BMI calculated as weight in kilograms divided by height in meters squared), change in comorbid conditions, quality of life, and Bariatric Analysis and Reporting Outcome System score.

Although surgery took longer in superobese patients, operative morbidity was similar in both groups. In the morbidly obese group, maximal weight loss was 15 BMI units and average maintained weight loss after 6 years was 13 BMI units. For superobese patients, the corresponding figures were 21 and 17 BMI units, corresponding to a 30.1% and 30.7% total body weight loss, respectively.

In more than 90% of morbidly obese patients but in less than 50% of superobese patients, BMI was less than 35 kg/m2 after 6 years. However, despite differences in residual weight and in BMI after 6 years, both groups had similar and impressive improvements in quality of life and comorbidities.

“Although many SO patients remain in the severely obese or MO category, equivalent improvements in quality of life and obesity-related comorbidities indicate that weight loss is not all that matters after bariatric surgery,” the study authors write. “Longer follow-up will be necessary to evaluate whether these improvements persist over time and whether and how much long-term weight regain, a recognized problem especially in the SO, affects them.”

In an invited critique, Jon Gould, MD, from the University of Wisconsin School of Medicine and Public Health in Madison, notes that the primary objective of bariatric surgery is improved health.

“Rather than reporting surgical results in terms of percentage of EWL [excess weight loss], the bariatric surgical community should emphasize the changes in health and quality of life that follow these operations,” Dr. Gould writes. “Weight loss is the first outcome discussed in our bariatric surgery lectures, in our clinical encounters with patients, and in our published reports. It is no wonder that, despite mountains of clinical evidence touting the health benefits of bariatric surgery, it is still acceptable for insurance companies to deny benefits for ‘weight-loss surgery.'”
Arch Surg. 2009;144:312-318.



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Diabetes Care, April 2009