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Real-world retrospective analysis of outcomes in patients undergoing bariatric surgery with class 1 obesity

Published:January 24, 2022DOI:https://doi.org/10.1016/j.soard.2022.01.011

      Highlights

      • This study includes 1,296 patients across many institutions in the US with class I obesity.
      • Patients lost up to 20% of their initial BMI.
      • At around two years after the surgery, the likelihood of being in remission from type 2 diabetes reached 45%.
      • Remission probabilities for hypertension are 60% for RYGB and 50% for SG, three years after the surgery; hyperlipidemia are close to 50% and 25% for RYGB and SG at two years.
      • There was no difference between the BMI trajectories and remission from T2D when comparing the two groups.

      Abstract

      Background

      NIH-established indications for bariatric surgery were set close to 3 decades ago.

      Objectives

      The purpose of this study was to evaluate outcomes in patients undergoing bariatric surgery with class I obesity, a class that does not fall into current indications.

      Setting

      University Hospital.

      Methods

      De-identified records from a clinic system’s Electronic Health Record database were accessed to identify adult patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 566) and sleeve gastrectomy (SG) (n = 730). Patients were compared in terms of resolution of co-morbidities and weight loss outcomes at 3 years following surgery. A mixed effects model was used, adjusting for the type of surgery, the number of quarters after the surgery when the averaged measurements were taken, and the interaction between these two variables.

      Results

      Patients lost up to 20% of their initial body mass index (BMI). Being of younger age, female, and having an obesity-related co-morbidity were associated with greater weight loss. At around 2 years after the surgery, the likelihood of being in remission from type 2 diabetes reached 45%. Remission probabilities for hypertension are 60% for RYGB and 50% for SG, 3 years after the surgery. On the other hand, the probabilities of remission from hyperlipidemia are close to 50% and 25% for RYGB and SG at 2 years. There was no difference between the BMI trajectories and remission from type 2 diabetes (T2D) when comparing the 2 groups.

      Conclusions

      Bariatric surgery is effective in weight loss and resolution of comorbidities in patients with class I obesity. This data further supports the need to revisit the current indication criteria.

      Key words

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      Linked Article

      • Comment on: Real-world retrospective analysis of outcomes in patients undergoing bariatric surgery with class 1 obesity
        Surgery for Obesity and Related DiseasesVol. 18Issue 5
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          The rationale that bariatric surgery should be performed in patients with body mass index (BMI) ≥35 kg/m2 is getting weaker [1]. For bariatric surgery, evidence of durable weight loss and effective co-morbidity resolution in class I obesity has been accumulated, and some countries, including Korea, are implementing insurance benefits for class I obesity with co-morbidities. Altieri et al. (2021) [2] conducted a significantly meaningful study that presented additional evidence of the usefulness of bariatric surgery in cases of class I obesity.
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