Resumen de Weight Change and Health Outcomes at 3 Years After Bariatric Surgery Among Individuals With Severe Obesit
Anita P. Courcoulas, Nicholas J. Christian, Steven Belle, Paul D. Berk, David R. Flum, Luis García, Mary Horlick, Melissa A. Kalarchian, Wendy C. King, James E. Mitchell, Emma J. Patterson, John R. Pender, Alfons Pomp, Walter J. Pories, Richard C. Thirlby, Susan Z. Yanovski, Bruce M. Wolfe
Importance Severe obesity (body mass index [BMI] =35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements, but little is known about long-term outcomes of these operations.
Objective To report 3-year change in weight and select health parameters after common bariatric surgical procedures.
Design and Setting The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers.
Participants and Exposure Adults undergoing first-time bariatric surgical procedures as part of routine clinical care by participating surgeons were recruited between 2006 and 2009 and followed up until September 2012. Participants completed research assessments prior to surgery and 6 months, 12 months, and then annually after surgery.
Main Outcomes and Measures Three years after Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), we assessed percent weight change from baseline and the percentage of participants with diabetes achieving hemoglobin A1c levels less than 6.5% or fasting plasma glucose values less than 126 mg/dL without pharmacologic therapy. Dyslipidemia and hypertension resolution at 3 years was also assessed.
Results At baseline, participants (N?=?2458) were 18 to 78 years old, 79% were women, median BMI was 45.9 (IQR, 41.7-51.5), and median weight was 129 kg (IQR, 115-147). For their first bariatric surgical procedure, 1738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1252 (63%) dyslipidemia, and 1601 (68%) hypertension. Three years after surgery, median actual weight loss for RYGB participants was 41 kg (IQR, 31-52), corresponding to a percentage of baseline weight lost of 31.5% (IQR, 24.6%-38.4%). For LAGB participants, actual weight loss was 20 kg (IQR, 10-29), corresponding to 15.9% (IQR, 7.9%-23.0%). The majority of weight loss was evident 1 year after surgery for both procedures. Five distinct weight change trajectory groups were identified for each procedure. Among participants who had diabetes at baseline, 216 RYGB participants (67.5%) and 28 LAGB participants (28.6%) experienced partial remission at 3 years. The incidence of diabetes was 0.9% after RYGB and 3.2% after LAGB. Dyslipidemia resolved in 237 RYGB participants (61.9%) and 39 LAGB participants (27.1%); remission of hypertension occurred in 269 RYGB participants (38.2%) and 43 LAGB participants (17.4%).
Conclusions and Relevance Among participants with severe obesity, there was substantial weight loss 3 years after bariatric surgery, with the majority experiencing maximum weight change during the first year. However, there was variability in the amount and trajectories of weight loss and in diabetes, blood pressure, and lipid outcomes.
Trial Registration clinicaltrials.gov Identifier: NCT00465829 Bariatric surgery results in large, sustained weight loss in severely obese populations. Although generally accepted as the most effective means for inducing weight loss in very heavy patients, few studies exist reporting outcomes longer than 2 years after the surgery was performed. Long-term outcome studies that do exist are mostly case series, are from limited geographical areas, or report surgical procedures no longer performed.1- 5 For example, high-quality long-term outcomes from the Swedish Obesity Study are well described, but most of the participants underwent a vertical banded gastroplasty procedure, an operation no longer used.6- 8 Six-year follow-up after Roux-en-Y gastric bypass (RYGB) was reported, but these data may not be generalizable because all the participants were from 1 surgical practice in Utah.9 Even though surgically induced weight loss is much more effective than nonsurgical treatments for seriously obese patients, surgery is still not universally accepted because of incomplete knowledge of long-term outcomes from the procedures.
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium was formed to acquire long-term data on the safety, effectiveness, and durability of bariatric surgical procedures currently performed in the United States using standardized data collection practices. LABS is a multicenter, observational cohort study with standardized and detailed data collection protocols. LABS has 3 phases; LABS-1, LABS-2, and LABS-3.10 The 30-day safety of bariatric surgery was reported in LABS-1.11 LABS-2 focused on longer-term safety, outcomes, and durability of health changes. The major priorities for LABS-2 were to determine weight, medical, surgical, and behavioral outcomes, including incidence and remission of comorbid conditions, and to evaluate patient, procedure, and other characteristics that were associated with these outcomes. LABS-3 included 2 substudies that examined mechanisms of diabetes change and psychosocial aspects in more detail.
We now report the major clinical outcomes from LABS-2, including 3-year weight change from baseline and diabetes, lipid, and hypertension outcomes after RYGB and laparoscopic adjustable gastric band (LAGB) procedures.
