Original Investigation |

Weight Change and Health Outcomes at 3 Years After Bariatric Surgery Among Individuals With Severe Obesity

Anita P. Courcoulas, MD, MPH1; Nicholas J. Christian, PhD2; Steven H. Belle, PhD, MScHyg2; Paul D. Berk, MD3; David R. Flum, MD, MPH4; Luis Garcia, MD5; Mary Horlick, MD6; Melissa A. Kalarchian, PhD7; Wendy C. King, PhD2; James E. Mitchell, MD8; Emma J. Patterson, MD9; John R. Pender, MD10; Alfons Pomp, MD11; Walter J. Pories, MD10; Richard C. Thirlby, MD12; Susan Z. Yanovski, MD6; Bruce M. Wolfe, MD13; For the Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
[+] Author Affiliations
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
2Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
3Department of Medicine, Columbia University Medical Center, New York, New York
4Department of Surgery, University of Washington, Seattle
5Department of Surgery, University of North Dakota School of Health and Sciences, Grand Forks
6Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
7Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
8Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks
9Department of Surgery, Legacy Good Samaritan Medical Center, Portland, Oregon
10Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
11Department of Surgery, Weill Cornell Medical College, New York, New York
12Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
13Department of Surgery, Oregon Health and Science University, Portland
JAMA. 2013;310(22):2416-2425. doi:10.1001/jama.2013.280928.
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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

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Figure 1.
Flow of Participants Through Recruitment, Follow-up, and Weight Measurements

aWeights of women in their second or third trimester and those up to 6-months postpartum were excluded from analyses.

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Figure 2.
Observed and Modeled Percent Weight Change by Time Point

Lines indicate modeled weight change; data markers, median values; bars, interquartile ranges.

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Figure 3.
Percent Weight Change Trajectories

Growth mixture models were used to estimate weight change trajectories for each participant and to classify participants with similar modeled trajectories into groups. Lines indicate modeled group trajectories; data markers, observed median values; bars, observed interquartile ranges.

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