Initial weight loss after laparoscopic SG predicts weight maintenance in Asians
Laparoscopic sleeve gastrectomy (SG) appears to be effective in Asians, with early weight loss correlating with midterm weight maintenance and remission of obesity-related comorbidities 1 year after the surgery, according to a study.
In a cohort of 272 patients who underwent the bariatric procedure at a single centre in Singapore, at least half achieved a >50-percent loss in excess weight at 1 month (65.7 percent), 2 months (65.5 percent) and 3 months (50.8 percent). [Surg Obes Relat Dis 2017;doi:10.1016/j.soard.2017.05.016]
Linear regression analysis found a significant correlation between percentage of excess weight loss (%EWL) at 3 months and %EWL in the midterm (1, 2 and 3 years; p≤0.005 for all). Of note, initial EWL of 35 percent at 3 months showed the best accuracy for predicting successful weight loss at 1 year, with 73.1 percent sensitivity and 81.4 percent specificity.
The overall remission rate of comorbidities at 1 year after laparoscopic SG was 22.2 percent for hyperlipidaemia, 55.6 percent for type 2 diabetes mellitus and 17.7 percent for hypertension. This remission was highly likely to occur among patients who achieved the defined cutoff point of >35 percent EWL at 3 months (p≤0.005).
On multiple regression analysis, male gender significantly correlated with %EWL at 3 months, while baseline body mass index (BMI) was inversely associated with %EWL. This suggests that male patients with a higher preoperative BMI were more likely to achieve suboptimal initial weight loss, the investigators said.
The mean age of the cohort was 39.4 years, and majority were female (59 percent) and had one or more comorbidities (62.9 percent). The respective mean preoperative weight and BMI were 115.4 kg and 42.5 kg/m2, with a mean follow-up duration of 27.6 months. Patients were predominantly Malay and Chinese (40 and 31 percent, respectively), while the rest were Indian (24 percent) or of other ethnicity (5 percent).
“The findings of our study have the potential to improve the care of patients undergoing laparoscopic SG,” the investigators said. “Patients that are high-risk for treatment failure can be identified quantitatively and early in the postoperative phase. This will allow for identification and modification of factors contributing to poor weight loss.”
In light of the absence of a standardized follow-up regime after laparoscopic SG, the investigators highlighted the need to conduct randomized controlled trials of behaviour or exercise interventions initiated early in the postoperative period to determine whether such interventions would be of benefit in improving weight-loss outcomes, as well as studies identifying successful habits in patients with long-term weight maintenance.
The present study might be limited by the risk of reporting bias due to the retrospective nature of the study, as well as the failure to examine data of patients who achieved remission of comorbidities after 1 year or those who relapsed.