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Long-term weight loss, diabetes remission maintained after RYGB

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December 6, 2017

Anita Courcoulas
Anita P. Courcoulas

Adults with obesity who underwent Roux-en-Y gastric bypass were likely to maintain much of their weight loss with variable weight fluctuations long term, according to findings published in JAMA Surgery.

Anita P. Courcoulas, MD, MPH, FACS, chief of the division of minimally invasive and metabolic surgery at University Pittsburgh Medical Center, and colleagues evaluated data from the Longitudinal Assessment of Bariatric Surgery (LABS) study on 1,738 adults (median age, 45 years; median BMI, 47 kg/m2; 80% women; 85% white) who underwent Roux-en-Y gastric bypass (RYGB) and 610 adults (median age, 44 years; median BMI, 44 kg/m2; 76% women; 90% white) who underwent laparoscopic adjustable gastric banding (LAGB) between 2006 and 2009 to determine long-term weight changes and health status after surgery. Participants were followed until Jan. 31, 2015. Research assessments were completed before surgery, at 6 months and annually for up to 7 years.

Mean percentage of weight loss at 7 years from baseline was greater in the RYGB group (28.4%) compared with the LAGB group (14.9%). However, mean regain of baseline weight from years 3 to 7 was also greater in the RYGB group (3.9%) than the LAGB group (1.4%).

Prevalence of diabetes, high LDL cholesterol, elevated triglycerides, low HDL cholesterol and hypertension was lower 7 years after RYGB compared with baseline (P < .001 for all). Only the prevalence of low HDL cholesterol and elevated triglyceride levels decreased from baseline to 7 years in the LAGB group (P < .001 for both).

Twenty-eight percent of participants in the RYGB group had diabetes at baseline, and the proportion of those in remission was 71.2% at 1 year, 69.4% at 3 years, 64.6% at 5 years and 60.2% at 7 years. Twenty-nine percent of participants in the LAGB group had diabetes at baseline, and the proportion of those in remission was 30.7% at 1 year, 29.3% at 3 years, 29.2% at 5 years and 20.3% at 7 years.

“For people undergoing gastric bypass, improvements in select health conditions (diabetes, dyslipidemia and hypertension) are also quite durable over time,” Courcoulas told Endocrine Today. “After gastric bypass in this study, remission of diabetes at 7 years was 60%. There was also a very low incidence (less than 1.5%) of new cases of diabetes over time in the group that underwent gastric bypass. In addition, we highlight significant variability in weight loss after both bariatric procedures studied, that points to the need to further understand and characterize more specific subtypes of obesity that may be more or less responsive to surgical treatments.”

In an accompanying editorial, Kelvin D. Higa, MD, clinical professor of surgery at the University of California San Francisco – Fresno Medical Education Program, and Jacques Himpens, MD, PhD, associate professor of surgery at the European School of Laparoscopic Surgery in Brussels, wrote that researchers need to “relentlessly and actively search for the potential harmful and even very long-term adverse effects of the procedures we perform every day.”

“The authors of the LABS study must be commended for their meticulous and valuable work that underscores the benefits of Roux-en-Y gastric bypass and adjustable gastric banding in terms of weight loss and adiposity based on chronic diseases,” they wrote. – by Amber Cox

For more information:

Anita P. Courcoulas, MD, MPH, FACS, can be reached at courcoulasap@upmc.edu.

Disclosures: Courcoulas reports she receives a research grant from Covidien/Ethicon J&J outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.