Worse bariatric surgery outcomes for Hispanics?

Last Updated: 2015-11-10

By Will Boggs MD

NEW YORK (Reuters Health) - Hispanics appear to have less weight loss after bariatric surgery than non-Hispanic whites, according to a single institution retrospective review.

"What works for Caucasians may not work for Hispanics," Dr. Oscar K. Serrano from Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, told Reuters Health by email. "There is something unique about Hispanics and why they are especially susceptible to obesity and obesity-related diseases."

In order to address the paucity of information about long-term outcomes of bariatric surgery among Hispanic patients, Dr. Serrano's team evaluated excess-weight loss (EWL) at six, 12, 24 and 36 months among 2,002 Hispanic patients and 133 non-Hispanic white patients who underwent bariatric surgery at their institution from 2008 through 2014.

Their findings were published online October 24 in the Journal of the American College of Surgeons.

Depending upon the specific procedure, EWL among Hispanic patients ranged from 26.3% to 44.1% at six months, 32.6% to 57.4% at 12 months, 29% to 58.6% at 24 months, and 27% to 55.4% at 36 months.

"Bariatric surgery is highly successful in Hispanic obese patients. However, the outcomes are "still markedly reduced when compared to non-Hispanic populations, the authors report.

EWL percentages were consistently highest after laparoscopic gastric bypass and lowest for laparoscopic gastric banding, with rates for laparoscopic sleeve gastrectomy falling in between.

"More research needs to be done to study the metabolism of obese Hispanic patients to understand how they respond to medical and surgical treatment and why they do so in such a way," Dr. Serrano said.

"Our study raises more questions than answers," he noted, "and these questions should be addressed in clinical trials that aim to understand the fundamental shortcomings among Hispanics."

Dr. Karen J. Coleman from Kaiser Permanente Southern California, Pasadena, recently reported three-year weight outcomes of bariatric surgery for Kaiser Permanente's healthcare system.

"There are a number of problems with making blanket statements about an ethnic group and their response to treatment," Dr. Coleman, who was not involved in the new study, told Reuters Health by email.

"Especially for a group as diverse as Hispanics, whose heritage comes from very different parts of the world with different cultural practices related to health behaviors. We just do not know enough about the Hispanic patients that have contributed to the bariatric literature so far," Dr. Coleman said.

"I do not for a minute believe that there are inherent physiologic differences between Hispanics and whites," she said. "There are two main reasons I think there are differences: 1. I believe, and this is conjecture because we have not studied it, that Hispanic people may come to bariatric surgery sicker than whites. There is evidence that minority patients wait until their conditions are more severe to seek medical care when compared to whites. We have shown in our own work that the longer a patient has diabetes the less likely bariatric surgery will result in remission. So, it is possible that Hispanic patients have a higher and more severe disease burden than whites at the time of surgery and this would attenuate the effects of surgery for this population. . . . 2. Hispanic cultures value food and eating as a form of social bonding and support. A Hispanic bariatric patient cannot participate in this practice the same way they did before surgery. They must often refuse the food offered to them and this creates conflict in their families."

Dr. Coleman concluded, "We need to get Hispanic patients, who suffer disproportionately from severe obesity and diabetes, to surgery earlier. We need culturally responsive programs post-surgery to provide Hispanic patients with resources and skills to deal with the barriers they encounter to successful weight loss."

Dr. Sarah E. Messiah from The University of Miami Leonard M. Miller School of Medicine, who has studied the effect of ethnicity on weight loss in adolescents in the year after bariatric surgery, said, "Indeed, ethnicity has shown to be a powerful predictor of post-WLS (weight-loss surgery) weight loss outcomes and attendance (at) post-WLS follow-up care appointments in our local practice that is predominantly ethnic minority patients (70% Hispanic, 20% non-Hispanic black). Specifically, we have found that up to 2-years after WLS, mean BMI reduction patterns and number of follow up visits are similar among non-Hispanic whites and Hispanics, and significantly better than non-Hispanic blacks. So, at this point the literature is mixed."

"We believe that perhaps we see similar EWL outcomes in our Hispanic and non-Hispanic white patients because Hispanics are in fact the dominant culture here and as such, act as non-Hispanic white patients do in other geographic area," she told Reuters Health by email.

Dr. Messiah, who was not involved in the new study, said patients' environments need to be taken into account.

"From a socioecological perspective, WLS patients need diverse resources and support for weight loss self-management in their daily lives including (1) individualized assessment, (2) collaborative goal-setting, (3) opportunities to learn post-WLS-specific skills specific to weight loss (e.g., measuring food amounts, daily physical activity goals) and to address challenges, including negative emotions, that may interfere with management, (4) ongoing follow-up and support, (5) community resources, such as facilities for regular physical activity and stores/markets that offer healthy diet options, and (6) continuity of quality clinical care," she said.

"In summary, it makes little sense to teach a WLS patient about post-WLS lifestyle changes while ignoring their environment (neighborhood, culture, community, work place)," she said.

SOURCE: http://bit.ly/1QfsUrC

J Am Coll Surg 2015.