Young people who keep off weight after bariatric surgery have improved QOL

Last Updated: 2017-08-25

By Marilynn Larkin

NEW YORK (Reuters Health) - Obese adolescents who undergo bariatric surgery and maintain their weight loss experience better quality of life - but it's not clear whether the quality-of-life improvements are a cause or a result of keeping the weight off, researchers say.

"Bariatric surgery produces robust weight loss; however, factors associated with long-term weight-loss maintenance among adolescents undergoing Roux-en-Y gastric bypass surgery (RYGB) are unknown," Dr. Justin Ryder of the University of Minnesota, Minneapolis and colleagues observe.

To investigate, the team analyzed records of 50 severely obese adolescents (mean age, 17; mean BMI, 52) who underwent RYGB from 2001 to 2007 and had a follow-up visit one year post-surgery and a second visit between five and 12 years post-surgery.

Weight trajectories in the RYGB group were compared with a nonsurgical comparison group of 30 adolescents (mean age, 15; mean BMI, 58). The nonsurgical group was offered nutrition counseling, group exercise and behavior modification; however, participation was limited, with only 16 patients completing a follow-up visit at six months and eight patients at one year, according to the International Journal of Obesity report, online August 14.

All study participants completed questionnaires about health and eating behaviors, impact of weight on quality of life, health responsibility, and physical activity at the second follow-up visit.

In the surgical group, the mean decline in BMI was about 39% from baseline to one year, and about 30% from baseline to the second follow-up visit, attributable to some weight regain between the first and second visits. In the nonsurgical comparison group, by contrast, BMI increased from baseline to the second visit by about 10% overall.

To uncover potential contributors to weight-loss maintenance versus weight regain after surgery, the surgical group was split into two subgroups:

- 23 weight-loss maintainers, whose BMI was about 58 at baseline, 36 at one year, and 35 at the second visit;

- 27 weight regainers, whose BMI was about 60 at baseline, 37 at one year, and 48 at the second visit.

However, questionnaire analyses revealed no differences in weight-related and eating behaviors, health responsibility, physical activity/inactivity, or dietary habits between the subgroups, although weight maintainers had better quality-of-life scores - overall and in each subdomain - at the second visit than did regainers.

Dr. Ryder told Reuters Health, "About half (of participants) were able to keep off the weight they lost at one year for up to eight years post-surgery. The other half gained back a portion of the weight, about half, over the same time period."

"The only statistically meaningful difference we found between those who maintained versus those who regained weight post-surgery was better quality of life in the group that maintained," he said by email. "However, we were unable to determine whether this was causative or a byproduct of the better weight control."

"Unfortunately, we were unable to identify any lifestyle factors which might have contributed to the great success among some individuals. However, more-sensitive and objective measures might help identify these factors in the future," he added.

"Another important aspect of this study was that despite a portion of the participants gaining back some weight, their weight was still substantially reduced (relative to) the nonsurgical comparison group," Dr. Ryder concluded.

Dr. Jon Schram, Medical Director, Bariatric Surgery, Spectrum Health, Grand Rapids, Michigan, said, "Our experience certainly mirrors the results of this study, which once again confirms that bariatric surgery provides the best option currently available for the morbidly obese."

"It is important to recognize, however, that surgery merely provides a tool to achieve success and that long-term success is determined by how well the tool is used," he told Reuters Health by email.

"The study is limited by relatively small numbers, but review of the data does indicate that behavior modification, adherence to program guidelines, and an active lifestyle all contribute to long-term success," he noted.

"There was a trend toward significance, and I think if the study population was larger, behavior modification would have been significant," he said. "Our experience has shown that when patients make lifestyle changes for the better, and meet protein goals - 80-100 grams/day for (our institution) - they achieve success."

SOURCE: http://go.nature.com/2gbVzEf

Int J Obes 2017.