Quality of Life after Bariatric Surgery

Weight loss surgery is helping in the reduction of Type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, sexual dysfunction, and even the mortality rate.

Bariatric surgery is recommended by the National Institute of Health for Obese patients with a body mass index (BMI) of at least 40 or less obese patients with serious coexisting medical condition I and a BMI of at least 35. According to National Health and Nutrition Examination Survey, 34% of Americans have metabolic syndrome, with a waist circumference greater than or equal to 102cm (men) or 88cm (women); triglyceride greater than or equal to 150 mg/dl, HDL less than 40 mg/dl (men) or 50 mg/dl (women); hypertension greater than or equal to 130/85 mmHg; and fasting glucose greater than or equal to 100 mg/dl.

The purpose of this study is to determine whether surgical weight loss helps in the reduction of type 2 diabetes and decreases mortality rate. Numerous prior studies have demonstrated a connection between drastic surgical weight loss and an improvement in type 2 diabetes, as well as a decrease in mortality rate. The primary endpoint of bariatric surgery is weight loss. The overall percentage of excess weight loss (EWL) is 47-70%. A systematic review discovered EWL greater than 50 %. A meta-analysis study also concluded that adjustable gastric banding (AGB) is associated with less weight loss.

In another prospective observational study, 4,776 consecutive patients undergoing a bariatric surgery reported a low mortality rate of 0.3%. There are a number of complications associated with surgical weight loss surgery, about 70%, such as myocardial infarction and pulmonary embolism, which are the major causes of mortality. Those with higher mortality rate after bariatric surgery are patients with a higher BMI, males, older age, smokers and those with multiple comorbidities.

Observational and meta-analysis both demonstrate that bariatric surgery is effective in controlling type 2 diabetes, decreasing anti-diabetic drug usage and a high remission rates. Of the 135,246 subjects using meta-analysis, 78% had complete resolution with HbA1c less than 6.5%. However, factors like shorter duration of diabetes, greater weight loss, and former oral antidiabetic drug usage are some of the anticipating reasons of type 2 diabetes remission. For clinical outcome, a study performed by Brethauer et al performed between 2004 and 2007 had a mean estimated weight loss of 55% and a mean HbA1c, which decreased from 7.5±1.5% to 6.5±1.2%.

In another study organized at Cleveland clinic, 150 patients with T2DM were randomized to conventional medical therapy with HbA1c level of 7.5±1.8% in the medical therapy group. For the mortality rate, a meta-analysis of 44,022 subjects from eight trials demonstrated a reduced risk of global mortality with (OR =0.58, CI 0.49-0.63).

Another study was organized to determine whether bariatric surgery improves one’s sexual function. Patients undergoing this procedure fill gender relevant questionnaires, whereby their sexual performance is assessed. This is done before the surgery and 6-7 months after surgery. A statistical analysis test was done using SPSS 11.0 software. Continuous variables were compared using student t-test for independent samples. Of the 51 patients who underwent the surgery, 48 of them finished the second half after the 6-7 months post-surgery questionnaires. With a P less than 0.001, the results were statistically significant. Of the 43 women, 20 of them had a Female Sexual Function Index (FSFI) score of 24.66 before surgery, indicating a sexual dysfunction; but only 4 remained with dysfunction after post-surgery. This indicated a P less than 0.001. For the men, there was a baseline of 40.2 to 43.9, so they did not achieve statistical significance. This study shows that weight loss positively influences sexual function in the obese population. A limitation of this study included a low response by bariatric patients.

In conclusion, there have been a number of studies that have broadened our knowledge on the safety and efficacy of bariatric procedures and the effect on obesity, type 2 diabetes, and sexual dysfunction. The surgery therefore helps to improve one’s quality of life.

Life after Bariatric Surgery in Adolescents

The authors of this study say the benefits of weight loss surgery for younger patients may persist for years. Since this was only a three-year study, I think this is a lot of speculation on their part.

While adolescent obesity is becoming an epidemic, with numbers doubling from 800 to 1,600 from 2003 to 2009 or six years, the bariatric surgeons must be licking their chops for the additional income.

Bariatric surgery is one of the feasible therapies for seriously obese adolescents. It includes a variety of procedures: reducing the size of a stomach with a gastric band, or removal of a portion, or resecting or rerouting to a small stomach pouch. To date there have been limited prospective studies analyzing BMI and other outcomes of currently used procedures. The purpose of the study is to examine the efficacy and safety of bariatric surgery in adolescents, even years after treatment.

The study was a multicenter, observational study using adolescents who were less than 19 years of age. They had to be obese and were recruited for undergoing bariatric surgery. The Committee of the study was made up of a Principal Investigator, a Data Coordinator, and a project scientist; this took place from March 2007 to February 2012. Data was collected at 6 months, 1, 2 and 3 years postoperative, with most research visits taking place at clinical centers or the subjects’ homes. Outcomes measured were weight loss, quality of life, coexisting conditions and micronutrient outcomes, using linear mixed and separate models. Poisson regression was also used to calculate unadjusted rates and 95% confidence interval.

Of the 242 adolescents recruited, 161 (67%) did Roux-en-Y gastric bypass and 67 (28%) did sleeve gastrectomy. 98% of participants had a BMI of more than 40, with the majority from a low income household. 99% of the cohort participated and completed 88% of all postoperative visits through the 3-year study endpoint. 90% completed all visits at 1 year, 89% at 2 years and 85% at 3 years. The mean weight reduction at 3 years was 41 kg, with a mean percentage weight loss of 27% (95% confidence interval).

At baseline, all participants were obese with a BMI greater than 30, but by 3 years 26% were no longer obese. 96 participants had an elevated blood pressure at baseline, but normalized by 3 years after their surgery with 74% of them having 95% confidence interval. For 171 participants with dyslipidemia at baseline, 66% were at a normalized value at 3 years (95% confidence interval) without lipid-lowering therapy drugs. For participants with abnormal kidney function, 86% of them had a normalized kidney function (95% confidence interval). For diabetes, there was no improvement in patients with type 1 after 3 years, but type 2 had a confidence interval of 95%, median glycated hemoglobin of 5.3%, a median fasting glucose of 88 mg/dl and median insulin of 12 IU/ml. The mean quality of life score was 63 (95% CI) at baseline, but increased to 83 by 3 years with a P less than 0.001 after the surgery.

For nutritional measures, patients had low levels of ferritin at the end of 3 years from baseline with 57% (95% confidence interval) and P less than 0.001. For vitamin B12, only 8% had a deficiency at the end of 3 years as compared to a baseline of 35%. 16% of participants who went through this surgery had vitamin A deficiency at the end of 3 years. One participant died from complications of hypoglycemia 3 years after surgery. Of the intra-abdominal procedures related to bariatric surgery 24% were performed within the first year, 55% within the second year and 21% within third year.

In conclusion, there was a significant reduction of weight, obesity, and coexisting conditions, and increase in their quality of life. However, there were specific deficiencies in micronutrients; therefore, multivitamin and mineral supplementation is needed. Abdominal procedures show an increased risk with bariatric surgery in the adolescent population.

A study of 53 younger adolescents with a mean age of 14 years had a mean BMI decrease of 20 and an increase of 5 cm in mean height 3 years after sleeve gastrectomy. This indicates that adolescents can lose a clinically significant amount of weight after bariatric surgery, and the majority of patients were able to maintain meaningful weight loss for at least 3 years.

The weakness of this study includes the use of a small population size, especially the diabetes sample size; also, the observational nature of the study introduces heterogeneity into the data. Additionally, the lack of a control group made it difficult to place the postoperative changes in weight and health status completely into perspective since behavioral treatment can result in modest improvement in weight and cardio-metabolic health.