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What are the 7-year weight and comorbid health changes following Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding?
In this multicenter longitudinal study, 7-year mean weight loss was 28.4% with weight regain after 3 years of 3.9% for Roux-en-Y gastric bypass and 14.9% with 1.4% weight regain for laparoscopic adjustable gastric banding. The prevalence of dyslipidemia was reduced 7 years following both procedures, and diabetes and hypertension prevalence were reduced following gastric bypass; remission of diabetes at 7 years was 60.2% for Roux-en-Y gastric bypass and 20.3% for laparoscopic adjustable gastric banding.
Most participants maintained much of their weight loss with variable fluctuations over the longer term, and comorbid health improvements were sustained after Roux-en-Y gastric bypass.
More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures.
To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB).
Design, Setting, and Participants
The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years.
Main Outcome and Measures
Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use.
Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants.
Conclusions and Relevance
Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB.
clinicaltrials.gov Identifier: NCT00465829
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Corresponding Author: Anita P. Courcoulas, MD, MPH, Department of Surgery, University of Pittsburgh Medical Center, 3380 Boulevard of the Allies, Ste 390, Pittsburgh, PA 15213 (firstname.lastname@example.org).
Accepted for Publication: September 2, 2017.
Published Online: December 6, 2017. doi:10.1001/jamasurg.2017.5025
Author Contributions: Dr King had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Courcoulas, Belle, Berk, Flum, Garcia, Horlick, Mitchell, Pories, Wolfe.
Acquisition, analysis, or interpretation of data: Courcoulas, King, Belle, Berk, Flum, Gourash, Mitchell, Pomp, Pories, Purnell, Singh, Spaniolas, Thirlby, Wolfe, Yanovski.
Drafting of the manuscript: Courcoulas, King, Singh.
Critical revision of the manuscript for important intellectual content: King, Belle, Berk, Flum, Garcia, Gourash, Horlick, Mitchell, Pomp, Pories, Purnell, Spaniolas, Thirlby, Wolfe, Yanovski.
Statistical analysis: King, Singh.
Obtained funding: Belle, Berk, Flum, Mitchell, Pories, Wolfe.
Administrative, technical, or material support: Courcoulas, Berk, Flum, Gourash, Horlick, Pomp, Pories.
Study supervision: Belle, Horlick, Pories, Spaniolas, Wolfe, Yanovski.
Conflict of Interest Disclosures: Dr Courcoulas reports a research grant from Covidien/Ethicon J&J outside the submitted work. Dr Flum reports receiving fees from an advisory committee role with Pacira Pharm and from a methodology committee role for the Patient Centered Outcomes Research Institute. Dr Gourash reports grants from Covidien/Ethicon outside of the submitted work. Dr Pomp reports speakers honoraria with Medtronic, WL Gore & Associates, and Ethicon. Dr Pories reports grant support from Johnson & Johnson and Nestle Corp, with all funds going directly to the Brody School of Medicine for bariatric and metabolic research. Dr Purnell reports consulting for Novo Nordisk global advisory panel. No other disclosures were reported.
Funding/Support: This clinical study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): grant U01 DK066557 (Data Coordinating Center); grant U01-DK66667 (Columbia University) (in collaboration with Cornell University Medical Center Clinical Translational Research Center, grant UL1-RR024996); grant U01-DK66568 (University of Washington) (in collaboration with CTRC, grant M01RR-00037); grant U01-DK66471 (Neuropsychiatric Research Institute); grant U01-DK66526 (East Carolina University); grant U01-DK66585 (University of Pittsburgh Medical Center) (in collaboration with CTRC, grant UL1-RR024153); and grant U01-DK66555 (Oregon Health & Science University).
Role of the Funder/Sponsor: The NIDDK scientists contributed to the design and conduct of the study, which included collection, and management of data. The project scientist from the NIDDK served as a member of the steering committee, along with the principal investigator from each clinical site and the data coordinating center. the data coordinating center housed all data during the study and performed data analyses according to a plan developed by the data coordinating center biostatistician and approved by the steering committee. The decision to publish was made by the Longitudinal Assessment of Bariatric Surgery-2 Steering Committee, with no restrictions imposed by the sponsor. As coauthors, NIDDK scientists contributed to the interpretation of the data and preparation, review, and approval of the manuscript.
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