Comment on: Systematic review and retrospective validation demonstrate prediction models can predict weight loss after bariatric surgery

Abstract Background Bariatric surgery is the most effective obesity treatment. Weight loss varies among patients, and not everyone achieves desired outcome. Identification of predictive factors for weight loss after bariatric surgery resulted in several prediction tools proposed. We aimed to validate the performance of available prediction models for weight reduction 1 year after surgical treatment. Materials and Methods The retrospective analysis included patients after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) who completed 1-year follow-up. Postoperative body mass index (BMI) predicted by 12 models was calculated for each patient. The correlation between predicted and observed BMI was assessed using linear regression. Accuracy was evaluated by squared Pearson’s correlation coefficient (R2). Goodness-of-fit was assessed by standard error of estimate (SE) and paired sample t test between estimated and observed BMI. Results Out of 760 patients enrolled, 509 (67.00%) were women with median age 42 years. Of patients, 65.92% underwent SG and 34.08% had RYGB. Median BMI decreased from 45.19 to 32.53kg/m2 after 1 year. EWL amounted to 62.97%. All models presented significant relationship between predicted and observed BMI in linear regression (correlation coefficient between 0.29 and 1.22). The best predictive model explained 24% variation of weight reduction (adjusted R2=0.24). Majority of models overestimated outcome with SE 5.03 to 5.13kg/m2. Conclusion Although predicted BMI had reasonable correlation with observed values, none of evaluated models presented acceptable accuracy. All models tend to overestimate the outcome. Accurate tool for weight loss prediction should be developed to enhance patient’s assessment. Graphical abstract

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How to better predict weight loss and type 2 diabetes remission after bariatric surgery? the potential role of genetic scoring systems in clinical practice

Endocrine Abstracts ◽

10.1530/endoabs.56.gp153 ◽

2018 ◽

Author(s):

Albert Lecube ◽

Rafael Simo ◽

Andreea Ciudin ◽

Sara Pich ◽

Nuria Vilarrasa ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Weight Loss ◽

Potential Role ◽

Scoring Systems ◽

Diabetes Remission ◽

Predict Weight Loss ◽

Type 2 Diabetes Remission

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Invited Discussion on: Body Contouring Surgery Improves Weight Loss after Bariatric Surgery—A Systematic Review and Meta-analysis

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02062-w ◽

2021 ◽

Author(s):

Fabio Xerfan Nahas

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Weight Loss ◽

Meta Analysis ◽

Body Contouring ◽

Body Contouring Surgery

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Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211472 ◽

2017 ◽

Vol 76 (11) ◽

pp. 1870-1882 ◽

Cited By ~ 40

Author(s):

Sabrina M Nielsen ◽

Else M Bartels ◽

Marius Henriksen ◽

Eva E Wæhrens ◽

Henrik Gudbergsen ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Weight Loss ◽

Longitudinal Studies ◽

Randomised Trial ◽

Risk Of Bias ◽

Current Evidence ◽

Short Term ◽

Quality Of Evidence

ObjectivesWeight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout.MethodsWe searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsFrom 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from −168 to 30 μmol/L, and 0%–60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose–response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery.ConclusionsThe available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials).Systematic review registrationPROSPERO, CRD42016037937.

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Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

10.21203/rs.2.10974/v2 ◽

2019 ◽

Author(s):

Jason Davis ◽

Rhodri Saunders

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Change ◽

Health Care Systems ◽

Sensitivity Analyses ◽

Published Data ◽

Morbidity Burden ◽

Co Morbidity ◽

Care Systems ◽

Predict Weight Loss

Abstract Background Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories . The present analysis explores how improving a patient’s post-surgical weight change could impact co‑morbidity prevalence, treatment and associated costs in the Canadian setting. Methods Published data were used to derive statistical models to predict weight loss and co‑morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1,710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

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