Racial Disparities in Bariatric Surgery Postoperative Weight Loss and Comorbidity Resolution: A Systematic Review

Introduction: White patients undergo bariatric surgery more frequently and with fewer complications compared to non-white patients. Yet, racial disparities in referral pattern for preoperative cardiovascular evaluation (CVE) are unexplored. We hypothesized that racial disparities exist in preoperative CVE in white vs. non-white patients undergoing bariatric surgery. Methods: We identified consecutive patients undergoing bariatric surgery at our institution from 2014-2018. The association of white vs. non-white race with referral for CVE, cardiac testing, surgical wait time, and postoperative weight loss was determined in a multivariate model adjusting for baseline demographic comorbidities and income. Additional adjustment for insurance provider was made for surgical wait time. Results: Of the 797 patients undergoing bariatric surgery during the study period, 86% (n=682) were non-white. White vs. non-white patients had similar age, gender distribution, and prevalence of hypertension, hyperlipidemia, Type 2 diabetes, and heart failure. A similar proportion of whites vs. non-whites were referred to cardiology for pre-operative evaluation (65% vs. 68%, p=0.52), while whites were more likely to undergo further preoperative cardiac testing after adjustment (68% vs. 55%, p=0.04; adjusted, OR 0.6, 95%CI 0.35-1.0, p=0.05). Despite less cardiac testing, non-white patients referred to cardiology waited longer for surgery (9.9 months vs. 12.1 months, p=0.008), including after adjustment (HR 0.7, 95%CI 0.53-0.91, p= 0.008. Weight loss at 6 months was higher in whites (12.9 kg/m 2 vs. 11.95 kg/m 2 , p=0.03), but equivalent at 1 year (whites 14.9 kg/m 2 vs. non-whites 14.3 kg/m 2 , p=0.33). Conclusions: In a bariatric surgery population, white vs. non-white patients were referred for CVE in similar proportion. However, white patients underwent more subsequent cardiac testing pre-operatively when compared to non-whites yet had a shorter wait time for surgery. Early weight loss was greater in whites, but equivalent between groups at 1 year.

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Racial disparities in bariatric surgery postoperative weight loss and patient satisfaction

The American Journal of Surgery ◽

10.1016/j.amjsurg.2021.09.011 ◽

2021 ◽

Author(s):

S. Samaan Jamil ◽

Abboud Yazan ◽

Yuan Liyun ◽

Toubat Omar ◽

Mirocha James ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Patient Satisfaction ◽

Racial Disparities ◽

Postoperative Weight Loss

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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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Responsiveness of virtual beverage portion size tasks and prediction of postoperative weight loss in bariatric surgery patients.

Appetite ◽

10.1016/j.appet.2021.105574 ◽

2021 ◽

pp. 105574

Author(s):

Tamima Sultana ◽

Jeon D. Hamm ◽

Jany Dotel ◽

Jeanine Albu ◽

Subhash Kini ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Portion Size ◽

Postoperative Weight Loss

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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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The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

International Journal of Obesity ◽

10.1038/s41366-020-0637-0 ◽

2020 ◽

Vol 44 (11) ◽

pp. 2279-2290

Author(s):

Erik Stenberg ◽

Ingmar Näslund ◽

Carina Persson ◽

Eva Szabo ◽

Magnus Sundbom ◽

...

Keyword(s):

Bariatric Surgery ◽

Socioeconomic Status ◽

Weight Loss ◽

Gastric Bypass ◽

Socioeconomic Factors ◽

First Generation ◽

First Generation Immigrants ◽

Preoperative Body Mass Index ◽

Postoperative Weight Loss ◽

The Mean

Abstract Introduction Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. Materials and methods This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. Results The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B −2.4 [95% CI −2.9 to −1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4–1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4–1.2], p < 0.0001) lost significantly more weight. Conclusions All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.

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