Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in the short term, the long-term impacts of surgery within this group and the sustainability of weight loss after surgery remains unclear. Objectives: We aimed to assess the long-term weight outcomes after bariatric surgery. Setting: The study was conducted at King Khalid University Hospital (KKUH), King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Methods: An observational prospective cohort study on adult patients with severe obesity undergoing bariatric surgery (sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB)) during the period between 2009 and 2015 was conducted. Weight loss patterns were evaluated pre- and post-surgery through clinical and anthropometric assessments. Absolute weight loss was determined, and outcome variables: percent excess weight loss (%EWL), percent total weight loss (%TWL), and percent weight regain (%WR), were calculated. Statistical analysis using univariate and multivariate general linear modelling was carried out. Results: A total of 91 (46 males and 45 females) patients were included in the study, with the majority belonging to the SG group. Significant weight reductions were observed at 1 and 3 years of follow-up (p < 0.001) from baseline. The %EWL and %TWL were at their maximum at 3 years (72.4% and 75.8%) and were comparable between the SG and RYGB. Decrements in %EWL and %TWL and increases in %WR were seen from 3 years onwards from bariatric surgery until the study period ended. The yearly follow-up attrition rate was 20.8% at 1 year post-surgery, 26.4% at year 2, 31.8% at year 3, 47.3% at year 4, 62.6% at year 5, and 79.1% at end of study period (at year 6). Conclusion: The major challenge to the successful outcome of bariatric surgery is in maintaining weight loss in the long-term and minimizing weight regain. Factors such as the type of surgery and gender need to be considered before and after surgery, with an emphasis on the need for long-term follow-up to enssure the optimal benefits from this intervention.

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Abstract P203: Demographic Predictors of Long-term Weight Loss Beginning One-Year After Bariatric Surgery at Two Medical Centers

Circulation ◽

10.1161/circ.129.suppl_1.p203 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Laura Rasmussen-Torvik ◽

Abigail Baldridge ◽

Jennifer Pacheco ◽

Sharon Aufox ◽

Kwang-Young Kim ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Mixed Effects ◽

Mixed Effects Models ◽

Linear Mixed Effects ◽

Post Surgery ◽

Percentage Weight

Objective: Existing studies of predictors of weight loss after bariatric surgery suffer from simplistic statistical methods and relatively short follow-up. We sought to determine predictors of long-term weight loss up to 9.6 years after bariatric surgery using data extracted from two electronic health records (EHR) systems and linear mixed effects models. Methods: Participants were selected from patients enrolled in the NUgene biorepository at either Northwestern Memorial HealthCare or NorthShore University HealthSystem. Individuals who had undergone Roux-en-Y gastric bypass (RNY) were identified through billing or surgical history procedure codes in the electronic health records (EHRs). All available weight measurements and dates were extracted from the EHR as well as surgery date. Sex, race/ethnicity, education, marital status, and height were taken from the NUgene intake questionnaire. SAS PROC MIXED was used to create linear mixed effects models to examine weight loss from 1- 9.6 years post-surgery. To examine overall weight loss and slope of weight regain, covariates and covariate interactions with time post-surgery were included in the mixed effects models. Results: 119 individuals from Northwestern and 43 individuals from NorthShore had undergone gastric bypass and had at least 1 weight measurement 1 year post-surgery. There were 3071 weight measurements which occurred at least 1 year post-surgery in the dataset; the median number of observations per person was 10 and the median weight loss represented by these measurements was 32.7% from pre-surgical weight. The regression model indicated that, on average, individuals experienced slight weight regain of about 0.8% of pre-surgical weight per year after their first year post-surgery. Over the 1- 10 years of follow up African Americans lost nearly 5 percentage points less weight than whites ( p =.0025) . People who were older and taller also experienced less percentage weight loss, and people with higher initial weights experienced a higher percentage weight loss (all p <.05), Older age was associated with significantly (p<0.05) slower weight regain after 1 year post-surgery. Discussion: EHR records from multiple institutions can be integrated to study outcomes after bariatric surgery. Demographic factors predict overall weight loss and a rate of weight regain after 1 year post RNY surgery. This information may be useful for both surgeons and prospective patients.

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0876 Obstructive Sleep Apnea, Low PAP Use, and Daytime Sleepiness are Associated with Weight Regain Following Bariatric Surgery in Adolescents with Severe Obesity

SLEEP ◽

10.1093/sleep/zsaa056.872 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A334-A334

Author(s):

J L Kaar ◽

L Patten ◽

A Kaizer ◽

S M Hawkins ◽

J M Moore ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Daytime Sleepiness ◽

Weight Regain ◽

Protective Factor ◽

Severe Obesity ◽

Post Surgery ◽

Obstructive Sleep ◽

Ameliorative Effect ◽

The Impact

Abstract Introduction Significant weight loss is seen following bariatric surgery, leading to an ameliorative effect on obesity-related comorbidities such as OSA. Weight loss maintenance is a priority, and identifying factors that may be associated with weight loss outcomes following bariatric surgery is of high importance. The current study examined whether OSA symptoms and PAP therapy were associated with weight outcomes following bariatric surgery in adolescents. Methods Participants from the Teen-LABS Study, which follows adolescents undergoing bariatric surgery were examined. Demographic and anthropometric data, OSA diagnosis, and PAP prescription and self-reported usage information were assessed 6 months before surgery. Pediatric Sleep Questionnaire (PSQ) responses were utilized from baseline to 48 months post-surgery. All analyses were adjusted for time, age, sex, surgery type, and ethnicity. Results 242 adolescents (76% female, 72% White, age at surgery = 16.6 [1.6] years) were included. 57% had a diagnosis of OSA at pre-surgical baseline, and 56% of adolescents with OSA reported PAP use at pre-surgery. BMI increase over time from year 1-4 post-surgery was 11% more for those with high PSQ severity compared to those with low PSQ severity (p = 0.01). Those with pre-surgical OSA that reported using PAP “often” or “always” at baseline had an 8% lower increase in BMI from year 1-4 post-surgery compared to those that reported using PAP “rarely” or “sometimes” at baseline (p = 0.004). Finally, endorsing daytime sleepiness on the PSQ was associated with a 11% greater increase in BMI during years 1-4 post-surgery (p = 0.01). Conclusion OSA and daytime sleepiness may be associated with greater weight regain following bariatric surgery in adolescents. Adherence to PAP therapy pre-surgery may be a protective factor in preventing or reducing weight regain following surgery. Daytime sleepiness may be an effect of OSA, or due to the insufficient sleep that is prevalent among adolescents. Research is needed to examine the impact of additional aspects of sleep health such as duration, timing, and quality on health outcomes, as well as the impact of PAP adherence and sleep interventions on weight regain following bariatric surgery in adolescents with severe obesity. Support None.

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Bariatric surgery in adolescents with obesity - long term perspectives and potential alternatives

Hormone Research in Paediatrics ◽

10.1159/000520810 ◽

2021 ◽

Author(s):

Rana Halloun ◽

Ram Weiss

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Severe Obesity ◽

Lifestyle Modification ◽

Perioperative Complications ◽

Nutritional Deficiencies ◽

Long Term Effects ◽

Long Term Outcome

Background: Severe obesity among adolescent shows a worrisome trend in regard of its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index (BMI) with little perioperative complications. Despite the increasing utilization of BS, data is still insufficient, regarding their long-term outcome in adolescents. We review short and long-term effects of bariatric surgery and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. Summary: BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow up, shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. Key Messages: We conclude that obese adolescents without major obesity related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity related complications with proper pre-operative preparation and post operative follow up in excellence centers.

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Abstract P342: Associations Between Sleep Duration and Sleep Quality and Long-Term Weight Status in Post-Bariatric Surgery Patients

Circulation ◽

10.1161/circ.137.suppl_1.p342 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Elsa Thomas ◽

Devon Roeshot ◽

Dympna Gallagher ◽

Marie-Pierre St-Onge

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Sleep Quality ◽

Sleep Duration ◽

Weight Change ◽

Weight Status ◽

Post Surgery ◽

Post Bariatric Surgery

Introduction: The prevalence of obesity continues to rise since 1980. This obesity epidemic has been paralleled by a trend of reduced sleep duration and sleep quality throughout the years. However, there is limited research on the relation between sleep duration and quality and its association with weight loss maintenance. The purpose of this study was to examine the association between sleep duration and quality and weight status in post-bariatric surgery patients at 9-y post-surgery. We tested the hypothesis that participants’ post-surgical weight change would be related to sleep duration and quality at 9-y. Methods: Sleep data were collected on a subset of participants (mean body weight = 94.1 kg ± 18.9) enrolled in an ancillary study to the Longitudinal Assessment for Bariatric Surgery trial. Self-reported hours of sleep per night and overall sleep quality were assessed once, at the 9-y visit using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results: Complete data were available on 14 participants (10 females and 4 males, age 52.1 ± 15.6 y), current weight 94 kg ± 18.9. Average total weight loss from pre-surgery was 28.5% ± 10.6, with an average weight gain of 0.3 ± 6.2 % over the last 2 y of follow-up. Participants reported average sleep duration of 6.8 ± 2.0 h/night at the 9-y evaluation visit and an average score of 7.9 ± 3.7 on the PSQI. There was no relation between sleep duration and current weight or percent weight change after maximum weight loss, which occurred around 2-y post-surgery. However, there were trends for an association between sleep quality and percent weight change after maximum weight loss (p=0.057) and percent weight change in the last 2-y of follow-up (p=0.066). In general, participants who lost more weight over the last 2 y of the study had lower scores on the PSQI, indicating better quality of sleep. Conclusion: Our results showed no association between sleep quality or duration and long-term changes in weight for patients who underwent bariatric surgery. However, those with better sleep quality tended to have more beneficial changes in weight over the latest 2-y. It is important to note that this study cannot address causality and whether improved weight influenced sleep quality or whether sleep quality influenced weight change. Further studies should examine the temporality of these association. Sleep quality may be an important sleep metric to consider for long-term weight loss maintenance.

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Preoperative μ-opioid receptor availability predicts weight loss following bariatric surgery

10.1101/2021.01.27.21250121 ◽

2021 ◽

Author(s):

Henry K. Karlsson ◽

Lauri Tuominen ◽

Semi Helin ◽

Paulina Salminen ◽

Pirjo Nuutila ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Opioid Receptor ◽

Weight Regain ◽

Postoperative Weight Loss ◽

Weight Loss Outcomes ◽

Preoperative Weight

AbstractBackgroundBariatric surgery is the most effective method for weight loss in morbid obesity. There is significant individual variability in the weight loss outcomes, yet factors leading to postoperative weight loss or weight regain remain elusive. Alterations in the µ-opioid receptor (MOR) and dopamine D2 receptor (D2R) systems are associated with obesity, appetite control, and reward processing. The magnitude of initial brain receptor system perturbation is a plausible predictor of long-term surgical weight loss outcomes. The aim was to test this hypothesis by measuring obese subjects’ MOR and D2R availability with positron emission tomography (PET) preoperatively before bariatric surgery and then assessing their weight development association with regional MOR and D2R availabilities at 2-year follow-up.MethodsWe studied 19 morbidly obese women (mean BMI 40, mean age 43) scheduled to undergo bariatric surgery, i.e. Roux-en-Y gastric bypass or sleeve gastrectomy, according to their standard clinical treatment. Preoperative MOR and D2R availabilities were measured using PET with [11C]carfentanil and [11C]raclopride, respectively. Subject weight was recorded at 3, 6, 12, and 24 months after surgery. Radiotracer binding potentials (BPND) were extracted and correlated with patient weight at different time points. ROIs were delineated in the striatum and in limbic and paralimbic components of the emotion and reward networks.ResultsMOR availabilities were not correlated with preoperative weight. MOR availabilities in the amygdala (r = −0.54), insula (r = −0.46), ventral striatum (r = −0.48) and putamen (r = −0.49) were associated with subject weight at 3 months. Significant association was found in the amygdala at 6 months (r = −0.53), 12 (r = −0.49), and 24 months (r = −0.50). D2R availabilities were associated with neither preoperative weight nor weight loss at any follow-up time point.ConclusionsTo our knowledge, this is the first study to demonstrate that neuroreceptor markers prior to bariatric surgery in patients with morbid obesity are associated with the postoperative weight loss. Preoperative MOR availability in the amygdala was associated with long-term postoperative weight development after surgery suggesting that postoperative weight regain may derive from dysfunction in the opioid system. Postoperative weight loss outcomes after bariatric surgery may be partially predicted based on preoperative receptor availability opening up new potential for treatment possibilities.Clinical Trials RegistrationSleevePET2, NCT01373892, http://www.clinicaltrials.gov

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Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Obesity Surgery ◽

10.1007/s11695-021-05499-3 ◽

2021 ◽

Author(s):

Arnaud Liagre ◽

Francesco Martini ◽

Radwan Kassir ◽

Gildas Juglard ◽

Celine Hamid ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Severe Obesity ◽

Postoperative Mortality ◽

One Anastomosis Gastric Bypass ◽

Sustained Weight Loss ◽

Biliopancreatic Limb ◽

Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

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Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Scientific Reports ◽

10.1038/s41598-021-93294-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andrew Yang ◽

Melinda Nguyen ◽

Irene Ju ◽

Anthony Brancatisano ◽

Brendan Ryan ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Liver Stiffness ◽

Convincing Evidence ◽

Alcoholic Fatty Liver ◽

Post Surgery

AbstractSignificant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

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Spontaneous Neural Activity Changes after Bariatric Surgery: a resting-state fMRI study

10.1101/2021.04.01.437973 ◽

2021 ◽

Author(s):

Yashar Zeighami ◽

Sylvain Iceta ◽

Mahsa Dadar ◽

Mélissa Pelletier ◽

Mélanie Nadeau ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Visual Cortex ◽

Neural Activity ◽

Dorsolateral Prefrontal Cortex ◽

Severe Obesity ◽

Normal Weight ◽

Post Surgery ◽

Spontaneous Neural Activity ◽

Dorsolateral Prefrontal

1.AbstractBackgroundMetabolic disorders associated with obesity could lead to alterations in brain structure and function. Whether these changes can be reversed after weight loss is unclear. Bariatric surgery provides a unique opportunity to address these questions because it induces marked weight loss and metabolic improvements which in turn may impact the brain in a longitudinal fashion. Previous studies found widespread changes in grey matter (GM) and white matter (WM) after bariatric surgery. However, findings regarding changes in spontaneous neural activity following surgery, as assessed with the fractional amplitude of low frequency fluctuations (fALFF) and regional homogeneity of neural activity (ReHo), are scarce and heterogenous. In this study, we used a longitudinal design to examine the changes in spontaneous neural activity after bariatric surgery (comparing pre- to post-surgery), and to determine whether these changes are related to cardiometabolic variables.MethodsThe study included 57 participants with severe obesity (mean BMI=43.1±4.3kg/m2) who underwent sleeve gastrectomy (SG), biliopancreatic diversion with duodenal switch (BPD), or Roux-en-Y gastric bypass (RYGB), scanned prior to bariatric surgery and at follow-up visits of 4 months (N=36), 12 months (N=29), and 24 months (N=14) after surgery. We examined fALFF and ReHo measures across 1022 cortical and subcortical regions (based on combined Schaeffer-Xiao parcellations) using a linear mixed effect model. Voxel-based morphometry (VBM) based on T1-weighted images was also used to measure GM density in the same regions. We also used an independent sample from the Human Connectome Project (HCP) to assess regional differences between individuals who had normal-weight (N=46) or severe obesity (N=46).ResultsWe found a global increase in the fALFF signal with greater increase within dorsolateral prefrontal cortex, precuneus, inferior temporal gyrus, and visual cortex. This effect was more significant 4 months after surgery. The increase within dorsolateral prefrontal cortex, temporal gyrus, and visual cortex was more limited after 12 months and only present in the visual cortex after 24 months. These increases in neural activity measured by fALFF were also significantly associated with the increase in GM density following surgery. Furthermore, the increase in neural activity was significantly related to post-surgery weight loss and improvement in cardiometabolic variables, such as insulin resistance index and blood pressure. In the independent HCP sample, normal-weight participants had higher global and regional fALFF signals, mainly in dorsolateral/medial frontal cortex, precuneus and middle/inferior temporal gyrus compared to the obese participants. These BMI-related differences in fALFF were associated with the increase in fALFF 4 months post-surgery especially in regions involved in control, default mode and dorsal attention networks.ConclusionsBariatric surgery-induced weight loss and improvement in metabolic factors are associated with widespread global and regional increases in neural activity, as measured by fALFF signal. These findings alongside the higher fALFF signal in normal-weight participants compared to participants with severe obesity in an independent dataset suggest an early recovery in the neural activity signal level after the surgery.

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Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta22680 ◽

2018 ◽

Vol 22 (68) ◽

pp. 1-246 ◽

Cited By ~ 25

Author(s):

Alison Avenell ◽

Clare Robertson ◽

Zoë Skea ◽

Elisabet Jacobsen ◽

Dwayne Boyers ◽

...

Keyword(s):

Weight Loss ◽

Cost Effectiveness ◽

Weight Regain ◽

Severe Obesity ◽

Clinical Effectiveness ◽

Cost Effective ◽

Research Unit ◽

Look Ahead ◽

Obesity Trends

Background Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. Objectives Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. Data sources Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). Review methods Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000–30,000. Results A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [–20.23 kg, 95% confidence interval (CI) –23.75 to –16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of –4.41 kg (95% CI –5.93 to –2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. Limitations Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. Conclusions Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. Future work Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. Study registration This study is registered as PROSPERO CRD42016040190. Funding The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.

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Abstract 16013: Evidence for Improvement in NYHA Class and Freedom From Hospitalization in Bariatric Surgery Patients With an Established Diagnosis of Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.16013 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael W Foster ◽

Sara E Badenhausen ◽

Colleen Tewksbury ◽

Noel N Williams ◽

J Eduardo Rame ◽

...

Keyword(s):

Heart Failure ◽

Bariatric Surgery ◽

Weight Loss ◽

Medical Record ◽

Median Time ◽

Severe Obesity ◽

Nyha Class ◽

High Volume ◽

Metabolic And Bariatric Surgery

Introduction: Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated. Methods: We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient. Results: There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m 2 , HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1). Conclusion: Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.

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