The Weight Loss Response to Roux En Y Gastric Bypass Is Host Mediated
Joseph a. Caruana*1, Shah Faisal2, Katherine L. Hess3, Scott V. Monte4,5, Mark Cavaretta1, Dang Tuan Pham1
1Surgery, Sisters of Charity Hospital and State University of New York at Buffalo, Buffalo, NY; 2Medicine, Sisters of Charity Hospital and State University of New York at Buffalo, Buffalo, NY; 3Health Information, D'Youville College, Buffalo, NY; 4Pharmacy, State University of New York at Buffalo, Buffalo, NY; 5CPL Associates, Buffalo, NY
Introduction: Following Roux-en-Y gastric bypass (RYGB) suboptimal weight loss (SOWL), defined as <40% excess weight loss (EWL) at 18 months, occurs in ~10% or >15,000 patients yearly in the US alone. Re operative techniques to accelerate weight loss (WL) in these “failures” have been disappointing.Methods: To learn more about the WL response we studied 2427 consecutive patients with open RYGB from 2000 to 2008. First, longitudinal patterns of WL were plotted from %EWL measured at follow up office visits with determination of the effects of gender, body mass index (BMI), and age. Secondly, 21 patients with SOWL were compared retrospectively with 84 matched case-controls having >40% EWL for demographic, anthropometric, social, and operative factors as well as co-morbidities and dietary compliance (DC). Finally, a prospective group with SOWL underwent aggressive dietary and behavior counseling over a 3 month period. Quantile regression techniques, multivariate analysis, or paired t-test was used to analyze outcomes.Results: %EWL over time was significantly less in males, patients with preoperative BMI >55, and those >42 years. After controlling for those variables in patients with SOWL only medication usage and DC were different. In the prospective SOWL group, patients reported improved protein intake, decreased hunger and stress, and better meal frequency yet had no significant WL after the intervention.Conclusions: WL after RYGB is affected by gender, weight, and age suggesting patient specific or ‘host’ related factors which are independent of behavior or DC. Further research to identify why some patients have poor WL after RYBG could shed light on the causes of obesity itself.
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