Socioeconomic predictors of weight loss after laparoscopic Roux-Y gastric bypass.
ABSTRACT Successful weight loss after laparoscopic Roux-Y gastric bypass (LRYGB) hinges on many elements including neurohormonal, anatomical, and postoperative behavioral changes. To date, the effects of socioeconomic factors have been inadequately studied. We examine several components of socioeconomic status and its relationship to weight loss after LRYGB.
Between August 2002 and July 2006, 405 LRYGB were performed by a single surgeon. Patient demographics were entered into a longitudinal, prospective database. At 1-year follow-up, 309 patients were available for analysis. Regional median household income (RMAHI) and primary insurance carrier were used as surrogates for preoperative socioeconomic status. Analysis of covariance (ANCOVA) test was used for statistical analysis. According to RMAHI, we divided the patients into three groups: US $20,001-40,000 (group A, n = 67), US $40,001-60,000 (group B, n = 153), and more than US $60,000 (group C, n = 89). Initial body mass index (BMI) was 52.76 +/- 1.01, 51.28 +/- 0.67, and 48.87 +/- 0.94 kg/m2, respectively. Additionally, patients were divided according to private insurance or state-based insurance. A total of 274 patients had private insurance, with an initial mean BMI of 50.6 kg/m2, and 35 patients had state-based insurance, with an initial BMI of 53.0 kg/m2.
After 1 year, weight loss in groups A, B and C was 110.6 +/- 4.3, 110.0 +/- 2.5, and 103.9 +/- 3.6 lb with BMI decrease of 17.7 +/- 0.6, 17.7 +/- 0.4, and 16.9 +/- 0.6 kg/m2, respectively. Weight loss in the private insurance group was 49.2 +/- 0.9 kg compared with 50.2 +/- 2.3 kg in the state-based group with BMI decrease of 17.4 +/- 0.3 and 18.4 +/- 0.8 kg/m2, respectively. There were no statistical significances in the effect of socioeconomic status, median household income, and insurance carrier on postoperative weight loss.
With appropriate patient selection, the socioeconomic status of patients undergoing LRYGB does not affect postoperative weight loss.
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ABSTRACT: Laparoscopic gastric bypass (LGB) has proven efficacy in causing significant and durable weight loss. However, the degree of postoperative weight loss and metabolic improvement varies greatly among individuals. Our study is aimed to identify independent predictors of successful weight loss after LGB. Socioeconomic demographics were prospectively collected on patients undergoing LGB. Primary endpoint was percent of excess weight loss (EWL) at 1-year follow-up. Insufficient weight loss was defined as EWL <or=-1 SD from mean EWL. Logistic regression was used in both univariate and multivariate models to identify independent preoperative demographics associated with successful weight loss. A total of 180 consecutive patients were enrolled over 30 months. Mean preoperative body mass index (BMI) was 48. Mean EWL was 70.1 +/- 17.3% (1 SD); therefore, success was defined as EWL >or=52.8%. According to this definition, 147 patients (81.7%) achieved successful weight loss 1 year after LGB. On univariate analysis, preoperative BMI had a significant effect on EWL, with patients with BMI <50 achieving a higher percentage of EWL (91.7% vs 61.6%; p = 0.001). Marriage status was also a significant predictor of successful outcome, with single patients achieving a higher percentage of EWL than married patients (89.8% vs 77.7%; p = 0.04). Race had a noticeable but not statistically significant effect, with Caucasian patients achieving a higher percentage of EWL than African Americans (82.9% vs 60%; p = 0.06). Marital status remained an independent predictor of success in the multivariate logistic regression model after adjusting for covariates. Married patients were at more than two times the risk of failure compared to those who were unmarried (OR 2.6; 95% CI: 1.1-6.5, p = 0.04). Weight loss achieved at 1 year after LGB is suboptimal in superobese patients. Single patients with BMI < 50 had the best chance of achieving greater weight loss.Surgical Endoscopy 07/2006; 20(6):864-7. · 3.43 Impact Factor
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ABSTRACT: Before gastric restriction, 118 morbidly obese women were psychiatrically assessed by clinical interview and self-report questionnaire. One year after surgery, 71 repeated the questionnaires. Weight was assessed at yearly intervals until the four year follow-up (n = 91). The maximum mean weight loss of 35 kg occurred at one year follow-up, when questionnaire respondents reported a slight overall improvement in personal and marital adjustment, and 72% rated themselves as very pleased with the results of surgery. Subsequently, 70% of patients regained weight, although the mean annual increase was only 1.9 kg. Marital dissatisfaction was a significant positive predictor of weight at one year, and generalized anxiety was a significant negative predictor of weight at four years. An increase in phobia scores at one year predicted subsequent maintenance of weight loss, whereas an increase in extrapunitiveness (mainly irritability and criticism of others) predicted subsequent weight gain.Journal of Psychosomatic Research 02/1990; 34(3):295-302. · 3.27 Impact Factor
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ABSTRACT: The authors studied whether morbidly obese patients who failed in stated weight loss criteria may be considered absolute failures or relative successes. 75 morbidly obese patients underwent biliopancreatic diversion (BPD) of Larrad, with a 4/5 gastrectomy (residual gastric volume 150-200 ml), a biliopancreatic limb divided 50 cm distal to Treitz' ligament, a 50-cm common limb and an alimentary limb of nearly all the bowel length (500-600 cm). Every patient had a follow-up of 5 years. A percent excess weight loss (%EWL) < 50% was considered a "failure". We analyzed the post-surgical changes in the preoperative obesity-related problems in these patients and the causes of the weight loss failure. At 5 years after the BPD of Larrad, 9 patients (12%) had a %EWL < 50%, with a mean %EWL of 36 in these patients. Most of these failed patients were cured or improved of their preoperative illnesses. The 2 males were alcoholics, and 6 of the 7 females had an abnormal psychological examination. Comparing the "failed" patients with the successful group, there is a statistically significant influence (p < 0.01) of lack of satiety, unmarried status, housewife or unemployed. Patients judged as a failure by weight loss criteria after bariatric surgery should not be considered absolute failures, because most of their preoperative illnesses were cured or improved, improving their quality of life. Thus, they are "relative successes".Obesity Surgery 04/2002; 12(2):249-52. · 3.10 Impact Factor