Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Background/objectives There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.publishedVersio

Livskvalitet etter fedmekirurgi

Bakgrunn: Antall mennesker som har utviklet en fedmetilstand øker stadig i Norge, som i resten av verden. Fedmekirurgi er blitt en vanlig behandlingsform ved sjuklig overvekt. Denne behandlingens positive innflytelse på livskvalitet er nå godt dokumentert. Den internasjonale foreningen for bariatrisk og metabolsk kirurgi (International Federation for the Surgery of Obesity and Metabolic Disorders, IFSO) hevder at vekttap har en fordelaktig påvirkning av livskvaliteten etter fedmekirurgi som er direkte proporsjonal med mengde vekt tapt etter operasjonen. Studien ønsket å undersøke denne uttalelsen. Teoretisk rammeverk: Verdens helseorganisasjons (WHO) definisjon på helse og livskvalitet er benyttet. Metode: En longitudinell kohort studie ble utført ved Kirurgisk klinikk, Gastrokirurgisk Seksjon ved Haugesund Sjukehus mellom 2007 og 2013. Livskvalitet ble målt gjennomsnittlig 4 år etter operasjonen med generisk skjema, RAND-36, og fedmespesifikke skjemaer; IWQoL-Lite og PROSURG. I tillegg ble angst og depresjon målt med HADS. 267 respondenter samtykket til å delta, hvor 206 besvarte det nettbaserte spørreskjemaet, som gir en svarprosent på 77. Hierarkisk multippel regresjon ble brukt til å beregne grupper av variabler (tid siden operasjonen, pasientegenskaper, sosio-økonomi, pre-operativ komorbiditet, post-operative komplikasjoner, opplevd livskriser og vekttap) og assosiasjon med livskvalitet. Resultater: Generell helse, RAND-36 var under normen for den Norske befolkning gjennomsnittlig 4 år etter operasjonen. Den fedmespesifikke (IWQoL-Lite) livskvaliteten var høy og respondentene var stort sett fornøyd med resultatet etter operasjonen (PROSURG). HADS indikerte liten grad av problemer med angst og depresjon. Fysisk livskvalitet (PCS) var assosiert med sosio-økonomi, pre-operativ komorbiditet og kirurgiske komplikasjoner. Mental livskvalitet (MCS) var assosiert med de sammen gruppene, samt opplevd livskriser. IWQoL-Lite og PROSURG var assosiert med vekttap etter operasjonen. Konklusjon: Studiet viste at fedmespesifikk livskvalitet har en sammenheng med vekttap, men generell livskvalitet er ikke det

Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study

Background: There seem to exist a belief that weight-loss is proportionally associated with improvement of health-related quality of life (HRQoL) after bariatric surgery. HRQoL is a complex multidimensional construct of one’s perception of health and well-being and is measured through generic and disease specific questionnaires. Objectives: This study aimed to test the associations between weight-loss after bariatric surgery, and both generic and obesity-specific HRQoL, and mental distress, controlling for other patient characteristics. Methods: The study was conducted at the Department of Surgery at Haugesund Hospital (Norway) based on a cohort of bariatric surgery patients operated between 2010 and 2013. Primary outcome measures included the SF-36 (generic HRQoL), IWQoL-Lite (obesity-specific HRQoL), and HADS (mental distress). Blocks of variables (time since surgery, personal characteristics, socioeconomics, comorbidities, surgical complications, experienced life crisis, and weight-loss) were entered into hierarchical linear regression models with the four outcome measures as dependent variables. Cumulative explained variance (r2) and increase in r2 after entry of each block of variables is reported. Results: A total of 206 completed the outcome measures a mean (SD) of 4.4 (1.1) years after surgery. The generic SF-36 physical and mental composite scores were significantly associated (p<.05) with socioeconomics, baseline comorbidities and surgical complications. Obesity-specific IWQoL-Lite scores were significantly (p<.05) associated with weight-loss. Conclusions: The study indicates that post-operative weight loss is associated with obesity-specific HRQoL but demonstrates no associations between weight-loss and generic HRQoL, when controlling for other patient characteristics

Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study

Background: There seem to exist a belief that weight-loss is proportionally associated with improvement of health-related quality of life (HRQoL) after bariatric surgery. HRQoL is a complex multidimensional construct of one’s perception of health and well-being and is measured through generic and disease specific questionnaires. Objectives: This study aimed to test the associations between weight-loss after bariatric surgery, and both generic and obesity-specific HRQoL, and mental distress, controlling for other patient characteristics. Methods: The study was conducted at the Department of Surgery at Haugesund Hospital (Norway) based on a cohort of bariatric surgery patients operated between 2010 and 2013. Primary outcome measures included the SF-36 (generic HRQoL), IWQoL-Lite (obesity-specific HRQoL), and HADS (mental distress). Blocks of variables (time since surgery, personal characteristics, socioeconomics, comorbidities, surgical complications, experienced life crisis, and weight-loss) were entered into hierarchical linear regression models with the four outcome measures as dependent variables. Cumulative explained variance (r2) and increase in r2 after entry of each block of variables is reported. Results: A total of 206 completed the outcome measures a mean (SD) of 4.4 (1.1) years after surgery. The generic SF-36 physical and mental composite scores were significantly associated (p<.05) with socioeconomics, baseline comorbidities and surgical complications. Obesity-specific IWQoL-Lite scores were significantly (p<.05) associated with weight-loss. Conclusions: The study indicates that post-operative weight loss is associated with obesity-specific HRQoL but demonstrates no associations between weight-loss and generic HRQoL, when controlling for other patient characteristics

Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Background/objectives: There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods: Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results: Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion: In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB

Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Background/objectives There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB

Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Background/objectives There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB