Courcoulas AP, et al. - This study was planned to analyze long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Researchers observed different weight loss patterns following bariatric surgery, however, over the long term, most of the participants maintained much of their weight loss with variable fluctuations. In terms of diabetes remission, some decline was evident over time, however, the incidence of new cases was low following RYGB.

Methods

• This is a multicenter observational cohort study performed at 10 US hospitals in 6 geographically diverse clinical centers.
• Researchers recruited adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009; follow up was performed until January 31, 2015.
• Presurgery, 6-month, and annual research assessments for up to 7 years were completed by the participants.
• Main outcome and measures included percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use.

Results

• This study included 2,348 participants.
• Among these, 1,738 underwent RYGB (74%) and 610 underwent LAGB (26%).
• For RYBG, they observed the median age of 45 years (range, 19-75 years) and the median body mass index (calculated as weight in kilograms divided by height in meters squared) of 47 (range, 34-81); 80% (1389 participants) of the participants were women, and 15% (257 participants) were nonwhite.
• For LAGB, they observed the median age of 48 years (range, 18-78), the body mass index of 44 (range, 33-87); 76% (465 participants) were women, and 10% (63 participants) were nonwhite.
• For a year-7 visit, follow-up weights were obtained in 1,300 of 1,569 (83%) eligible participants.
• Mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight seven years following RYGB; mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight between years 3 and 7.
• Researchers noticed that seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain.
• They identified 6 distinct weight change trajectory patterns for RYGB and 7 for LAGB.
• Trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss were followed by most of the participants, however patterns were variable.
• Following both procedures, dyslipidemia prevalence was lower at 7 years compared with baseline; diabetes and hypertension prevalence were lower following RYGB only.
• Among those with diabetes at baseline (488 of 1,723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission for RYGB at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), and for LAGB, were 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9), respectively.
• For RYGB, the incidence of diabetes at all follow-up assessments was less than 1.5%.
• Fourteen RYGB and 160 LAGB participants underwent bariatric reoperations.