Preoperative Weight Loss and Five-Year Outcomes After Metabolic Bariatric Surgery

Overview

This retrospective study evaluated the impact of preoperative weight loss on total weight loss (%TWL) up to five years after metabolic bariatric surgery (MBS). Patients with higher preoperative weight loss achieved significantly greater long-term %TWL, with differences persisting through five years postoperatively.

Background

Metabolic bariatric surgery (MBS), including Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG), is the most effective treatment for obesity, improving weight and obesity-related comorbidities. Preoperative weight loss is hypothesized to reduce perioperative risks and improve postoperative outcomes, but evidence has been inconsistent, partly due to variable definitions and short follow-up durations. This study aimed to clarify the association between preoperative weight loss and long-term weight outcomes over a five-year period.

Data Highlights

Statistical analyses showed significant differences in %TWL across quartiles at multiple time points, with Bonferroni-adjusted p-values <0.007. Linear mixed models and multivariable regression confirmed the positive association between preoperative weight loss and long-term %TWL after adjusting for confounders.

Key Findings

• Patients were stratified into quartiles based on preoperative weight loss (%preopWL), with higher quartiles achieving greater %TWL at 1, 3, and 5 years post-surgery.
• Significant differences in %TWL between quartiles persisted through five years, indicating sustained benefits of preoperative weight loss.
• Multivariable analyses adjusting for age, gender, BMI, and procedure type confirmed preoperative weight loss as an independent predictor of long-term %TWL.
• Both Roux-en-Y Gastric Bypass and Sleeve Gastrectomy patients showed this association, though RYGB generally resulted in greater %TWL.
• Preoperative weight loss may reflect patient motivation and behavioral factors contributing to sustained postoperative success.
• Complication rates were monitored but not detailed here; preoperative weight loss is also thought to reduce perioperative risks.

Clinical Implications

Encouraging and supporting preoperative weight loss in patients undergoing metabolic bariatric surgery may enhance long-term weight loss outcomes. Tailoring preoperative programs to achieve meaningful weight reduction could improve sustained postoperative success and potentially reduce perioperative risks. Clinicians should consider integrating structured preoperative weight loss targets into bariatric care pathways.

Conclusion

Preoperative weight loss is positively associated with greater and sustained total weight loss up to five years following metabolic bariatric surgery. These findings support the implementation of preoperative weight loss strategies to optimize long-term surgical outcomes.

References

1. Various Authors/Studies 2017-2023 -- Metabolic Bariatric Surgery and Weight Loss Outcomes